Mental Health Services: Black and Minority Ethnic Communities

Lord Boateng Excerpts

Tuesday 28th November 2017 Lords Chamber

Asked by

[Lord Boateng]

To ask Her Majesty’s Government what progress they have made in improving mental health services for people from black and ethnic minority communities.

[Lord Boateng (Lab)]

My Lords, in moving the Motion in my name on the Order Paper, I pay tribute at the outset to the very many black and minority ethnic patients who have suffered from what the Prime Minister rightly described as “a long-standing injustice” —discrimination in the mental health service of our NHS. I want also to pay tribute to their carers, their families and the clinicians who have stood behind and alongside them in what has often been a difficult and challenging fight to have recognised the injustice to which they have been subjected.

This injustice is rooted in the issue of race. There is no escape from that reality, however uncomfortable it may be. All the evidence—from the Mental Health Foundation and the Prime Minister’s own excellent race disparity audit—shows that, if you are from a black or minority ethnic community, you are more likely to be hospitalised, to be in receipt of pharmaceutical rather than talking therapeutic interventions, to be detained or to have less good outcomes than your white counterparts. You are also more likely to feel alienated and ill served by the mental health service. This is the sad reality of the conditions that black and minority ethnic patients face in the mental health system.

In earlier debates in this House, we have heard that it is the Secretary of State’s wish that safety should run like a golden thread through the NHS. This is a commendable wish but, sadly, for black and minority ethnic people NHS mental health services are not a safe place. Too many have died or been the subject of abuse for us to be able to say this with any degree of certainty.

In his ground-breaking report on the tragic circumstances surrounding the death in secure hospital accommodation of Rocky Bennett, Mr Justice Blofeld referred to institutional racism in NHS mental health services. He referred to the services received by black and minority ethnic communities as “a festering abscess” on the NHS. I fear that many people who have experienced what the black and minority ethnic communities go through in the NHS will concur with that verdict.

The Prime Minister has done the nation a great service by highlighting the injustices in the treatment of black and minority ethnic people within the NHS and by initiating an independent review of the Mental Health Act. I commend and welcome that, but it is important to remember that it is only one part of the picture. The wider picture is the context in which the Act is administered. So we look forward to the outcome of the independent review. We hope that the Government will legislate urgently on it and that it will have rights-based conclusions. These will enable patients to access services that are underwritten by capacity within the health service so that we can meet the norms that we look to achieve. We hope for all those things.

In the meantime, it is vital that we address the issue of patient care now. I hope that in the course of this short debate we will be able to come up with some practical recommendations and proposals in that regard which can be implemented—and implemented as a matter of urgency. Over the years, there have been many inquiries and studies in this area. They were initiated by successive Governments with good intentions but the reality is that, in the main, they have been only partially implemented and when they have, I fear that they were underresourced. I urge the Minister, as she takes forward the Prime Minister’s initiative on mental health, to ensure that along with the recommendations come resources, a timescale for those recommendations to be implemented and, importantly, a gathering of the data to enable us to judge the outcomes. Without the data, we will not be able to make the judgments or have the insights necessary to establish whether patients are getting the care that they need.

It is also important that we spread good practice. I have been a very junior Health Minister and I know that the holy grail in the NHS is to spread good practice. There is some great stuff going on out there, even in the field of BAME mental health, but there is also some terrible stuff. The challenge for Ministers, service providers and commissioners is in how we spread the good practice and ensure that inevitable pressures on budgets do not lead to neglect of this area because it is simply all too difficult. It is difficult and complex; we are dealing with not just an illness but racism and the encompassing social disadvantage and exclusion. No one pretends it is easy but we have to address it, and in ways that make a practical difference on the ground to hard-pressed clinicians, to hard-pressed community workers and, above all, to the patients and their carers.

I shall make a number of brief points on some positive ways forward. First, it is important to recognise the interface between local authorities, health authorities, hospitals and providers in this area. I believe—I championed this as Chief Secretary to the Treasury and I go on doing so—in having pooled budgets wherever you possibly can. I am also driven to the conclusion that although the Treasury does not like hypothecation or ring-fences, there is no alternative when it comes to mental health. If we do not ring-fence then I am afraid, for reasons that many Peers in this Room who have day-to-day experience of it will know, it simply will not happen. I urge the Minister, as she takes forward these proposals with her colleagues, to look at pooled budgets and ring-fencing.

Secondly, it is important that we find ways of ensuring that patients themselves have a voice and that patient advocacy is taken seriously. My early experience as a young community lawyer in this area showed that patients need advocates. They may need community advocates and sometimes they need professional advocates. We have to look at how they access help in that regard.

My third point is on early intervention. I fear that, when we look at what the evidence shows in relation to black and minority ethnic communities, all too often it is the police and the prison officers who have to deal with this issue, because there has been no earlier accessing of services. I have been Police Minister and Prisons Minister. I know just how hard it is for those professionals, without adequate training or support from the surrounding services, to deal with mental health patients in custodial settings and in circumstances in which the police are called to the scene on the streets or in private premises. We have to look at ways, whether community street triage or whatever, of ensuring that the police and prison services get the professional support, and the funding underpinning that, to enable them to respond and, even more importantly, that these communities have a sense that they can access services before they reach that acute and desperate level; that is, early intervention.

Finally, progress and best practice in this area have tended to come when the community and the voluntary sector in the community have been involved. There are some excellent examples in Brent, Lambeth, Birmingham and elsewhere of black and minority ethnic community-led voluntary organisations working with GPs and hospitals to deliver services. Very often, these organisations are the first to get cut at a time of pressure on local authority and health budgets. They are, in fact, the last organisations we should be cutting out of the picture, because they are a depository of good practice and understanding and a gateway into the service for the community.

I end on that, save to say: we know what needs to be done. I sense that across the Chamber, in both Houses and in the wider community there is a desire and a will that it should be done, so let us adopt what I learned in South Africa as a particular approach when there is a will and when there is an outcome. It is encapsulated in this one word “Vukuzenzele”, which simply means, “Let’s get on with it. Let’s do it”.