Mental Health Bill [ Lords ] (Ninth sitting)

Debate between David Burton-Sampson and Zöe Franklin

Committee stage
Tuesday 24th June 2025 Public Bill Committees

[Zöe Franklin]

It is a pleasure to serve under your chairmanship, Mr Vickers. New clause 1 seeks to ensure that racial disparities in the use of community treatment orders are properly understood, monitored and addressed. We have known for many years that black individuals are disproportionately subjected to coercive powers under the Mental Health Act 1983, including detention, restraint and community treatment orders, yet progress has been painfully slow.

The new clause would require the Secretary of State to undertake a review within 12 months of the Bill passing and to publish the findings within 18 months. It would look specifically at whether certain racial or ethnic groups are over-represented among those who are subject to community treatment orders, and whether there are disparities in outcomes—including treatment effectiveness and patient experience—across racial groups. The aim is not just to collect data, but for meaningful scrutiny of how coercive community powers are applied and whether they are serving all groups equally.

The 2018 independent review of the Mental Health Act found that black individuals were more than eight times more likely to be placed under a CTO than white individuals. That is not a minor discrepancy, but a structural injustice. The review also raised concerns that CTOs were not necessarily used because they are clinically effective, but because they are seen as a way to manage risk, particularly where racialised assumptions come into play. We must ask, are CTOs truly supporting recovery, or are they disproportionately used to control and surveil? Are they fostering trust or fear in mental health services?

The new clause would give Parliament the information we need to answer those questions. It would set a timeline for transparency and create a foundation for future policy reform that is rooted in fairness and equality. In the absence of this new clause, we risk continuing a system where racial injustice is baked into mental health practice, without sufficient oversight or accountability. If this Government are serious about tackling racial inequality in mental health, they will have no objection to this basic measure of review and reporting.

We have discussed specific disparities in previous clauses, but new clause 3 aims to ensure that systematic and sustained action is embedded in the way that mental health services are run. The disproportionate detention and coercive treatment of black and minority ethnic people under the Mental Health Act has been evidenced for decades, yet progress on addressing these inequalities has been too slow and too inconsistent across the country.

New clause 3 takes a structural approach. It would require each mental health provider to appoint a dedicated senior lead to take responsibility for reducing inequalities within their services—not in name only, but through published plans covering staff diversity, culturally appropriate advocacy care planning and the use of advance choice documents. It would also ensure that frontline staff receive ongoing training that equips them to recognise and respond to disparities and uphold anti-discriminatory practice, with regular refreshes to ensure that this learning stays live. Importantly, it would place a duty on the Secretary of State to publish an annual report breaking down how the Bill is used across racial and other demographic groups, and what progress is being made to close those gaps.

This is not about creating more paperwork; it is about requiring leadership, transparency and accountability at every level, from clinical teams through to Government. If this Bill is to earn the title of a reform, it must act decisively on the most pertinent inequalities in the system. I urge the Committee to support the new clauses.

[David Burton-Sampson (Southend West and Leigh) (Lab)]

It is a pleasure to serve under your chairship, Mr Vickers. Sadly, there are clear racial inequalities within the mental health system, as in other areas of health, and this must change. People from ethnic minority communities are more likely to experience a mental health problem, are less likely to receive support, and have poorer outcomes from services. It is very concerning that black and ethnic minority people are over-represented in detentions in our mental health system, and there are well-documented worries over disparities in the quality of care that they receive.

Decades of evidence and lived experience testimony point to systemic injustice. Black British people suffer a 6% higher rate of common mental health problems than white British people, and black adults are twice as likely to show symptoms of post-traumatic stress disorder—at 8%, compared with 4% of the white British population. Black men are over 10 times more likely to be placed under community treatment orders, and black women are more likely than any other group of women to experience common mental health problems. Studies have shown that experiences of racism link to depression, psychosis and post-traumatic stress. When people are assaulted—not just physically, but emotionally and psychologically—by the structures around them, it leaves a lasting impact.

I have witnessed at first hand the racial disparities at a visit to my local in-patient mental health care at Rochford community hospital, where I could see a visibly disproportionate number of black men on the ward, compared with the percentage of black men I know live in my community. People from ethnic minority communities are more likely to come into contact with mental health services through crisis pathways, the police, accident and emergency, and detention. They are more likely to be restrained, isolated and subjected to coercive treatment. We must listen to what these communities are telling us.

Research by Mind identified nine key barriers to accessing care, from stigma and discrimination to Eurocentric models of treatment, language and cultural barriers. People feel othered by a system that was not built with them in mind. We need to rebuild trust and recognise that mental health cannot be separated from the broader social and political context. Austerity, Brexit, the Windrush scandal and covid-19 have all disproportionately affected the black, Asian and minority ethnic community. That has led to a decrease in trust towards the establishment, and that bleeds into general distrust of organisations and officials working in healthcare settings and mental health.

People from BAME communities have shared many examples of direct and indirect discrimination they have experienced within mental health services. Those negative lived experiences further erode trust in the system and often deter people from seeking help. Racial disparities in mental health are a pressing issue that requires immediate and sustained action.

New clauses 1 and 3, tabled by the hon. Member for Winchester and outlined by the hon. Member for Guildford, have good intentions, but we need to reflect on whether they fit in the Bill. I would suggest not. The drivers of disparity here are much deeper than the scope of the Bill, and it would be wrong to attempt to wrap up the solution to this issue within it. That does not mean that action should not be taken.

I am hopeful that this Government are doing wider work to drive down racial inequalities, including with the challenge we can see here with mental health. Perhaps the Minister will outline more about the Government’s work, and therefore why the new clauses are not needed. I support the intent of the hon. Member for Winchester, but I cannot support the new clauses as an addition to the Bill. I would be happy to meet the Minister and others to discuss further ongoing overall inequalities for the BAME community.