DMH 306 Songhai
Submission to the Joint Scrutiny
Committee
and
Response
to
Draft Mental Health Bill
Monday, 1 November
INTRODUCTION:
1.1. Songhai is a voluntary sector organisation
dedicated to developing modernised mental health services for
black and minority ethnic communities (BME). It has played a
major role in supporting the establishment of the Black and Minority
Ethnic Mental Health Network. Songhai is involved in many alliances
and partnership work including the Mental Health Alliance. We
have considered the views of several organisations as well as
services users and carers in making our submission.
1.2. Our response to the Bill is largely
based on our work with members of the black and minority ethnic
communities. The issues surrounding race and mental health are
well documented and long standing. Our concern therefore is to
respond to the proposed Bill in the light of some of these long
standing issues so as to ensure that impact of any new legislation
does not disadvantage BME communities further.
1.3. The compulsory institutionalisation
of BME communities in places that have been proven to be racist
is now well versed. It is also common knowledge that members
of the BME communities are more likely to enter the mental health
system through the criminal justice system. The distrust and fear
of services have been critical factors in determining both the
pathways into care as well as the onset of more severe conditions
before services are sought.
1.4. There is also well documented work
which has shown that members of the black and minority ethnic
communities are more likely to be misdiagnosed and diagnosed under
psychotic conditions and treated using medication which is often
of a higher dosage. Culturally appropriate and acceptable behaviour
has also been wrongly construed as symptoms of abnormality or
aggression. The recourse to advocacy, tribunals and to appropriate
care packages has been slow to positively impact on BME communities.
1.5. We welcome the opportunity to be
able to comment on the draft Mental Health Bill. We believe that
there are some elements in the Bill that can be positive with
the appropriate guidance on their interpretation.
1.6. Overall we believe the guidance
and general principles will be critical in a Bill that uses broad
categories of definition which can leave a lot to interpretation.
As part of the general principles, we think the Bill should be
set in the context of human rights and equality, respecting the
diversity of people and their individual needs. There should
be clear links made to the various equalities legislation, of
particular interest to us is the link to the Race Relations Amendment
Act and the Delivering Race Equality document currently being
redrafted by National Institute for Mental Health in England.
1.7. We support the submissions by National
Black and Minority Ethnic Mental Health Network, Mental Health
Alliance, African and Caribbean Mental Health Commission and Transcultural
Psychiatry Society. Our specific response to the Bill covers
the following areas: compulsory admission, treatment, advocacy
and Safeguards.
2. COMPULSORY ADMISSION:
2.1. Chapter 1 Paragraph 9 defines
the conditions for compulsory detention. We are gravely concerned
about the implications of subparagraphs (7) and (8). We believe
that if the bill is enacted as it stands, it will substantially
increase the number of people who are compulsorily detained, without
any appropriate treatment being available to them. As with all
other forms of detention, we believe that black and minority ethnic
people are more likely to be detained under these new categories.
We therefore request from the Committee to remove these paragraphs
from the Bill.
2.2. If our request is rejected, measures
should be put in place to ensure these powers are not used disproportionably
against members of black and minority ethnic communities.
3. TREATMENT:
3.1. We welcome the addition of non-medical
forms of treatment including counselling and psychological intervention.
However, when a wide definition of treatment is used within a
bill that is largely centred on detention and compulsion, it naturally
raises concerns about the coercive nature of these treatments.
This could lead to people being detained to receive treatment,
but this treatment amounting to no more than staying in hospital.
4. ADVOCACY:
4.1. We believe that access to an Independent
Mental Health Advocate is critical for black and minority ethnic
communities. Given that BME communities are more likely to be
misdiagnosed, compulsorily detained and offered treatment options
that are inappropriate and often harmful, access to advocacy should
be immediate and not delayed. The immediate appointment of an
advocate would save time in contesting the diagnosis or treatment.
4.2. Beyond this, the advocate also
plays a crucial role for black service users because of the services
they receive whilst in care. Apart from pockets of good practice,
mental health institutions do not adequately deliver to the religious,
cultural and linguistic needs of their BME service users. The
lack of staff competencies in these areas often results in discriminatory
or sometimes racist practices and further isolates and excludes
black service users.
4.3. In order for the advocacy to be
effective, we believe that the skills of the advocate are very
important. The advocate will need to play a crucial role to challenge
any discriminatory practice as well as secure more appropriate
provision. This requires advocacy skills as well as a good knowledge
and appreciation of the issues relevant to the service user.
Training that will equip advocates to best fulfil this role is
important. We believe that the allocation of 140 extra advocates
will be insufficient if they are to fulfil their role effectively.
Properly trained, advocates that are able to deliver to diverse
needs and that are not over stretched will ensure a better use
of this resource.
5. SAFEGUARDS:
5.1. We are concerned that many of the
current safeguards protecting patients from unlawful detention
and inhumane and degrading treatment whilst detained have been
removed or substantially reduced under the draft bill.
5.2. Under the current legislation hospital
managers review the detention of the patients when a section is
renewed or if the patient appeals. In recent years many Trusts
have made an effort to recruit from their local communities and
even service users, ensuring that the managers' panels reflect
the diversity of the community they serve. The new recruits have
learnt to be independent and to hold professionals to account.
In addition, hospital managers are increasingly using their powers
to order additional reviews to ensure there is a degree of progress
for long-term patients. Under the new proposals this layer of
accountability and review will be totally removed.
5.3. Although we welcome some of the
additional roles for the tribunals, we believe that by their nature,
the tribunals will be more remote from the local populations,
and they will be less likely to mirror the cultural and social
backgrounds of the patients.
5.4. We also believe that the cost and
staffing implications of the tribunals have not been considered
adequately. This will lead to much longer waiting times and consequently
many people will be detained unnecessarily. Again, disproportionate
numbers will be from BME communities.
5.5. We believe that within a relatively
short time the detaining authorities will be challenged under
various articles of the Human Rights Act for denying access to
fair hearings in reasonable time, as more and more cases will
be held up waiting for tribunals to take place.
5.6. We are also concerned that the
abolition of the Mental Health Commission and inclusion of some
of its functions under the Healthcare Commission will dilute this
vital role, and will result in the loss of the expert knowledge
and skills developed over many years.
6. CONCLUSION:
6.1. We concur with the widely held
view that some aspects of this bill are more concerned with law
and order issues rather than care of mentally ill people.
6.2. People from black and minority
ethnic communities have consistently been overrepresented and
mistreated within the law and order system. We believe that unless
this bill is reviewed and substantially improved it will add to
this injustice and increase the alienation and social isolation
of substantial sections of the community.
7. CONTACT DETAILS:
7.1. Songhai welcomes enquiries about
our response to Draft Mental Health Bill. We would be happy to
discuss this further or clarify our submissions. We can be contacted
at:
Songhai
47-49 Durham Street
London
SE11 5JA
Direct line: 020 7091 9481
Fax: 020 7091 9300
Email: bakhtiar.hormoz@songhai.org.uk
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