Mental Health Services: Black and Minority Ethnic Communities

Baroness Chisholm of Owlpen Excerpts

Tuesday 28th November 2017 Lords Chamber

[Baroness Chisholm of Owlpen (Con)]

My Lords, I thank the noble Lord, Lord Boateng, for securing this short debate and other noble Lords for their contributions on this important issue, which is close to my heart as well. I will try to address as many points as possible after my opening remarks. I apologise if I speak rather fast, but I always seem to be beaten by the clock when there is so much that I want to say. As the noble Baronesses, Lady Hussein-Ece and Lady Watkins, and the noble Lord, Lord Brooke, all mentioned, we know that people from black and minority-ethnic backgrounds experience significant inequalities in access to, and experience of, mental health care, with particular overrepresentation in acute and secure mental health services.

In the past, as noble Lords have mentioned, matters have gone terribly, tragically wrong, so in July 2016, as the noble Lord, Lord Boateng, mentioned, the Prime Minister launched the race disparity audit, an audit of public services to help end the burning injustices that many people from ethnic minorities experience. Last month, the Cabinet Office published the audit, which showed a complex picture. In some measures it reported significant disparities between and within ethnic groups, and in others it showed that there had been a narrowing of the gaps between ethnicities.

As the noble Lords, Lord Brooke and Lord Ouseley, mentioned, we know that black women are more likely than any other ethnic gender group to experience a common mental health disorder such as anxiety or depression. Similarly, black men are the most likely to have experienced a psychotic disorder in the past year. However, as the noble Lord, Lord Brooke, mentioned, white British adults are more likely to be receiving treatment for a mental or emotional problem than other ethnicities.

As the noble Baroness, Lady Watkins, mentioned, we also know that a disproportionate number of people from black and minority ethnicities are detained under the Mental Health Act. As the noble Baronesses, Lady Hussein-Ece and Lady Watkins, the noble Lords, Lord Ouseley and Lord Brooke, and the right reverend Prelate all mentioned, the Mental Health Foundation reported that Afro-Caribbean men were more likely to enter mental health services via the criminal justice system. The report also suggested, as did the noble Lord, Lord Ouseley, that there was a potential for mental illness to be overdiagnosed in people whose first language was not English. As the noble Lord, Lord Brooke, mentioned, we also know that the stigma of mental illness prevents many people from a variety of cultural backgrounds seeking early help.

The current situation is clearly unacceptable. Therefore, what are we doing? As the noble Lords, Lord Boateng and Lord Ouseley, mentioned, we are reforming mental health legislation. We have commissioned an independent review of the Mental Health Act, which will report next year, aiming to improve the lives of tens of thousands of people detained under the Act each year. Professor Sir Simon Wessely will chair the review and work is under way with stakeholders to identify priorities, as the noble Lord, Lord Brooke, mentioned, with an interim report expected in early 2018. The noble Lord, Lord Boateng, will recall from his time in government the previous revision of the Mental Health Act, which he commenced in the late 1990s. Earlier this year, the Government accepted the recommendations of the independent Mental Health Taskforce report, the Five Year Forward View for Mental Health, which made it clear that inequalities must be tackled at local and national level.

However, this is not just about reports. As the noble Lords, Lord Boateng, Lord Ouseley and Lord Hunt, mentioned, it is about what is happening now. We are committed to real service improvement. NHS England set an expectation for local services to improve representation and recovery rates for black and minority-ethnic groups in improving access to psychological therapies services, leading to consistent improvement over the past five months. These therapies, as the noble Lord, Lord Boateng, and the noble Baroness, Lady Watkins, mentioned, are vital.

In secure care, NHS England’s project to address the overrepresentation of black individuals in mental health secure settings has resulted in a new mental health community forensic model to be piloted from next year. A “black voices” network has also been established to encourage co-produced approaches to wider initiatives.

NHS England has also commissioned the National Collaborating Centre for Mental Health to develop guidance to support commissioners and providers in addressing health inequalities. In due course NHS England will publish new pathways for crisis and acute care, building on input from experts-by-experience from ethnic-minority backgrounds. As the noble Lord, Lord Boateng, said, patients who have a voice need to be part of the solution. This will be followed by a community mental health pathway in 2018-19 and a patient and carers race equality standard.

