The Approved Mental Health Professionals (AMHP) Leads Network comments on the Commission on Race and Ethnic Disparities report

Comment by The Approved Mental Health Professionals (AMHP) Leads Network

The Approved Mental Health Professionals (AMHP) Leads Network is deeply concerned by the publication of the report of the Commission on Race and Ethnic Disparities and its conclusion that there is no evidence to support the existence of systemic or institutional racism in Britain.

We focus on the section considering mental health, which covers three pages of the report.  We note that the commission report quotes various data evidencing the higher numbers of people from black communities who are detained under the Mental Health Act (MHA) and also subject to Community Treatment Orders (CTOs). The report states that these disparities are often taken as evidence of racism, but argue that these data must be benchmarked against disparity in the prevalence of mental illness.

The report suggests the reported increased prevalence of severe mental illness is caused by exposure to racist attacks and fear of racism. It also suggests that black people are less likely to present early for treatment, thus presenting with more severe mental disorder, therefore leading to higher frequency of detention. The report goes on to suggest that the reason for reluctance of people from black communities to seek help early is “…from fears that mental health provision is discriminatory, manifesting itself in people of an ethnic minority seeking help elsewhere, or putting off getting help, so that the problem manifests itself later, in some cases, in the criminal justice system.”

The Commission concludes that it “does not believe that the evidence it reviewed offers support to claims of discrimination within psychiatry.”

We believe this analysis is overly reductionist and individualistic, laying the responsibility at the feet of individuals rather than the mental health system. It does not consider the impact of structural racism on the mental health of individuals from racialised communities, such as contact with the criminal justice system, poverty, housing, employment and wider health issues. However, we will focus specifically on the outcomes for people who are experiencing mental ill health, rather than the causes.

It is important to acknowledge the reality that people from certain racialised communities are cautious in seeking help from mental health services. This was noted in the Sainsbury Centre for Mental Health report “Breaking the Circles of Fear”[1], which acknowledged the fear and reluctance of people from African and Caribbean communities to seek early help for mental health problems. “…black people generally have an overwhelmingly negative experience of mental health services…They are getting the mental health services they don’t want but not the ones that they do or might want.[2]”

So the fears that mental health provision is discriminatory is borne of experience, not of misinformation or misunderstanding. The following data will provide evidence to support this.

Even taking into account the claims of the Commission that “Black Other” data distorts the overall figures, Black African patients are over seven times more likely to be made subject to Community Treatment Orders than white patients, and Black Caribbean patients more than ten times more likely.

Black people who are already detained under the Mental Health Act are significantly more likely to be forcibly restrained than white patients, and they are also much more likely to be placed in seclusion. Black patients are more likely to be treated with anti-psychotic medication and less likely to be offered psychological (talking) therapies. All these data are reported widely in research and government documents.

We believe it is important to recognise and take steps to address the institutional racism in the mental health system that was identified in the report of the inquiry into the death of David Bennett in 2003[3].

This will not be solved by “targeted public awareness programmes aimed at ethnic minority communities”[4]. It needs structural change and an acknowledgement of the racism that is inherent within the mental health system. The Mental Health Act Review was commissioned to address this issue and the current White Paper is an important opportunity to create an environment in which the over-representation of people from black and minority ethnic communities is addressed.

We believe it is vital that the original purpose of the review is not undermined by the report from the Commission on Race and Ethnic Disparities and urge that the proposed legislation is not diluted or diverted by the impact of this report.

[1] Breaking the Circles of Fear. Sainsbury Centre for Mental Health. 2002.

[2] Ibid. p6

[3] Independent Inquiry into the Death of David Bennett. Norfolk, Suffolk and Cambridgeshire Strategic Health Authority. 2003

[4] Commission on Race and Ethnic Disparities: The Report op. cit. p224.