Mental Health Services: Black and Minority Ethnic Communities

Lord Ouseley Excerpts

Tuesday 28th November 2017 Lords Chamber

[Lord Ouseley (CB)]

My Lords, I thank the noble Lord, Lord Boateng, for securing this debate and for his eloquent introduction to it. No one is better equipped to articulate this issue than the noble Lord, with his experience not only on the streets across London and other parts of the country but in occupying high office.

My own experience with mental health services goes back some four or five decades, running local authority adult care services at a time when mental health services were almost invisible. Predominantly white mental health patients were hidden away, left in corners or locked away. Very rarely were any specialised services prioritised for people with mental health conditions. That is the memory that I still hold of seeing how mentally ill people were treated. Thankfully, we have moved on and that era is now over. We are better aware of the needs of people with mental health disorders.

As the noble Lord, Lord Boateng, pointed out, what was important during that period was community-based responses to the needs of people within those communities who were being deprived of the right diagnosis and the right care. The extent and complexity of mental health issues require careful consideration to determine the appropriateness and adequacy of provision to meet the different and varied needs of patients and sufferers, as well as providing support for their dependants and carers. That was the situation then and it remains so now.

Another complexity within this debate is how we respond to an increasingly diverse population, with a wide range of ethnic minority groups experiencing some degree of adverse mental health conditions. Given language and cultural differences and the way that people interact with standardised perceptions of monocultural responses, there are likely to be wrong diagnoses and inappropriate prescriptions. That has been the case in responding to the mental health needs of black and minority ethnic sufferers over the years.

Incremental improvements in service provision have been driven by representations and campaigning by voluntary community groups. That has been backed up by community representation and research studies showing ethnic disproportionality and race disparities, with the evidence of discriminatory treatment. Data from surveys and studies consistently confirms variations in the prevalence of disorders affecting different ethnic groups and requiring appropriate responses to meet their particular needs.

Arguing about the particular and different needs of ethnic minorities is often seen as pleading for special treatment. However, we should understand that, by responding to the different needs of BAME patients and sufferers, the NHS is able to enhance its responses to all sufferers and patients by recognising the importance of dealing with each individual in an evidence-based and appropriate manner. It is the way in which we are able to deal with one particular problem that exposes the weaknesses of not treating people as individuals and diagnosing their needs in a proper and appropriate way. The ultimate benefit of ending discrimination and disproportionality in mental health services as they impact on black and minority ethnic communities will be the essential knock-on effect of making mental health services provision more appropriate for meeting the individual needs of every mental health patient and sufferer in the country.

Race and ethnic disproportionality is a fact, as the noble Lord, Lord Boateng, pointed out. It is a reality. With one in six adults in the UK and one in 10 children experiencing some form of mental health condition, the NHS is under pressure to respond with adequate resources—one issue already picked up—expert practitioners, clinicians, carers and the provision of advice and support to meet the medical and care needs of patients and sufferers and, to stress once again, their families and those who are supporting them.

The Government’s recent Race Disparity Audit reveals that, in the general adult population, black women were recently assessed as more likely to have experiences of common mental disorders such as anxiety and/or depression and black men were the most likely to have experienced psychotic disorders. There is nothing new in that. Most significant, and well known for years among the black and minority ethnic communities, is the fact that black adults were more likely than adults in any other ethnic minority group to have been sectioned under the Mental Health Act.

Assumptions made by some police officers when attending reported incidents, particularly involving black and ethnic minority men, often result in them being detained in police cells rather than receiving appropriate treatment for their mental health disorders. Many of the deaths in custody, which have indeed disproportionately involved black and minority ethnic men, appear avoidable in retrospect. Some have even received inquest verdicts of unlawful killing without any consequential prosecutions or justice for the families of the deceased. The use of unreasonable force in such scenarios has been highlighted by campaigning organisations, and the recently reported use of Tasers by police entering mental hospitals when called on is another issue that must be addressed, because it is of concern to the community.

With regard to the progress being made to improve mental health services for black and minority ethnic communities, it is important to get some response from the Minister about the guidance alluded to by the noble Lord, Lord Boateng, on good practice: how it is being disseminated and implemented, the action that should flow and who is involved in assessing the effectiveness of the implementation and the process. Are community organisations, families and, indeed, patients part of that process? There is also concern about the involvement of community groups in helping to reduce barriers and improve the uptake of and access to psychological therapies to all sections of the community.

In conclusion, my final point is one which probably deserves a lot more time. It is the increasing number of children and young people who are affected by mental health conditions. It would be useful if the Minister could tell us what systems are in place for the rapid and early identification of children in need of specialised services and for them to be referred to the Improving Access to Psychological Therapies programme, with access to evidence-based and appropriate interventions.