Special Report: black people over represented in mental health system

Black people are more likely to go into psychiatric hospital than the rest of the population, they are admitted more under the Mental Health Act and are more likely to experience seclusion and physical restraint once inside the mental health system.

Black people are also more likely to be referred to psychiatric services by the police and court, according to the first ever census on the ethnicity of inpatients in mental health services in England and Wales published this week.

The Count me in mental health and ethnicity census was carried out by the Healthcare Commission, the Mental Health Act Commission and the National Institute for Mental Health in England and describes services on 31 March 2005 and records ethnicity on 33,828 people, which is 99 per cent of people eligible for the census. Patients were cared for by 102 NHS trusts and 110 private and voluntary sector providers.

Ninety per cent were NHS patients and 70 per cent were being cared for in just 23 of the 212  pyschiatric hospitals and units monitored.

Although shocking, none of the findings are that surprising. Numerous other recent studies show more mental illness, higher rates of admission to psychiatric care and detention among black people.

The main facts the census uncovered are as follows:

• Almost 10 per cent of mental health inpatients are black or mixed-race. But these ethnic groups make up 3% of the general population, according to the 2001 census.

• Black people are three times more likely to be admitted to psychiatric hospitals in England and Wales than the rest of the population.

• Black people are up to 44 per cent more likely to be detained under the Mental Health Act.

• They are twice as likely to be referred to mental health services by the police and courts as the rest of the population. Black people are less likely to be referred by their GP than white people.

• Within psychiatric services black men are about 50 per cent more likely than average to be put into seclusion in closed rooms.

• Rates of control and restraint are 29 per cent higher among black Caribbean men than the average for all inpatients.

• Black and mixed race men are more likely to be on a medium or high secure ward.

Ethnic monitoring has been mandatory in mental health services since 1995 but has “not been done well,” say Sir Ian Kennedy, Healthcare Commission chairman and Kamlesh Patel, Mental Health Act Commission chairman, in their joint foreword to the report.

This is the first time robust information about the ethnicity of inpatients in mental health services has been gathered. “The importance of information on the ethnic background of people who use services cannot be overstated,” notes the report.

However the aim of the census is to provide information, not solutions.

“It demands an explanation. It does not provide one. The job of discovering the reasons behind the data must be undertaken with urgency,” say Kennedy and Patel.

The pair continue: “It is wrong and intolerable if someone is categorised as mentally ill and hospitalised solely on the basis of colour or ethnic origin.

“It is equally wrong and intolerable if someone who is mentally ill and would benefit from care in hospital did not have that benefit because those charged with such decisions are anxious that they may be accused of racial prejudice.”

Mental health charities say the census results are not surprising and must inform action.

Mind says the census backs up its “ongoing concerns that there are worryingly high levels of direct and institutional racism in the NHS.”

Director of policy Sophie Corlett called for the government to change the draft Mental Health Bill. She said the bill “currently creates rather than solves racial equality issues”.

Corlett also said the government has “failed to conduct proper racial equality impact assessments for the bill”.

It is not only Mind saying this. A leaked report from a government-appointed advisory group claims a full race impact assessment of the Mental Health Bill has not been carried out.

The Race Relations (Amendment) Act 2000 makes an assessment legally binding. This means the Mental Health Bill could be legally challenged.

At the Sainsbury Centre for Mental Health, chief executive Angela Greatley says: “Black people have known for a long time that they get admitted to hospital too readily and lack the same treatment choices as white people. Now the scale of the problem is clear.

Mental health services face an uphill task to deliver race equality,” she says, urging “concerted action, backed up with new investment,” to address the issues.
“The inequalities laid bare must be a cue for action and not become accepted as routine fact,” added Greatley.

Other statistics from the survey:

• Almost 80 per cent of patients were on mixed sex wards

• Six per cent of inpatients said they spoke a language other than English as their first language. This figure was over 60% for Chinese inpatients

• Nearly 45 per cent of inpatients said they were Church of England, 13% Roman Catholic,  3% Muslim. Less than 2% of inpatients were Jewish, Hindu or Buddhist.  20% of patients did not have a religion.

• Patients from all minority ethnic groups were generally younger than patients from the white groups. This finding is representative of the general population, where members of black and minority ethnic groups are younger overall.

• Three per cent of patients were on a high secure ward

• Fifty five per cent of inpatients were men and 45% were women in total. Among white groups, these percentages were similar. But the proportion of men was higher among inpatients from other ethnic groups.

Sixteen ethnic categories were used in the census. These are white British, white Irish, other white, white and black Caribbean, white and black African, white and Asian, other mixed, Indian, Pakistani, Bangladeshi, other Asian, black Caribbean, black African, other black, Chinese, and other.

There will be another census in 2006, extended to include inpatients with learning disabilities.

Health minister Rosie Winterton says she is “confident that we have started to build the sort of service that can make the inequalities that the census confirms a thing of the past”.

Many in mental health do not share her optimism.

Download Count me in, first national census of inpatients in mental health hospitals and facilities

Click here