Race impact assessment on mental health legislation: special report

The government is failing to take adequate measures to reduce discrimination against black people in the mental health system, according to campaigners.

The criticisms follow a decision by the Department of Health not to carry out a full race impact assessment on the Mental Health Act 1983.

Cliff Prior, chief executive of charity Rethink says a full race impact assessment is an “absolute necessity.”

But the DH will only carry out the assessment on its proposed amendments to the act.

The government has justified the move by saying it is already taking action with its delivering race equality programme, launched last year. It was created after Afro-Caribbean service user David Bennett died after being restrained by staff in 1998.

The DH will also update the 1983 Act’s code of practice to reflect the duty to promote race equality in the Race Relations Amendment Act 2000.

Race equality
In response, Matilda MacAttram, director of the Independent Race Relations Health Consultancy, calls the DH’s decision a “slap in the face for the Afro-Caribbean community and all those working to achieve race equality.”

She says the move is “highly concerning” in the light of census findings published last year showing that black people are three times more likely to be detained under the Mental Health Act than the general population.

The mental health and ethnicity census, the first of its kind, found that almost one in ten mental inpatients are black or mixed-race, despite the groups making up just three per cent of the population.

“These findings publicly brought to light the huge discrimination in mental health services, which had been long been known on the ground,” MacAttram says.

“There are a plethora of reports that clearly show how the 1983 Act has destroyed lives, but the government is still not taking the issue seriously.”

The Commission for Racial Equality has written to the DH to request a full race impact assessment.

The Mental Health Alliance, a group of over 70 organisations campaigning on the Mental Health Act, believes the government’s measures will be inadequate to produce legislation that promotes race equality positively.

Lord Victor Adebowale, chief executive of charity Turning Point, argues the need for a full assessment on the Mental Health Act is “clear.”

Ethnic communities
Adebowale adds: “The inequalities in mental health services and the fear they provoke mean far too frequently patients from different ethnic communities come to the attention of services as a last resort and at crisis point. This makes treatment via the Mental Health Act a more likely route. 

“It is all the more imperative that the government takes a more proactive stance to address the discrimination and discrepancies in mental health services.”

Prior at Rethink adds :“At the very least, there must be a clear principle at the start of the new act that respect for diversity will underpin all actions taken under the amended act.”

There are also concerns that the delivering race equality programme is faltering and cannot be used as a substitute for a full race impact assessment of the act.

“If the programme was adequately funded it might stand a chance,” MacAttram says.

She adds: “You can’t carry out a five year plan when the fundamental legal framework is discriminatory.”

Chinyere Inyama, a leading mental health lawyer, argues that the Department of Health is “paying lip service” to race equality legislation.

He also questions why other legislation – including the Nationality, Immigration and Asylum Act 2002 – had full race impact assessments, while the Mental Health Act will not.

Lack of investment
Inyama also claims that the delivering race equality programme is “crumbling” because of a lack of investment – leading to alleged workforce problems – and points to concerns over its future.

“The Department of Health says they are doing their bit to reduce race discrimination in the mental health system with this programme, but it only runs for five years and no-one knows what will happen after that.

“I doubt it will have a lasting impact on legislation and see nothing concrete to reassure us that the next twenty years will be different from the last.”

MacAttram says campaigners will continue to push for a full race impact assessment on the Mental Health Act.

She warns: “The government has to realise this is not a merely a case of good versus bad policies. For black people being failed at the hard end of psychiatric care, it’s a case of life or death. If nothing changes we will lose more people to the system.”