Mental Health Bill [HL]

Baroness Whitaker Excerpts

Committee stage
Wednesday 22nd January 2025 Lords Chamber

Moved by

[Baroness Whitaker]

63: Clause 20, page 30, line 5, at end insert “and provide information in a culturally appropriate manner.”
Member’s explanatory statement
The appropriate practitioner must provide culturally appropriate information when preparing or reviewing a care and treatment plan.

[Baroness Whitaker (Lab)]

My Lords, I have apologised that I was not able to be at the Second Reading of this most welcome Bill. I declare interests as a former member of the Tavistock and Portman NHS Foundation Trust board and various positions in Gypsy, Traveller and Roma organisations as set out in the register. I read the Hansard record of the Second Reading debate and was particularly heartened by my noble friend the Minister’s acknowledgment of previous legislation’s lack of attention to racial disparities.

This deficiency is especially applicable to the situation of Gypsy, Traveller and Roma people, which Amendments 63, 101, 107, 113, 116 and 124 address, but I warmly support the other amendments in this group. The communities I speak of are usually airbrushed out of consideration of race discrimination. That is partly because their numbers have been small when national surveys have been made in the past, even though the proportion within their populations who suffer the multiple effects of discrimination is larger than in any other recognised minority-ethnic group, and perhaps partly because they are not distinguished by colour.

I am grateful to the Traveller Movement for detailed briefing and to the noble Lord, Lord Bourne of Aberystwyth, and the noble Baroness, Lady Bakewell of Hardington Mandeville, for their support. The amendments I speak to are all intended to probe how this Bill can avoid the same cruel mistake of omitting ways to deal with the mental health effects of discrimination against these communities. Basically, they stipulate that mental health practitioners must be trained and obliged to ensure that the care, treatment, advice and information they give are attuned to the culture of the people they are looking after. In healthcare generally, almost one-third of respondents to a Traveller Movement survey said that they experienced discrimination. These are the voices that the noble Baroness, Lady Bennett, referred to, and I thank her for adding her name to one of my amendments.

There is reason to believe that this discrimination experience applies significantly to mental ill-health because this is not a familiar concept to some in the more traditional communities. Most of the rare, targeted provision has come from the voluntary sector. ONS research, which has now begun to put right the gap in our knowledge, shows that mistrust and fear of discrimination have delayed them seeking help. We do, however, still need its data to be disaggregated with regard to Gypsies and Irish Travellers, which are very different communities. Incidentally, the NHS data dictionary is not collecting such data at all, so the full picture may be even worse.

Amendment 63 applies the principle of cultural attunement to care and treatment plans. Only then would new subsection (6), which requires consultation to establish the patient’s wishes and needs, be properly fulfilled. This will mean taking account of possible mistrust, literacy rates, digital exclusion and any language barriers, because although Romani Gypsies and Irish Travellers have been in the UK for centuries, there may also be new arrivals from the Roma communities of east and central Europe.

Let me quickly sketch in the context. At present, one survey found that 66% of domestic abuse service providers—professionals—did not know how to engage with Gypsy, Roma and Traveller people. There is in particular a fear on the part of those communities that their children may be taken into care if they seek support for acute mental health problems, and some cases of suicide have thereby resulted. In fact, suicide is, tragically, much more common in these communities than in other groups. The NHS’s own research, carried out by the University of Worcester, cites an estimate that suicide is seven times more likely. It makes recommendations mandating specific cultural training in all aspects of healthcare. Research by Friends, Families and Travellers has found that lack of support from mental health and other public services is specifically mentioned by those affected to be one of the causes, together with cultural stigma. Anxiety is three times more likely and depression over twice as likely. The Roma Support Group also picks out cultural stigma as one of the barriers to effective treatment for mental illness, as well as lack of knowledge on the part of practitioners about the background of Holocaust survival experienced by older members of the Roma community, and often transmitted over the generations. Where literacy is low, it has been found that there is little understanding of mental health and insufficient access to services; and 46% from these communities reported that they had no access to digital primary care services.

Amendments 101 and 107 apply the same principles of trained cultural access to the provision of an independent mental health advocate, as does Amendment 112 to giving information about the complaints procedure. Amendment 113 brings in the providers of information on complaints for community health patients, and Amendments 116 and 124 do the same for advance choice documents in England and in Wales.

Finally, the Women and Equalities Committee pointed out in 2019:

“Despite the fact that information and guidance has been available to frontline healthcare staff for some time, discriminatory practices are more widespread than they should be”.


Apart from the new, most welcome planning policy, very little has changed since then, no doubt because the committee’s other recommendation, that there should be a cross-departmental strategy to tackle the overlapping inequalities faced by these communities, which have resulted in the worst health outcomes for any minority-ethnic group, was never developed by the previous Government despite the initial steps taken by the noble Lord, Lord Bourne, when Minister for Communities. The Minister has cited the NHS role in a

“wider equality monitoring review programme”

in a Parliamentary Answer. Can she tell the House how this will cover access to mental health services? The present lack of engagement is why cultural understanding, created by specific training, must be in the Bill. These amendments would help the Bill realise its ambition of fully informing patients of the choices available to deal with serious mental ill-health, strengthening their voice and improving their involvement in their own care. I beg to move.

--- Later in debate ---

[Baroness Merron (Lab)]

I suspect that the right reverend Prelate knows where I would be coming from on this. He and the noble Baroness, Lady Berridge, are quite right that consideration of one’s religion and religious practices and not making assumptions about them are absolutely crucial.

[Baroness Whitaker (Lab)]

I thank my noble friend for her understanding of the crucial meaning of the data shortage and for her very helpful account of further work. The problem with relying on Gypsy, Roma and Traveller being covered by equality legislation guidance is that, unless they are specifically named as what they are, lots of people have no idea that they are there, that they are subject to an appalling level of discrimination and that they need a targeted response, directed—as it would be with a faith community or other community—at the reason they are so discriminated against.

But, on the whole, I am glad that the Minister has got the point about so many things and I sense that she has sensed the depth of feeling raised in this very short debate. I will thank very briefly everyone who joined in. The noble Baroness, Lady Bennett of Manor Castle, quite rightly pointed to the range of cultures that are potentially alienated by not being understood at all, as well as the need for data. I was very grateful for the support of the right reverend Prelate the Bishop of Manchester, because what he says is based on his real experience. I am very glad that my noble friend Lord Davies went on about the centrality of this issue; it is not a marginal add-on, it is part of our society. Of course, the plea of the noble Lord, Lord Kamall, for more research and proper data is really essential. I enjoyed his note of hope and I hope very much that we will be able to continue it and increase the progress. I had better withdraw my amendment for the time being, but we may need to return to this.

Amendment 63 withdrawn.