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A collective failure for race equality in mental health
Posted Thursday 7 April 2011
Yesterday the last Count me in census survey findings were published. It's been produced every year for the past six years as part of the Government's commitment to tackling race inequality in mental health services.
This year, we can take a long term view and make a judgement: we've failed. We've failed to change the over-representation of people from black and minority ethnic communities detained under the Mental Health Act. Hospital admission rates are still higher among some minority groups and people from Black Caribbean and Black and White Caribbean communities spend more time in secure settings.
For many years, people from Black Caribbean and Black African backgrounds have been the most over-represented ethnic groups on mental health wards. The sharp increase in the latest census could be explained by a decrease in the 'Other Black' category. However, there is still a clear over-representation amongst these groups which doesn’t look like it’s going to change soon.
The report also shows, worryingly, that more people from mixed (black/white) parentage find themselves in mental health hospitals. The rate of increase is far larger than any other ethnic group. Given that those of mixed parentage are also among the youngest inpatients this trend will only get worse with time.
The data paints a rather bleak picture for those groups that remain massively over-represented on mental health wards. The whole mental health community has to take responsibility for this situation. The Government, mental health services, local authorities, charities, individual service users — everyone has tried hard, but it hasn't made any difference. Maybe the indicator was wrong, maybe the strategy was wrong. Either way, this report tells us an inconvenient truth — despite positive changes in mental health care, we still let down too many people from black and minority ethnic communities.
So, what next? 2011 is a chance to draw a line and look again. The mental health strategy, the new Health Bill, and changes to social care and personalisation are going to change the health and social care landscape. We must make sure that those changes are to the benefit of people from black minority and ethnic communities and not to their detriment.
The new Health and Wellbeing Boards at a local level must reflect the needs and diversity of their local communities — the Health Bill needs to embed this principle. The Centre for Mental Health highlighted particular issues around people in medium secure care, often out of their area, for whom hope and recovery are distant prospects, and who cost cash-strapped trusts unnecessary amounts. Local services need to be responsive to local communities — a number of voluntary organisations, including local Minds, work with community groups in community spaces, respecting cultural perspectives on mental health.
Our Time to Change campaign will be running a major pilot in Harrow working with the South Asian community to address issues of stigma and discrimination. This kind of approach needs to be woven across the mental health strategy, the new commissioning boards and local commissioning consortia. Our Care in Crisis campaign will seek to address issues relating to acute and crisis care services.
The Count me in census has helped to have a wider picture of inpatient and detained mental health care. The Care Quality Commission have helped paint a clear picture of our inpatient system. Now is the time for the mental health community to stand up and be counted, and work with people from all backgrounds to make change happen.
What have your experiences been? How could we all make change happen? Tell us what you think in the comments below.
Paul Farmer, Mind Chief Executive
5 Comments
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Thank you for this, Paul. Informative, enlightening, and extremely worrying.
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How about bringing some psychiatrists over from the West Indies and seeing if they diagnose black men and women like British psychiatrists?
This could identify if the problem was environmental, by which I mean something happens in the UK which creates the pathologised phenotypes, or if the problem is overdiagnosis by UK psychiatrists.
I'm not sure which would be worse: identifying overdiagnosis by psychiatrists here or finding out some unspecified environmental factor causes mental illness in black people in the UK. At least the former is an easier problem to solve.
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I am South Asian and have spent time in hospital twice in my life for mental illness. I am surprised at the findings and agree with the person above that it is worrying. I agree wholeheartedly with everything you have written and the study you are doing in Harrow sounds very interesting and worthwhile.
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Skhunkhuna. I am South Asian too. Thankfully we don't have the problem of overuse of the label of schizophrenia, the overuse of the Community Treatment Order, the high rate of sectioning and other problems which happen to black men and women.
It's not just the UK which has this problem. The US is guilty the overdiagnosis of black men with the label of schizophrenia too (I'm unaware if there's a problem with the overdiagnosis of black women in the US).
It's been know for a while but it seems there's no solution. It doesn't happen in the Caribbean though. If I remember right in the New Horizons mental health strategy consultation document it mentioned that the rate of diagnosis of black men and white men in the Caribbean was roughly equal.
There are cases of people diagnosed with schizophrenia or schizotypal personality disorder leaving the UK to return to the Caribbean and not getting a diagnosis from their mental healthcare system.
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I have worked in various mental health settings for the past 20 years and have been a UKCP registered psychotherapist in private practice for the last 10 years. I am also a novelist. I worked as a mental health social worker in London in the 1990s. I am a black woman of West African heritage and witnessed overt and covert racism. The statutory mental health system does not see people, it sees symptoms, then diagnosis to identify, label, and 'treat'. Inherent in the diagnosis is the assumption that an individual is ill not the system of power and oppression which fosters mental illness. I believe this is why black people are over represented. We are told not to get angry or speak up, to turn the other cheek - the constant erosion of our minds and spirit. From birth black people's actions have to be controlled and suppressed. We have to cross-over ie. deny aspects of ourselves to fit in and psychologically we pay a high price. No one want to hear our truth, even we don't want to hear it after a while. This level of splitting good black vs. bad black takes its toll. This is what oppression does it forces us to blend in and keep smiling eventhough inside we are often rageful. We even learn to hate ourselves as we try to become acceptable and guess what, eventually we break and are sectioned. These consultants can not know the depth of black people... and the oppressive wheel keeps on turning.
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