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We must start talking about mental health, part 1

AWARENESS: Black people are four times more likely to be detained under the Mental Health Act compared to the white population

EVERYONE IS still digesting the recent announcement during Black History Month of Theresa May launching the Race Disparity Audit across all government departments, which again highlights the nature and impact of structural racism on the black community from housing education, criminal justice, workforce, and culture.

However, the biggest indictment of racism is the failure of the response of the community around mental health. The following stark statistics remind us that sadly this is still one of the biggest travesties of human rights and system failures in health and social policy since the closure of asylums in the 1980s:


•Detentions under the Mental Health Act – Black people are four times more likely to be detained compared to the white population (possibly higher if you include mixed race race)

• Access to Treatment – black and Asian people are less likely to receive treatment for mental or emotional problems and thus less access to talking therapies

• Gender and Common Mental Disorder – 29% of black/black British women experienced a common mental disorder in the past week, at a much higher rate compared with white British women and other BAME women

• Psychotic Disorder – Significantly higher percentage of black men experienced a psychotic disorder in the past year than white men.

The impact of overrepresentation of black people in mental health services for the past thirty years or so has many consequences for policymakers, politicians, NHS and social care providers, and the black community:

1. Many black communities have lost trust in services due to experiences of racism and cultural differences, as highlighted numerous reports especially in the 2002 report Breaking the circles of fear.

2. Stigma around mental health still exists, making it difficult to talk about problems and to seek early help for fear of being given a diagnosis.

3. The ingrained prejudice and stigma against the Mad, Bad, Dangerous and Black presents a massive challenge to the black community involved in the mental health system.

WORK: Theresa May has a big job on her hands to tackle mental health

4. Inequality and discrimination of black communities can lead to increased risk of psychosis.

5. There is a lack of black representation in decision making within the NHS, as well as amongst employees of mental health services.

6. There is a lack of capacity in communities to deliver mental health interventions.

7. Most health spending is tied up in acute rather than preventative services.

8. There is difficulty in addressing causal factors for poor mental health, such as deprivation and social exclusion, which are disproportion- ately present in poorer and black communities.

What is clear, reflecting on issues around policy development and commissioning of mental health services, is that there is collective system failure plus a lack of leadership at all levels. Sadly, the current models of service development and thinking are not working and there is no space to develop a black perspective on solutions and new models of care.

We have had more than 30 years of race equality training, strategies, pledges, and indicator sets which have failed to shift the agenda, much to the dismay of many service users, frontline staff, senior system leaders, activist and politicians. This further adds to the malaise and the perception that “black mental health” is an intractable issue that is impossible to address.

The government’s plans to have an independent review of the 2007 Mental Health Act under the leadership of Professor Sir Simon Wessely, which is welcomed by the mental health world, are only worthwhile if it tackles the issue of over-representation around detention, physical restraint and Community Treatment Orders which has a negative impact on the lives of black service users and carers.

One positive step is the Mental Health Units (Use of Force) Bill, introduced by Steve Reid, voted through the House of Commons recently. It’s also known as Seni’s Law after Seni Lewis, who died in Maudsley Mental Health Trust in south London after being physically restrained.

If successful the Bill will limit the use of force in mental health units by increasing training in deescalation techniques, ensuring that every use of restraint in recorded and making sure that an independent review is automatically triggered whenever anyone is harmed using restraint.

More than 64,000 people have signed the petition in the last few months which again highlights the need for major reform in mental health law. After much delay, the Government on October 30 published Dame Elish Angelina QC’s independent review of deaths and serious incidents in police custody.

The report makes 110 recommendations, regarding the use of restraint, the custody environment, training for officers and making it easier for families facing inquests into deaths in police custody to access legal aid. The report has a dedicated chapter on ethnicity exploring deaths in custody of many cases such as Sean Rigg, Seni Lewis, Anthony Burrell, Rocky Bennett, Christopher Alder.

Dame Elish stated: "Deaths of people from BAME communities, young black men, resonate with the black community's experience of systematic racism, and reflect wider concerns about discriminatory over-policing, stop and search, and criminalisation."

The report has nine recommendations on racial inequality around deaths in custody covering training, role of IPPC, monitoring, and racist attitudes.

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