Race and Mental Health – Tipping the Scale
Marcel Vige is Head of Equality Improvement here at Mind. In this blog, he considers the issues around racial inequality and the Mental Health Act, and the urgent need to address them.
That people from various Minority Ethnic groups, in particular Black people from African and Caribbean heritage, 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 Black people contend with to this day.
This is not to say there are no examples of effective mental health support experienced by Black people while receiving treatment under the Mental Health Act. It does though reflect the reality that use of the act, which gives authority to compel people to accept mental health treatment, falls disproportionality on particular sections of the community.
"Everyday use" of the act is crucial in understanding why this situation persists despite so many attempts over the years to address it. It demonstrates the reality that the sectioning process doesn't need to be "abused" by mental health professionals and those with the power to section. 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 significantlylower rate of sectioning compared to Black people'?
Much like any institution within the UK, our understanding and response to mental health problems and the use of sectioning powers of the Mental Health Act did not emerge in a vacuum. They're a product of the particular history and culture in which they're based. This means that understanding, and addressing the huge disparity in 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 consequent 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, and by extension the rest of us, understand and respond to mental health problems.
The recommendations in the Mental Health Act Review 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 detention will, along with other recommendations, help address some of the current inadequacies in the operation of the Act that disproportionately impact on Black people. That said, without more fundamental, systemic adjustments around the operation of power and privilege, the impact of the recommendations are likely to be piecemeal rather than transformative in terms of reducing the over-representation of Black people subject to the Act. Shifting the context in which the recommendations are deployed means infusing professional training of staff, and commissioning services with an understanding of and responses to the effects of structural racism and white privilege.
It means nothing less that a root-and-branch deconstruction of current practice, stripping out or counteracting the effects of structural racism in the operation of mental health policy and the commissioning and delivery of services. This would result in professional training and services that look very different to those currently in operation. It would also enable the recommendations emerging from the review to achieve their desired effect of reducing disproportionate sectioning of Black people and improving their experiences of mental health services generally.
While the insights detailed in this blog are my own take on what drives racial inequality within mental health, particularly related to the Mental Health Act, also necessary responses, they're informed by the consultations conducted by Mind throughout the course of the review. These consultations involved focus groups and a reference group, all comprising Black and Minority Ethnic people with personal and professional experience of the Act. The views expressed were very much about a need to grapple with deep-seated drivers of racial disparity that persist despite the various initiatives aimed at improving mental health services for Black and Minority Ethnic people.
A key message expressed by those engaged with was the need to stop tinkering around the edges and grapple with the drivers of inequality, which are about fundamental differences in power and privilege within wider society.
The inequalities explored here, of which the Mental Health Act is the prime example, are how such 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 recommendations. Only then can we realistically tip the scales towards mental health services that work for everyone.
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Marcel Vige is the Head of Equality Improvement here at Mind. 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.
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