Analysis

Compulsory detention under mental health act still more likely in BME service users

Black service users are much more likely to be detained in hospital under the Mental Health Act than their white counterparts – so what is being done to address the issue? 

Black service users are much more likely to be detained in hospital under the Mental Health Act than their white counterparts so what is being done to address the issue?

Latest data from the University of Sheffield suggest that black service users are almost three times more likely to be detained under mental health legislation than white patients.

The research, published in The Lancet in June, also shows that compulsory admissions to psychiatric inpatient beds are also greater in areas where there are high levels of deprivation and in those with more non-white residents.

While mental health experts agree that there is no single or simple solution to the problem, they urge new action to tackle the significant inequality brought to light

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Black service users are much more likely to be detained in hospital under the Mental Health Act than their white counterparts – so what is being done to address the issue? 


Detainees under the mental health act were three times more likely to be black than white, research finds
 Picture: iStock

Latest data from the University of Sheffield suggest that black service users are almost three times more likely to be detained under mental health legislation than white patients.

The research, published in The Lancet in June, also shows that compulsory admissions to psychiatric inpatient beds are also greater in areas where there are high levels of deprivation and in those with more non-white residents.

While mental health experts agree that there is no single or simple solution to the problem, they urge new action to tackle the significant inequality brought to light by the study.

1.2 million patients

The study was based on data from more than 1.2 million service users in 64 NHS trusts in England during 2010-11.

It shows there is significant variation by NHS provider and that men had a higher probability of being compulsorily admitted to hospital than women.

Data were available for 1,238,188 patients covering 93% of NHS trusts (64) in England.

Researchers say the non-uniform detention rate might reflect 'local factors', such as the challenges of delivering home-based crisis care in areas with high levels of socio-economic deprivation.

Familiar story

Former RCN professional lead for mental health nursing Ian Hulatt says the findings add to an already large evidence base in relation to inpatient admissions under the legislation.

Mr Hulatt says: 'This touches on a familiar story in relation to black and minority ethnic [BME] individuals and their over-representation in mental health settings.

'The debate about why BME people are more likely to be detained under the Mental Health Act has been rumbling on for a long time.

'It is tricky because there are a number of viewpoints and no one definitive answer.'

Service users who were 18 years or younger were least likely to be admitted compulsorily as a psychiatric inpatient, while those age 18-35 had the highest risk of this kind of admission.

Mr Hulatt says arguments to explain high rates of admission among BME services users include the harmful effects of exposure to racism; a lack of trust in or access to services; institutional racism in the NHS and even genetic vulnerability.

'What [these figures] ask is are our services culturally sensitive and competent, and do we need to rethink how we are engaging people from different ethnic communities?'

He adds that it is crucial that nurses’ undergraduate education includes and discusses ‘these dimensions and dynamics’ to enable them to practise competently in the future.

No improvement

The Centre for Mental Health (CMH) deputy chief executive Andy Bell says that, for black communities, experiences of mental healthcare have worsened over time and the figures should be looked at in the context of other issues.

Mr Bell also says a national strategy to deliver race equality between 2005 and 2009 had failed to deliver its objectives.

'The dial has remained stuck and there is no evidence of improvement whatsoever,' Mr Bell says. 'We have known about the high rates of detention for many years and this is far from new.'

The CMH recently published a report focused on young black men and their well-being and resilience.

Mr Bell explains: ‘What we found was that, during their teenage years, these young men were being exposed to a constant stream of messages which wore down their well-being; fear of police; constant negative stereotypes about black men; experiencing everyday racism in society.’

He says evidence shows that at the age of 11, boys from African-Caribbean backgrounds do not have higher rates of mental ill health than other boys, but by their early twenties, schizophrenia rates and detention rates in mental health settings are markedly higher.

'What we are now calling for is a new concordat, with leadership from government, to drive action in local areas to jointly produce solutions with communities to improve the well-being of young men.

'We have a system that is badly stuck and black communities are feeling the brunt of this.'

Legislation or resources

The study’s lead author Professor Scott Weich says the problem of having to detain people compulsorily will continue until more preventative services, which address issues such as relapse, are provided.

Professor Weich says: ‘This is probably more about resources than legislation. Partly it is delving deeper into understanding something more about the circumstances in which care is being delivered.’

Black patients were three times more likely to be detained to a mental health bed compared to white people, but patients of Asian or mixed ethnicity were also significantly more likely to have been admitted.

But Mind policy and campaigns manager Leila Reyburn says the overhaul of the Mental Health Act (MHA), which led to the revised 2007 Act, was intended to achieve a reduction in the use of compulsion in mental health services.

Instead, NHS Digital data show that the number of people compulsorily admitted to hospital for mental healthcare exceeded 63,000 in 2015-16, which is 43% more admissions per year than in 2007.

Ms Reyburn says it is important to ensure a sufficient range of quality mental health services are offered to meet people’s individual health, cultural and religious needs.

'For services to be accessible, they must be able to engage with the experiences of people who use them.

‘After years of chronic underfunding for mental health services, now more than ever it’s vital we see the government’s promised extra £1 billion reach the front line where it is needed most.’

She says that underlying contributory factors to poor mental health, such as deprivation and inequality, also need to be recognised and tackled.

'It’s vital commissioners invest in local, culturally relevant initiatives to promote the well-being and resilience of young people from high risk and marginalised groups.’

Up My Street project

Three Birmingham-based community projects were commissioned by the charity Mind to improve the resilience of young African Caribbean men in the city.

Evaluation of the projects found evidence of the ‘incrementally damaging impact’ of a constant stream of negative media representations of black men and demonising portrayals of black culture that led young men to ‘mask’ their true selves.

The ‘wear and tear’ of these and other pressures on young African-Caribbean men has been found in extensive research to damage people’s mental and physical health.

It also found that young black men distrust statutory organisations, particularly health services.

Even after contact with Mind’s ‘Up My Street’ projects, most of the young men were reluctant to approach formal services if they needed help with a serious problem.

 

Recommendations

The Centre for Mental Health has made 15 recommendations for change to help address low resilience and well-being in young African Caribbean men.

Mentoring and culturally-informed youth work approaches, led by positive black male role models who proactively reach out to young men, were found to have great value.

Recommendations include:

  • Partnership working between government and relevant national bodies to develop a concordat for black and minority ethnic mental health.
  • Adequate support for black boys when considered for school exclusions, including interventions, such as access to positive role models.
  • A government mental health awareness programme in schools, including a major element targeted specifically at black boys.
  • NHS mental health trusts should create apprenticeships and other employment opportunities for young black men to become mentors.
  • Schools, colleges, local children’s commissioners, Jobcentre Plus and justice services should invest in community experts to identify and take action on inequalities affecting young people.

The report also suggests that the Department for Education should commission research into the experiences of African-Caribbean boys in schools and how to embed positive messages about identity, heritage and well-being, in education.

It said schools would then gain a better understanding of the often hidden impact of persistent negative messages and racist experiences on learning and well-being.


Further information

 

 

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