Post-legislative scrutiny of the Mental Health Act 2007 - Health Committee Contents

7  Ethnicity and the use of the Mental Health Act

Disproportionate representation of minority ethnic groups

108.  The CQC found in 2011-12 that there was a "continuing trend in high rates of detention amongst certain black and minority ethnic groups."[140] The general trend for hospitalisation and detention under the Mental Health Act 1983 is at disproportionately high rates amongst minority ethnic groups. Rates of detention were 2 to 13 times greater than was expected[141] and this particularly applies to the Black and Black British population.[142]

109.  We heard evidence about the experiences of minority ethnic groups within the mental health system and the reasons which explained much higher rates of detentions amongst these groups. The MHA have found that Mixed, Black and Black British groups are "40% more likely than people in the White group to be using mental health services, with or without compulsion."[143] In oral evidence Alison Cobb expanded on this and told the Committee that it might be the case that:

people from black communities may be afraid of services and have fears around being detained, medication or how they might be treated. The impact of that results in damaged trust and people not wanting to engage with services and, perhaps, delaying making contact with services until really late in the piece, when it may be more likely that the Act will be used.[144]

110.  The Department of Health accepts that there is:

long-standing concern about the disproportionate numbers of people from minority ethnic groups, particularly Black Caribbean, Black African and other Black groups, using in-patient mental health services and detained under the 1983 Act.[145]

Bruce Calderwood spoke in more detail about this concern, saying that this problem was specific to migrant communities. Specifically discussing detention, he said:

There are higher rates here than there are in either the Caribbean or in Africa, so there is something around the experience of black and Afro Caribbean people in this country as opposed to where they, their parents or grandparents come from, which actually is helping to cause much higher levels of psychosis than in the general population.[146]

Dr Griffiths added that this was not simply a problem which England or the United Kingdom must address and that "It is a phenomenon all over the world that migrant populations have higher rates of mental illness."[147] Bruce Calderwood told the Committee that there was also a 'London effect' whereby:

The pattern of detention due to the Mental Health Act in London is very different from the rest of the country, and that seems to be, again, to do with social isolation, homelessness and people not having anyone to look after them. It is very difficult to disentangle race effects from the London effects.[148]

Anne McDonald told us that social factors attached to living in London along with the city being a major transport hub might be part of this phenomenon. Interestingly, she said that:

if you present for an assessment under the Mental Health Act, the [...] likelihood of actually being detained are very similar between Birmingham and Oxford but much higher in London.[149]

111.   Bruce Calderwood and Dr Griffiths argued in their evidence that the disproportionate detention of people from black communities could not be attributed to institutional racism in the system. They accepted that, inevitably, racism would occur and acknowledged that racism in society might be a driver of mental health problems.[150] Overall, however, they concluded that "it looks as if the much higher rate of the use of the Mental Health Act can be explained to a considerable extent by some of these demographic characteristics."[151]

Effect of the 2007 Act

112.  We did not take any evidence which claimed that the 2007 Act was inherently weighted against certain people or communities or had exacerbated the problems identified within the system. It is telling, however, that 15% of CTOs issued between 2008-2011 were for Black or Black British patients.[152] This group represented approximately 3% of the population in 2009 and it demonstrates that even the most recent innovations in care have not managed to overcome the ethnic imbalance. The extent to which CTOs are issued to Black patients is even more disproportionate than the rates of detention under the Mental Health Act. Bruce Calderwood explained to the Committee that when a patient is detained under the Mental Health Act:

it is not just about diagnosis and whether you have a mental disorder; it is about risk. There are many determinants of risk, some of which are contained in your social circumstances.[153]

Naomi James told us that some patients subject to CTOs had reported elements of risk being too heavily weighted in their care plans.[154] The evidence presented to the Committee demonstrated that societal factors which create risk will influence clinical decisions regarding treatment.

113.  Alison Cobb emphasised the significance of delivering advocacy services to detained patients and those on CTOs. In Chapter 2 we identified the problem that those most in need of advocacy were least likely to be able to access it. The University of Central Lancashire found that this problem is apparent for minority ethnic groups.[155] This is a failing in the system which we believe can be resolved.

114.  Introducing the Bill to Parliament, Lord Warner said that decisions around treatment must consider whether services are "culturally appropriate".[156] This is a vital consideration and it is right that the legislation should address this point. It is, however, the responsibility of NHS England and clinical commissioners to commission and construct mental health services that make the legislative intent a practical reality.

115.  Effective commissioning of advocacy by local authorities can begin to tackle the failure to provide minority ethnic patients with a robust advocacy service. Anne McDonald said that it is important to commission in a way "which improves quality and access"[157] and this should be a priority in relation to advocacy. Helping Black patients to use and exploit their rights would be a small but important step in begin to address the disproportionate number of Black patients subject to the provisions of the Mental Health Act.

140   CQC, January 2013, p 16 Back

141   Ibid, p 17 Back

142   Q 170 Back

143   Mental Health Alliance, May 2012, p 18 Back

144   Q 63 Back

145   Department of Health, July 2012, p 13 Back

146   Q 170 Back

147   Ibid Back

148   Q 173 Back

149   Q 175 Back

150   Q 170 ff. Back

151   Ibid Back

152   CQC, January 2013, p 89 Back

153   Q 170 Back

154   Q 45 Back

155   Department of Health, July 2012, p 18 Back

156   HL Deb, 28 November 2006, col 658 Back

157   Q 179 Back

previous page contents next page

© Parliamentary copyright 2013
Prepared 14 August 2013