The government’s efforts to reorganise health and social care to promote public mental health fails to pay any attention to inequalities.
Aside from the odd mention in policy statements and the ongoing rhetoric about the perils of state multiculturalism, there is little action.
A debate in the House of Lords on Monday 8th October aimed to show how the government plans to improve and prioritise mental health services. Despite briefly highlighting some of the current problems facing black and minority ethnic communities in mental health, no plan of how to tackle this was mentioned.
Over-representation of ethnic minorities in mental health care
Meanwhile figures released by the NHS Information Centre in 2011 showed that between 10 to 12% of patients detained in hospital under the Mental Health Act are of black Caribbean or black African origin.
Detentions for black people rose from 2,731 (10.7% of all those detained) in 2005-2006 to 4,624 by 2009-2010. They are also increasingly over-represented on community treatment orders.
BME communities frozen out of consultations
These figures indicate there was no improvement during the Department of Health’s Delivering Race Equality programme, which ended in 2010. A year later the Care Quality Commission ceased collecting data under the Count Me In census, implying that nothing could be done.
The national health charity The Afiya Trust, among others, openly criticised the coalition government for not consulting with black and minority ethnic communities and organisations on this unwanted decision – and with good reason.
Other sectors handle inequalities more assertively
Health and social care settings unrelated to psychiatry and mental illness seem to deal with inequalities more dispassionately and more assertively. Mental illness continues to raise all sorts of anxieties about coercion and misuse of the legislation, which doesn’t make it a politically attractive option.
In response, the Mental Health Providers Forum recently launched a comprehensive and much needed resource for health and social care practitioners to generate a more professional understanding of the Mental Health Act 2007.
The Mental health legislation resource sets standards and outlines case studies to demonstrate the best ways to use the Act to protect service users and promote good mental health care.
It pays attention to ethnicity and culture in how the Act is used and highlights the dilemmas of providing care for people through detention.
Social care professionals often find themselves in complex terrain which requires them to not only have a better knowledge of the law but stronger skills to assess patients, provide court reports and give oral evidence.
These professional skills will attract greater scrutiny under the new public health policy and outcomes framework, with its arrangements for public health commissioning and greater service provision from local authorities.
Training needs for social care professionals
To meet these growing practice-based training needs, I have established a new masters degree in mental health and law in partnership with the law department at Queen Mary, University of London.
The programme will provide continuing professional skills development to enable a new group of senior professionals become leaders in the field of mental health law. Hopefully many of our future graduates will feel inspired to meet the challenge of reducing all inequalities in mental health.
But frontline workers and senior staff can’t do this on their own. The Department of Health, Public Health England, Health Education England, clinical commissioning groups and local authorities will have to revisit their mental health policies to ensure that a commitment to equalities is embedded within future care.
Professor Kamaldeep Bhui is professor of cultural psychiatry & epidemiology at the Wolfson Institute of Preventive Medicine and director of the Cultural Consultation Service, which are both based at Queen Mary, University of London.