THAT BLACK people are far more likely to be sectioned under the Mental Health Act will come as no surprise to anyone with passing knowledge of the mental health system in England and Wales. It reflects the long and difficult history of black people’s experience of the mental health system, which is itself part of a broader struggle with structural racism that we contend with to this day.
“Everyday use” of the act is crucial in understanding why this situation persists, despite so many attempts over the years to address it. Increased sectioning of black people is a consequence of the normal functioning of everyone concerned. This would all be fine if black people were inherently more prone to mental health crises requiring sectioning. However, a quick comparison with international data shows that black people in majority black countries (countries in Africa and the Caribbean) don’t experience such symptoms to a greater extent than white British people within the UK.
This means there’s something about being black in the UK that leads to the massively higher rates of sectioning compared to white people. Or, turning this around, perhaps a more important – certainly less frequently asked question is “Is there something about being white in the UK that leads to significantly lower rate of sectioning compared to black people?”
Our understanding and response to mental health problems and the use of sectioning powers did not emerge in a vacuum. Understanding and addressing the huge disparity in the use of the Mental Health Act between black and white people requires an examination of the preconceptions that inform professional decisions around who is (and who isn’t) sectioned, and how this is rooted in deep-seated stereotypes associated with particular groups.
We need to examine how white privilege and the positioning of blackness as “other” informs definitions of mental illness, wellness and what’s seen as treatment success. In effect, there needs to be a fundamental reworking of how mental health professionals understand and respond to mental health problems.
The recommendations in the Mental Health Act Review, published last year, are useful in-so-far as they focus on areas of challenge for black people in their experience of the act. A more diverse workforce, culturally informed advocacy and tightened criteria for sectioning will, along with other recommendations, help address some of the current failure in the use of the act that disproportionately impact black people.
That said, without more fundamental, systemic adjustments around the operation of power and privilege in mental health services, the impact of the recommendations are likely to be limited in reducing the over-representation of black people subject to the act. Mind, the mental health charity, was heavily involved in informing the review of the Mental Health Act, with black people with lived experience of it, and this was the message we heard repeatedly from them.
Shifting the context in which the recommendations are deployed means prioritising professional training of staff, and commissioning services with an understanding of the effects of and responses to structural racism and white privilege. It means nothing less than stripping out or counteracting the effects of structural racism in the operation of mental health policy and the commissioning and delivery of services.
The inequalities explored here, of which the Mental Health Act is the prime example, are how power and privilege manifest within the mental health system. Recognising and responding to this is an essential first step, underpinning initiatives such as those detailed in the review of the act. Only then can we realistically tip the scales towards mental health services that work for everyone.
Marcel Vige is the head of equality improvement at Mind, the mental health charity. With the Equality Improvement team, Marcel leads on the delivery of Mind’s strategic ambition to remove inequality in the provision of mental health support. This involves partnering with teams across Mind to ensure prioritisation of the needs of marginalised groups, also delivering flagship programmes focussing on specific groups, e.g. the current Young Black men project.