Mental Health Services: Black and Minority Ethnic Communities

Baroness Tyler of Enfield Excerpts

Tuesday 28th November 2017 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I, too, congratulate the noble Lord, Lord Boateng, on the incredibly powerful and vivid way in which he introduced this debate. I will remember for a long time the words about this being a festering abscess.

The fact that we are having this debate shows not only how complex and critical the subject is but, frankly, how little progress has been made in improving mental health services for people from the BAME communities, despite repeated reports over the years highlighting the issues, debates in this Chamber and elsewhere. We pride ourselves on being a nation of diversity and equality, and yet the Government’s recently published Race Disparity Audit demonstrates that this is an issue in which we have patently not managed to provide anything like an adequate solution. Indeed, the NHS adult psychiatric survey published only last year showed that black adults were the least likely to receive treatment for mental illness.

The NHS’s The Five Year Forward View for Mental Health states:

“There has been a transformation in mental health over the last 50 years”,

due to “advances in care” and,

“the growth of community based mental health services”.

Obviously, such advances are welcome. However, research over that time period has shown repeatedly that people from BME communities have more adverse experiences and negative outcomes from mental health care, in terms of access to care and experience and type of care—things we have already heard about today.

Despite earlier targeted programmes, such as the Department of Health’s Delivering Race Equality programme—back in 2005, for those with a long memory —these inequalities have not improved. There are still significant ethnic disparities in rates of admission to hospital, detention under the Mental Health Act and practices such as the use of seclusion, as we heard from the noble Baroness, Lady Watkins. Indeed, one of the main concerns driving the independent review of the Mental Health Act is the disproportionate number of people from black and ethnic minorities detained under the Act. Like other noble Lords, I welcome the review and the sharp focus that the Prime Minister has placed on mental health as part of a wider social justice agenda.

I want to say at this point—I think it has come across strongly this evening—that it is so important that the review does not look purely at the point at which someone is being detained, but considers how we can prevent people from reaching a crisis in the first place and what we can do to improve crisis services for people who need emergency help. That has been one of the key points in the debate.

It is a statement of the obvious, but still worth saying, that focusing primarily on mental ill-health, rather than on how we can keep our communities healthy in the first place, is like trying to fix a leak by putting a bucket under the hole. Preventing mental health issues from arising, and intervening early if problems surface, can happen at a local level. Local government has a vital role to play. Clearly, local authorities need adequate funding to commission personalised services and to promote good mental health and well-being in their communities. I know from LGA figures how the core money that local authorities receive from central government has been going down year on year, which makes it difficult for them to fulfil their public health duties. Against this backdrop, can the Minister say what plans the Government have to encourage local commissioners to implement the Joint Commissioning Panel for Mental Health guidance on services for black and minority ethnic patients, specifically to identify and implement concrete measures to reduce the inequalities we have heard about?

As other noble Lords have highlighted in the debate, it is also important to acknowledge the socioeconomic factors that play a large part in psychiatric illness, with people from poorer backgrounds, people living in deprived communities and people encountering adversity and, yes, discrimination being particularly at risk. There are other critical issues: repeated studies have shown that cultural understanding is key to providing an effective mental health service that works for everyone. Other noble Lords have talked about that; I do not want to repeat what they have said.

It is a matter of real concern that there has been no real specific, targeted and strong national framework for improving mental health care for black and ethnic minority communities since 2010. Campaigning groups have expressed concern that mental health services lack a sense of strategic direction for reducing the inequalities in black and ethnic minority mental health that we have heard about.

However, there is positive news to report. There is good practice on the ground. Previous reports have highlighted many suggestions for solutions, and I have heard heartwarming stories from different local communities about the projects that have been set up to tackle the issue. Like the noble Baroness, Lady Watkins, I was encouraged to hear about the Black Thrive project in Lambeth, particularly the way in which it encouraged local people to understand their mental health needs and what services are available, and supported them to use their voices to shape and influence the commissioning of local services.

I applaud the new Synergi Collaborative Centre that has just been launched. This five-year collaboration between Queen Mary University of London, the University of Manchester and Words of Colour Productions is concerned with addressing the links between ethnic inequalities, multiple disadvantage and severe mental illness, with funding from the Lankelly Chase Foundation. This begs the question: what are the Government going to do to support and encourage excellent initiatives such as these? To be truly effective we need a clear national framework championed by government to improve mental health services for people from black and minority ethnic communities, with clear lines of accountability. It cannot all be left to the voluntary sector and local responses, however praiseworthy they may be.

Last year, the Government committed to invest an additional £1 billion in front-line mental health services by 2021 to deliver the five-year forward view for mental health—a welcome road map for reform of mental health services. I noticed that there was no mention of this in the Budget; indeed, there was no mention of mental health at all. I conclude by asking the Minister what proportion of money announced for the NHS in last week’s Budget will be earmarked for mental health care, whether it will be ring-fenced and whether specific money will be earmarked for tackling the quite shocking inequalities in access and outcomes for black and minority ethnic communities that we have been talking about.