Mental Health Act ‘needs major reform’ as black patients four times as likely as whites to be sectioned

‘Our experience has been, professionals come with stereotypes, which are usually negative if you’re a black person,’ mental health patients tell independent review

Alex Matthews-King
Health Correspondent
Thursday 06 December 2018 01:14 GMT
Budget 2018: new mental health services to be introduced to 'end stigma', Philip Hammond says

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Sweeping reforms are needed to restore rights to mental health patients and end the “burning injustice” which means people from ethnic minorities are disproportionately sectioned, an independent review has concluded.

Black people are four times more likely to be detained under the “outdated” Mental Health Act than whites, in a legal process that allows patients to be kept on a secure ward and treated against their will.

While the review said the act is still necessary to hold people who are a risk to themselves or others, it said it found patients are too often denied a say in treatment which can include electroconvulsive therapy.

It also said there is a need to challenge attitudes and – largely unconscious – biases towards ethnic minority patients which leads to excessive use of restraint and “community treatment orders”.

Black patients are subjected to these orders at nearly ten times the rate of white patients, and required to keep to strict medication and assessment meetings – and even certain living arrangements – or risk being returned to hospital.

Addressing this requires removing barriers that make minority communities less likely to get treatment for mental health conditions despite being disproportionately affected.

It also requires work on making mental health staff more aware of the problems faced by non-white patients, and making services accountable for addressing them.

One service user told the report: “I feel like our experience has been, professionals come with stereotypes, which are usually negative if you’re a black person.

“It seems professionals have to make a special effort to treat us like human beings.”

In the wake of the review, commissioned by Theresa May in 2017, the government announced it would be advancing legislation to enact two of its 150 recommendations.

That includes new rights for patients to challenge psychiatrists’ treatment decisions at a tribunal, and to nominate who should make decisions about their treatment and detention – rather than relying on a “nearest relative” who may be abusive.

However, these changes do not directly address the systemic issues experienced by black and minority ethnic patients.

Steve Gilbert was one of the review chairs, and consults with organisations about his experiences with serious mental illness and race.

He was sectioned at the age of 26 after a manic episode, and his experiences, and those of family members with mental health conditions, have shown him the barriers to getting early support and appropriate treatment.

“Most of the disparity in decision making isn’t conscious,” Mr Gilbert told The Independent.

“I’ve not come across staff that are racist, but I have come across staff who were ignorant about the issues that affect people from black African Caribbean communities.”

“When we think about the decisions that are made, more often than not you’re perceived as presenting a risk if you’re a young black African or Caribbean male – as opposed to someone who is white but has a similar experience to you.

“I’ve got a really loud voice, but that can be misinterpreted as me being aggressive. But it gets a bit loud when I’m scared or anxious.”

The review was ordered in 2017 after NHS data showed the number of people detained under the act rose by about 30 per cent between 2011/12 and 2015/16.

Matt Hancock: The truth is that, for an awful long time, mental health has simply not had the same level of support – both resources and how society talks about it'

In 2017/18, some 49,551 people were detained under the Mental Health Act and the average cost of each detention has been estimated at £18,315 – for a bill of more than £900m a year.

Other recommendations include:

  • Empowering patients to challenge deviations from their advanced care plan at tribunal, and only allowing treatments such as electroconvulsive therapy with a judge’s authorisation;
  • Major investment in community services to prevent patients reaching crisis and to support them outside hospital, as well as in bringing dilapidated specialist inpatient mental health hospitals up to scratch;
  • Ending the current definitions of prisons and police stations as a “place of safety”, which means prisoners can go months without treatment and people in crisis can be taken to police cells. 

While there has been a 95 per cent fall in the use of police cells and custody suites as a place of safety since 2011, they still accounted for 3.9 per cent of detentions in 2016/17, figures showed.

“If there’s one important theme from the whole thing, it is to ensure the voice of patients is heard louder and more distinctly and carries more weight than it has in the past,” said Professor Sir Simon Wessely, former chair of the Royal College of Psychiatrists, who chaired the review.

“The Mental Health Act was written when people with a mental health problem were something to be afraid of.”

“But the way we think about mental health and illness has changed dramatically… It is time for the Mental Health Act to be brought up to date.”

Prime minister Theresa May said: “The disparity in our mental health services is one of the burning injustices this country faces that we must put right.

“For decades it has somehow been accepted that if you have a mental illness you will not receive the same access to treatment as if you have a physical ailment. Well, that is not acceptable.

“By bringing forward this historic legislation – the new Mental Health Bill – we can ensure people are in control of their care, and are receiving the right treatment and support they need.”

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