However, we know that successfully improving mental health care for black and minority-ethnic groups needs specific local community as well as national action. The noble Baroness, Lady Tyler, and the noble Lord, Lord Brooke, talked about a joined-up approach. That is why initiatives such as Birmingham’s 300 Voices project, led by the government-funded Time to Change campaign, are essential. Young African and Caribbean men, health professionals, the police and community representatives shared their experience of mental health support, including issues of stigma and discrimination, and produced a practical toolkit which can be rolled out to communities across the country.

The Care Quality Commission is developing a publication to highlight providers’ good practice in reducing the need for restrictive interventions. This will be published by December 2018. We know that restrictive physical interventions are risky for all individuals involved and have a negative impact on patients’ dignity and trust in services. The CQC also has an important role in improving equality as part of the mental health trust inspections. As the noble Lord, Lord Boateng, mentioned, good practice is vital. The CQC recognises the good practice of those providing services with a focus on improving black and minority-ethnic mental health.

The noble Baroness, Lady Hussein-Ece, talked about recognising that mentally ill people need access to dedicated care at all times of the day. That is why, in January 2016, we announced that crisis resolution and home treatment teams would receive £400 million in additional funding by 2021 and that we would invest £247 million to 2021 in hospital emergency departments to support people with immediate mental health needs. Just last month, we launched a new £15 million scheme—Beyond Places of Safety. This will provide capital grants to help develop and enhance facilities for urgent and emergency mental healthcare in 2018-20, including places of calm—crisis cafés that offer support to people who are at risk of mental health crisis.

The noble Lord, Lord Ouseley, and the noble Baroness, Lady Hussein-Ece, talked about children and mental health. The soon-to-be-published joint education and health committees’ Children and Young People’s Mental Health Green Paper will set out improvements for the mental health of children. To further help equip our children and young people with the life skills they need, we have committed to providing mental health first aid training to a teacher in every secondary school by 2019, and to reach 1,000 schools by the end of the year. In their manifesto, the Government expanded this commitment to every primary school, and we are exploring options to deliver this.

During a debate yesterday on education and skills, there was an interesting comment about pharmacies as a tool for gathering information on people who are prescribed anti-depressants. This could give a local view of problems in an area and enable people to move in to help.

The noble Lord, Lord Boateng, and the noble Baroness, Lady Hussein-Ece, talked about recruitment and training. The Mental Health Workforce Plan, published in July, underpins the start of one of the biggest expansions of mental health services in Europe, creating 21,000 new posts by 2021. The recommendations of the independent review of the Mental Health Act, alongside ongoing work in response to the Five Year Forward View for Mental Health, will be instrumental in addressing the perennial injustice of racial disparities on display within mental health services. We will sustain efforts at national and local level to do so.

Many noble Lords mentioned the importance of data. NHS England is requesting from NHS Digital and other partners that all relevant data reports are broken down by protected characteristics. Breakdowns of access and outcomes across ethnic groups are now available within the mental health services dataset. This will allow the systematic identification of areas for improvement and monitoring of progress.

The noble Baroness, Lady Hussein-Ece, mentioned the workforce, as did the noble Baroness, Lady Watkins. I mentioned the extra 21,000 but it is interesting that in looking at the present workforce, there were 15,512 community psychiatric nurses in May 2010 and in July 2017 there were 16,583. The figure has gone up but obviously not by enough and we need to really concentrate on that.

The noble Baroness, Lady Watkins, talked about overseas staff and staff speaking the necessary languages. We have to concentrate more on making sure that we try to bring people into mental health nursing and the other professions who speak a range of languages. But as far as Brexit is concerned, it is important that these staff are not unnecessarily concerned about their future. The Prime Minister has been clear that she wants to protect the status of EU nationals living here.

I am looking at the time but I want to answer the point made by the noble Lord, Lord Crisp. He mentioned carers being excluded from an initial assessment. This seems absolutely extraordinary and I am going to take it back to the department. It seems to me completely obvious that they should be included in first-time assessments and, if it is not happening, I shall certainly find out why. As to when the response is coming out, I say soon.

The noble Lord, Lord Boateng, mentioned ring-fencing and I say quickly that it is for local areas to decide where to invest, based on local needs, in line with national priorities set out by the Government and NHS England.

As always, if there are points that I have not covered, which I am sure is true, I will make sure that we write to noble Lords. We must all work together to make sure that the vulnerable, their families and carers can feel confident that they are getting the right treatment in the right place and at the right time. As the noble Baroness, Lady Watkins, said, the treatment must also be equal for all. I thank noble Lords for all their contributions.