Mental Health Services: Black and Minority Ethnic Communities

Lord Crisp Excerpts

Tuesday 28th November 2017 Lords Chamber

[Lord Crisp (CB)]

My Lords, it is a pleasure to follow my noble friend Lady Watkins of Tavistock, who is a mental health nurse—an extraordinarily important profession in the whole world of mental health. I also congratulate the noble Lord on raising this important debate. As he said, there has been some improvement but there is much further to go, and it needs to be used and tackled systematically and practically. I note that this is not a simple issue, bringing together as it does issues of race, culture, societal attitudes and epidemiology. However, there should no longer be any excuses for the slow progress that is being made. It has been discussed and thought about for years, and expert guidance is now available from the Joint Commissioning Panel for Mental Health, set up by the Royal College. I declare an interest as an honorary fellow of the Royal College of Psychiatrists.

First, can the Minister say how effectively this guidance on commissioning is being applied, and with what impact? As other noble Lords have said, it is also good to see that the review of mental health has been asked by the Prime Minister to look particularly at the disproportionate numbers of people from black and minority ethnic groups who have been detained under the Act. I ask the question that other noble Lords have asked as well: will this review consider what can be done to prevent people from black and minority ethnic communities reaching mental health crisis point in the first place? We need to stop the flow into the system, not just treat people better when they are in the system.

On my own recent experience and observation, as the noble Lord, Lord Brooke of Alverthorpe, already mentioned, I had the honour to chair on behalf of the Royal College an independent commission on adult acute in-patient psychiatric care, which was made up of a whole group of patients, carers and many people from black and minority ethnic communities. We published a report in February last year—almost two years ago— and as the Minister knows, we are still waiting for the Government’s response. I thank her colleague, the noble Lord, Lord O’Shaughnessy, for his recent reply to my Written Question, which assured me that the response will be published soon—indeed, I think he said “shortly”.

We made headline recommendations about treating mental and physical health with parity of esteem. The two big issues were: why do we not have a four-hour standard for mental health as we do for physical health; and why are so many people still being admitted for general psychiatric issues out of their own area, sometimes over long distances?

Those were the headline issues, but we also addressed issues relating to people from black and minority ethnic communities. We found clear evidence of the problems that people have talked about here. We saw and heard from people about their experiences. We also saw and heard about good experiences and good practice—both exist within the health service, as the noble Lord, Lord Boateng, said.

We made two specifically relevant recommendations. The first one was about carers. We found that all too often carers were excluded from the initial assessment of patients when they were brought into the service—sometimes with good cause, of course, but in general not; in general it was a routine exclusion of carers. This is related to the points made by the noble Lords, Lord Boateng and Lord Ouseley, about the importance of community-led engagement and voluntary organisations. Carers are a vital source. They provide continuity of experience and advocacy and some level of stability. Their exclusion is probably particularly damaging in cases of people from black and minority ethnic communities who may be feeling disadvantaged within that environment in the first place. We recommended that patients and carers are enabled to play an even greater role in their own care, as well as in service design, provision, monitoring and governance.

I am delighted to say that the noble Lord, Lord Brooke of Alverthorpe, has already mentioned the second recommendation—it is always good when one’s own recommendations are recommended by someone else—but let me spell it out a little more. I suspect people know that in the NHS there is a workforce race equality standard. This is a standard introduced by Yvonne Coghill and colleagues from NHS England which looks at the way in which the workforce within the NHS is treated with regard to a few key indicators about how people from black and minority ethnic communities may be treated differently from others. That was published earlier this year and is starting to have an impact and effect because trusts are able to see the actual experience of their staff. We said as part of our review, “Why is there not a patient and carers race equality standard? Why is there not a standard that looks at the experience of patients and carers?” This could potentially have the same impact of drawing to the attention of trust management and trust boards—who sometimes do not know about these things because they are not close enough to the ground—the experience of their patients and carers. It is interesting that one was introduced in the NHS for staff before one for patients and carers, but I will not go down that route. We recommended that a patient and carers race equality standard should be introduced and piloted in mental health because it was evident that there was a problem in that area.

I conclude—satisfactorily within my time, I hope—by asking a final question: when will we receive our response; and, when the Government respond, will they accept these two recommendations on carers and, importantly, on the patients and carers race equality standard?