Mental Health Services: Black and Minority Ethnic Communities

Lord Brooke of Alverthorpe Excerpts

Tuesday 28th November 2017 Lords Chamber

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I too thank my noble friend Lord Boateng for promoting this important debate and for the very masterly way in which he introduced it. I also welcome the return of the noble Baroness the Minister. I normally speak on alcohol and drugs issues but there is a very strong overlap here with mental health, and I hope to speak on mental health more in the future than I have in the past—particularly on this area, where I have some experience.

As we are aware, the Government’s recently published race audit highlighted differences in the rates of mental illness among different ethnic groups. For example, it is estimated that in the past year psychotic disorders were more than 10 times as prevalent among black men as among white men. With regard to access to treatment, the audit highlighted that white British adults were more likely to receive treatment for a mental or emotional problem compared with other ethnic groups.

The acute care commission report, led by the noble Lord, Lord Crisp, who is here today, helpfully summarised some of the evidence around access to general mental health services. For example, Indian, Bangladeshi and Chinese people had consistently low referral rates to crisis teams, but BME groups, particularly black Caribbean patients, were generally more likely to be admitted to hospital once they had been seen by a crisis team. There is also evidence that some BME groups have more complex pathways into care than white patients, with more involvement by the police and the criminal justice system, as my noble friend Lord Boateng and others have mentioned.

We also know that, compared to white patients, black patients are 53.8% more likely and Asian patients 42.4% more likely to be detained under the Mental Health Act. I therefore welcome the independent review into the Mental Health Act being led by Professor Sir Simon Wessely. I hope that it will provide an in-depth analysis of why this is happening. I hope that the review will also consider how we can prevent people reaching a crisis in the first place and how we can improve crisis services for those who need them most. Therefore, I would be grateful if the noble Baroness could say just what research will be coming out in this exercise and how we are going to establish the main causes behind these problems.

Moving back to services, we know that the literature suggests that there are multiple complex reasons for these differences between ethnic groups. BME groups have higher rates of mental illness, and there are also some psychosocial factors to take into consideration. For example, there is evidence that some BME groups are less likely to view themselves as having a mental illness. In some communities, there is still a large amount of stigma surrounding mental illness and there can also be a mistrust of the services on offer. These factors may lead to patients not seeking help early and thus presenting in crisis.

So why is this still happening? We have known about inequalities in our mental health care system for many years and a number of policies have tried to tackle these issues—for example, there was the Delivering Race Equality in Mental Health Care report as long ago as 2005. These policies have helped to raise awareness of the issues, but the inequalities still remain. What is the Minister’s analysis of why these policies have not had the desired effect and how can we implement policy which starts to improve the current situation?

Next, I would like to focus on the recommendation from the acute care commission, led by the noble Lord, Lord Crisp, which asked for a patients’ and carers’ race equality standard to be piloted to try to improve the experience of care for people from BME communities. What progress has been made on the report’s recommendation that it should:

“Identify a clear and measurable set of Race Equality Standards for acute mental health services by October 2016 and pilot them in a selection of Trusts from April 2017”?


We need to raise awareness of mental ill health and availability of services among BME groups. We need to ensure that there are strategies in place to reduce the stigma of mental illness and to ensure that services are more culturally aware. One recommendation from the guide published by the joint commissioning panel for mental health is that we need,

“targeted investment in public mental health interventions for BME communities”.

What it is being done to ensure that commissioners across the country are starting to take this recommendation on board and act on it?

How can the Government bring together different groups, such as healthcare services, social services, police, community groups, commissioners and, of course, drug and alcohol treatment services, so that patients and carers work together on this topic to develop culturally appropriate interventions and to make real improvements? One problem that I often see is that if someone has a drink and drug problem as well as a mental health one, no attention is paid to the latter. Vice versa, if someone goes into hospital with mental health as well as drink and drug problems, no help is offered to them. They fall between the two and we need to look for ways to bring the services together and avoid a repetition of the problems.

In summary, inequalities in mental health have, as we all know, persisted for many years. Past attempts have not had the impact we would like to see in improving the situation. We need to be united in our campaign efforts to ensure that people from BME groups get the access to mental health services they need. We need to improve public mental health and focus more on prevention than we have in the past. The Five Year Forward View for Mental Health says:

“People with mental health problems, regardless of their age, ethnicity, or any other characteristic will have swift access to holistic, integrated and evidence-based care for the biological, psychological and social issues related to their needs, in the least restrictive setting and as close to home as possible”.


How can we make this a reality now?