Mental Health Services: Black and Minority Ethnic Communities

Baroness Hussein-Ece Excerpts

Tuesday 28th November 2017 Lords Chamber

[Baroness Hussein-Ece (LD)]

My Lords, I thank the noble Lord, Lord Boateng, for securing such an important and timely debate on an issue of real interest to many people and communities across the country. Good mental health is essential for a healthy society, and it is positive that recently there has been a greater emphasis on mental health and calls for it to be afforded parity with physical health. I have worked with people with mental health difficulties. I worked in Tottenham in mental health services, I was a councillor in Hackney and in Islington, and I sat on one of the first mental health and social care trusts, the Camden and Islington trust, which was established about 15 years ago to bring mental health and social care together—so we have come a long way. However, the figures show that black and minority ethnic communities are still not getting access, quality services and, as the noble Lord, Lord Boateng, said, early intervention at the appropriate time.

Yesterday, while preparing for this debate, I read that there are now 5,000 fewer mental health nurses than there were in 2010. Will the Minister say whether that is the case—and, if it is, what is being done to recruit more mental health nurses?

Figures show that in recent years people from the black community have had the highest rate of detention in hospitals under the Mental Health Act—56.9 per 100 people—and people from Asian groups have had the second-highest rate. These are shocking and very stark figures. We know that socio-economic factors contribute to these findings. We know that coming from a poorer background, living in an inner city and encountering poverty and discrimination contribute to poor mental health. Stigma is attached, and there is a lack of willingness to seek help when necessary because families and individuals worry that they may be stigmatised within their own community.

For a long time there has been a lot of research—it is not new research; it has been going on for many years—and many findings about the challenges facing BME communities. However, so far there has not been significant change to improve the outcomes and satisfaction consistently—this is the important point—across the country. There are pockets of excellence, and some very good services, but they are not always accessible to people across the country. Health services and local councils, as I have said in my previous roles, have a range of statutory duties and functions related to mental health and supporting mental health well-being. From housing to public health, social care and leisure services, councils lead local services that help prevent mental ill-health and which support early intervention and provide ongoing support.

The evidence, some of which was referred to by the noble Lord, is overwhelming. It always shocks me—it did when I first read it 15 years ago, and it still shocks me now—that people from black and minority ethnic groups living in the UK are more likely to be diagnosed with mental health problems, more likely to be diagnosed and admitted to hospital, more likely to experience a poor outcome from their treatments, and less likely to have talking and other therapies.

It is particularly shocking that African-Caribbean people are still more likely to enter mental health services via the courts or the police than from primary care, which is the gatekeeper for treatment for most people. They are more likely to be treated under the Mental Health Act and more likely to receive medication, and are often overrepresented in high and medium secure units and prisons. This was the finding of a report by the Mental Health Foundation in 2014. I would be very surprised if those figures have changed dramatically in the intervening years. It is very disappointing.

I will turn briefly to youth justice. The Taylor review in 2016 indicated that many children and young people who offend have mental health, behavioural or learning difficulties, and often these conditions have gone undiagnosed. These problems can often be the root cause of a child’s offending, and frequently are a barrier to progress in education and proper engagement at school. This is particularly concerning because as many as 60% to 70% of children and adolescents who experience mental health difficulties have not had appropriate interventions at an early age. Can the Minister say what is being done to address this appalling statistic?

In a recent review of child and adolescent mental health services by the CQC, waiting times were highlighted as a big concern. Young people themselves, when they were interviewed for the report, said that they felt that the waiting lists were the big problem and that when they reached crisis point they ended up in A&E. Staff in A&E are already at breaking point and are not trained sufficiently to deal with this. This is a real problem and creates a revolving door for many young people.

At school, mental health support is not always there. As we have already heard, early intervention support is not always available, so young people and children in schools who need it are often quickly labelled as “naughty”, “a troublemaker” or “difficult”, and find themselves excluded or facing time out of school, when in fact what they and their family need is proper support in dealing with these early signs. There is a great disparity in the way BME communities, children and young people are treated. There is a plethora of research and information which highlights this. We do not need to prove it; we know it exists. What we are doing is highlighting what we can do about it.

The commission called for a patients and carers race equality standard to be piloted in mental health, to ensure that there is no discrimination against particular groups of patients, alongside other efforts to improve the experience of care for people from BME communities, including staff training. Will the review of the Mental Health Act consider how we can prevent more people from BAME communities reaching mental health crisis in the first place?

What steps will the review of the Mental Health Act take to ensure that the views of a cross-section of society are being represented? It is really important that views are heard. If we want to reduce the inequalities in mental health for BAME communities, we need to make health services work for them. That means listening, particularly to those who are already in the system, their families and their carers, who are constantly trying to get the best services for family members. It also means supporting the voluntary and community organisations that are working to meet the needs of communities. Without this, it would be impossible for BAME people to have confidence in mental health care services.