Changes to the Mental Health Act need to be backed up by a real strategy to reduce inequalities in mental health for black and minority ethnic people, says Dr Frank Keating
I have mixed feelings on the proposed review of the Mental Health Act. On the one hand, I welcome it and on the other, I think it is wasteful of resources. I welcome the review because of the well-documented evidence that racialised groups are disproportionately affected in mental health care, treatment and outcomes. They access those services they do not want and do not have access to the services they need. Moreover, they are coerced into using services, e.g., compulsory detention. The review offers an opportunity to transcend a purely medicalised approach to responding to mental and emotional distress. The mental health disparities faced by Black, Asian and Minority Ethnic (BAME) communities go broader than just psychiatry: it is social, cultural, economic and political. If the review is to yield positive outcomes, then these factors should be taken into consideration, given the backdrop of significant cuts in mental health services.
However, the fact that a psychiatrist will lead the review casts serious doubt as to whether the issues will be examined outside a narrow medical perspective. There have been numerous suggestions and calls that people with lived experience of being sectioned under the mental health act should drive the review. I would argue that if the review is going to yield positive results or outcomes for BAME communities, it is vital that representatives of these communities are centrally involved in the review. This is pertinent given that the review terms of reference state that there will be a focus on improving treatment and support and dignity. We know that the serious concerns raised by BAME groups at the time of the previous review that led to the 2007 amendments to the Mental Health Act, were largely ignored. For example, concerns that individuals from BAME backgrounds will be disproportionately affected by the use of Community Treatment Orders were not heeded and yet, the evidence shows that this is now the case.
I am not convinced that the review is going to lead to a reduction in the disparities for BAME communities. The overuse of the Act in relation to these communities stretches deeper than mere use thereof: it is about individual and institutional racism; a lack of community based resources; stigma and stereotypical views (particularly those around dangerousness); the economic crisis and governmental policies that further entrench inequalities to list but a few. The Government’s recent race disparity audit showed that BAME communities experience multiple layers of disadvantage that has been known for years and is getting worse. Numerous reports have highlighted this over the last few decades and it is not entirely clear how a review of the Act is going to address or redress these disparities. I suggest that what is needed is not a review of the Mental Health Act, but a National Strategy to reduce racial disparities in mental health. I am aware that we did have the Delivering Race Equality Strategy in 2005, but I propose that a strategy that is underpinned by the principles enshrined in the Human Rights Act (1998) can go further in eradicating these seemingly intractable disparities.
Dr Frank Keating is a Senior Lecturer at the Department of Social Work, Royal Holloway University of London