Reform of the Mental Health Act must come now if we are to see an end to structural racism within mental health services
- More than one in ten calls to Mind’s legal line in 2021 were about the Mental Health Act (MHA) as number of people detained under the Act increases by 12% from December 2020 to December 2021.
- Mind analysis of NHS data shows that 12,013 adults were detained under the Mental Health Act in 2021 this is a 12% increase in people being detained under the Mental Health Act from December 2020.
- Nearly 5000 people were given a Community Treatment Order (CTO) in 2021
- In 2018 10,442 calls were answered by Mind's Legal Line, of which 988 were related to MHA (9%), In 2021 this rose to 11,856 calls to Mind's Legal Line, of which 1371 calls were related to the Mental Health Act (12%). This has increased by a third since 2018.
More than three years have passed since the Independent Review of the Mental Health Act, which made a series of recommendations to the UK Government to overhaul outdated legislation which allows people with mental health problems to be held against their will (‘sectioned’) in certain circumstances.
At a virtual conference, Mind and Race on the Agenda, sponsored by Garden Court Chambers, explored the urgent need for Mental Health Act reform and how we achieve racial equity within mental health services, hearing from people with their own experience of mental health problems who have spent time in hospital while sectioned under the Mental Health Act during the pandemic.
Mind and Race on the Agenda are making the case for what we need in terms of Mental Health Act reform:
- Less need for compulsion – better services and making sure people have their rights respected.
- An end to Community Treatment Orders (CTO) which has increased disparity with use of the Act.
- Less ability to detain and impose treatment – tighter criteria and better engagement with people’s needs and preferences
- Maximum dignity, safety and meaningful involvement in care, and ability to challenge poor care, through better advocacy.
- A commitment to tackle institutional racism head on
Rheian Davies, Head of Legal at Mental Health Charity Mind says:
“A recent worrying rise in detentions further confirms the urgent need for fully funded reform of the Mental Health Act, to make sure anyone who is experiencing a mental health crisis and is a risk to themselves is treated in a safe and therapeutic environment. NHS data showed that nearly 5000 people were given a community treatment order (CTO) in December 2020.
“Structural racism continues to pervade the Mental Health Act. Black and Black British people are still far more likely to be detained under the Act, restrained against their will, and be more likely to be re-admitted to hospital without getting the right support. When someone is experiencing a mental health crisis, they may be suicidal, self-harming, or in psychosis, and feeling very frightened or distressed. At the very least, their loved ones should expect that they will be kept safe, treated with dignity, and receive the care they need by the services which are designed to protect them. Part of this is making sure that people can make decisions about their care as part of standard clinical practice. To see racial equity within mental health services there must be a heightened commitment to antiracism, which addresses systemic biases in how people are treated and challenges institutional racism head-on.”
Maurice McLeod, Chief Executive of Race on the Agenda says:
“There was a lot of energy at the conference because inequality in mental health care is such an important issue. There were lots of people with lived experience of the system, as service users, carers, or mental health practitioners. This meant a wide range of different opinions were expressed. But the agreement (which was quite noticeable) was that things are bad and are likely to be made worse, or at least not improved, by this new Act.
“Along with Mind, ROTA will continue to work for a mental health care system based on value and respect for all and which is accessible to those who need support.”
22-year-old Hannah is Black and White British and lives in London. Hannah has been diagnosed with borderline personality disorder (BPD). Hannah says:
“I was last restrained in April 2021. Using restraint and restraint techniques is dehumanising, especially given that you’re meant to be in a place of safety, and it feels like you’re being physically punished for being unwell, with no control over your care. Rather than focussing on verbal de-escalation and sitting down with you, getting on your level, and asking how you can help, staff rely on calling the restraint team in, and once that happens there isn’t much you can do or say to stop it from happening. Sometimes there are six people who pin you to the floor. This doesn’t help you when you’re unwell, it makes things worse. When I’ve been in hospital, I have spent time on mixed-sex wards, and I notice the over-representation of Black men and women in hospital. Black men are most likely to be restrained from my experience. People from non-minority backgrounds don’t seem to be restrained as much, staff would spend longer verbally de-escalating with them.
“I have seen it from both sides as I used to work as a forensic recovery support worker, based in the community. I’ve received training on restraint and medication. The training isn’t person-centered the people carrying out the restraint training try to make it as impersonal as possible, but I think this is unsafe.
“There is also a huge staffing problem with vacancies and a reliance on agency staff – this means people are not able to build respect or trust with staff – which can be hard when you’re really unwell. There needs to be more funding for mental health services to make sure hospitals are actually safe.”
Marcia Rigg, Activist, and sister of Sean Rigg a musician and producer, who died in police custody in 2008 says:
"They keep saying lessons have been learned but the only lessons they've learned is how to get away with killing Black men."
Mental health practitioner, commissioner, and black survivor research activist, Colin King says:
“The event made a positive and assertive attempt to empower critical analysis and discussion of the reform of the Mental Health Act, from both lived experienced activists and from mental health staff to address the ethical practice and race equality issues for change. We were privileged to attend to canvass for an abolition of the Community Treatment order. We urgently need a radical shift towards patient safety through frameworks that address personal, and system change for Seni’s Empowerment Community Network.”