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Many black people find their first crisis interaction with the mental health sector involves the police
The need for change to the mental healthcare and treatment of black people in the UK is widely acknowledged and long overdue – discriminatory and inequality practices still persist.
Nursing Management. 28, 6, 15-16. doi: 10.7748/nm.28.6.15.s5
Published: 02 December 2021
The Independent Review of the Mental Health Act made a series of recommendations to address the inequalities that exist for people from minority ethnic communities in accessing mental health treatment, their experience of care and their mental health outcomes. However, the government’s recent follow-up consultation on reforming the Mental Health Act in England did not ask specific questions about the impact of the proposed changes on people from minority ethnic communities.
The RCN, in its consultation response, highlights the need to focus on racial inequalities in Mental Health Act reforms.
There is compelling research and evidence over the past 20 years that black and African-Caribbean people, particularly men, are over-represented in the use of mental health services, and experience poorer outcomes than their white counterparts.
Black people are four times more likely to be detained under the Mental Health Act, and twice as likely to be arrested under section 136, according to official figures.
Recent data from NHS Digital for 2019-20 show black people are now more than ten times more likely to be given a community treatment order than white people.
Such disparity may be due to systemic and institutional forms of racism and stereotypical views of black men as violent and dangerous when mentally ill.
Many black people find their first crisis interaction with mental health services involves the police and compulsory hospital admission rather than being admitted on a more informal basis.
So the key questions for commissioners and providers to consider are:
» Why are black people more likely to be detained when diagnosed with a mental health issue?
» Is this due to clinicians working under the Mental Health Act not having effective communication and engagement strategies when caring for people from minority ethnic communities?
» Or are there other factors preventing people from accessing services when they most need them?
Mental illness is not always culturally acceptable, which can act as a barrier when someone needs help and support. Research has found that, for some, there may be an inability to recognise and accept the symptoms and diagnosis of mental illness.
The stigma that some cultures associate with mental illness means they prefer not to talk about their condition with family members for fear of the negative effect on how they are perceived in their community.
Lack of openness in family settings can also hinder discussion about mental health, and consequently, symptoms of mental illness can be ignored until it becomes a crisis.
Fear and mistrust of services also prevents some from seeking help until their mental state deteriorates to the point that it requires the use of the Mental Health Act. Updated legislation must demand mandatory training on human rights and equalities issues for all healthcare staff working under the act, including the effect of systemic, institutional and interpersonal forms of racism and discrimination.
‘Culturally sensitive and tailored care is vital when caring for individuals from diverse backgrounds with a range of traditions, languages and faiths, as well as cultural norms about mental ill health that differ from those of the majority population’
Training must also incorporate how to demonstrably identify and tackle all forms of bias affecting the delivery of services, as well as the outcomes and the experiences of patients and carers. And monitoring of this training should be included in the Care Quality Commission inspection guidance.
Culturally sensitive and tailored care is vital when caring for individuals from diverse backgrounds with a range of traditions, languages and faiths, as well as cultural norms about mental wellness and ill health that differ from those of the majority population.
It is important for mental health services to avoid the ‘one size fits all’ approach and develop a system that shows respect for different cultures.
Long-held beliefs and practices require careful navigation by healthcare professionals to build trust in services. Healthcare practitioners do not necessarily need to be knowledgeable about all cultures, but their approach should be one of openness, respect and a willingness to learn about the culture of the person they are caring for.
Working in partnership with carers and significant others should seek to address some of the inequalities in healthcare and tackle fear and stigma that exists about mental illness.
Practitioners from minority ethnic backgrounds are significantly under-represented in statutory mental health roles, including responsible clinician, approved clinician and advanced practitioner roles. More must be done to develop a clear and flexible pathway for nurses to take on these roles.
To turn the tide in terms of organisational culture, it’s crucial the workforce is represented at every level of people we care for and be extended to the new mental health advocacy roles proposed in the revised Mental Health Act review.
Much more needs to be done to shape the mental health services to meet the needs of a diverse UK population.
Centre for Mental Health (2020) Racial Disparity in Mental Health: Challenging False Narratives. tinyurl.com/CMH-racial-disparity
Memon et al (2016) Perceived barriers to accessing mental health services among black and minority ethnic (BME) communities: a qualitative study in Southeast England. BMJ Open. doi:10.1136/bmjopen-2016-012337
RCN (2021) Consultation Response: Reforming the Mental Health Act. tinyurl.com/RCN-mha-reform
Sainsbury Centre for Mental Health (2002) Breaking the Circles of Fear. A Review of the Relationship Between Mental Health Services and African and Caribbean Communities. tinyurl.com/SCMH-circles-fear
