Mental Health Services: Black and Minority Ethnic Communities

Debate between Viscount Younger of Leckie and Baroness Watkins of Tavistock

Tuesday 28th November 2017 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I thank the noble Lord, Lord Boateng, for bringing this crucial debate to this House and for exploring many of the key issues so eloquently. I declare my interest as a qualified mental health nurse of some 39 years’ standing, who has worked in south London and in rural communities. I am particularly pleased to welcome the return of the noble Baroness. She qualified as a nurse at about the same time as me. I also thank Kathleen McCurdy, a psychiatrist from Oxleas NHS Foundation Trust, who is working with me at the moment and who has helped me with this speech.

Other noble Lords have already highlighted the huge disadvantage faced by black and minority ethnic people in the area of mental health. They suffer higher incidences of mental illness, higher rates of admission, threefold excess of compulsory detention under the Mental Health Act, longer periods of hospitalisation, negative experiences of services and poorer overall outcomes than the majority of the population.

As the recent race disparity audit highlights, it is impossible to generalise about BME people and health in the UK. Given the multicultural nature of our country, the term encompasses any number of different societies and cultures, each with a heterogeneous population. We have to remember that each patient is a person with their own unique needs within this wider cultural context and with a right to equal and uncoerced treatment for their mental health problems. Co-design between patients, their significant others and health professionals is essential good practice.

As a signatory to the UN Convention on the Rights of Persons with Disabilities, the UK was scrutinised last year by a committee, which was highly critical of our treatment of people with a range of disabilities. Its subsequent report expressed significant concern about the use of physical and chemical restraint in healthcare settings on people with disabilities and expressly noted that this disproportionately affected persons belonging to ethnic minority communities. The committee criticised what it referred to as the,

“absence of a unified State party strategy to review these practices”.

I am optimistic that the current review of the Mental Health Act will offer recommendations on that, but that will of course take time. Indeed, there is plentiful evidence to suggest higher rates of coercive practices when it comes to the groups we are talking about. Not only are the rates of compulsory detention under the Mental Health Act significantly higher for ethnic minorities, in particular Afro-Caribbean men, but research by McKenzie and Bhui suggests that people of BME backgrounds are more likely to be placed in seclusion during their admission and much less likely to be offered psychotherapy or other talking therapies. Even following release from hospital, the use of restrictive practices persists for some ethnic groups. Black men are five times more likely to be placed on a community treatment order than their white counterparts, meaning that they may be recalled to hospital if they do not comply with a set of conditions.

Another aspect I wish to highlight is the interface with the criminal justice system, as many BME patients come into contact with mental health systems not via GPs but via the police, the courts or in prison. Black people are 50% more likely to be referred to the mental health system by the police. Additionally, black people disproportionately make up 25% of prisoners and some 40% of young offenders. Other groups are also over- represented in prison populations, particularly Traveller communities, but none is as highly represented as the BME group.

The Angiolini report, published in January this year, acknowledges the disproportionate number of BME people who die after the use of force in custody. We know from a report by the Equality and Human Rights Commission that 50% of people who die in custody have mental health problems and 20% are black, which is hugely in excess of the 3% black people in the population as a whole. This is perhaps an unsurprising statistic given the number of high-profile cases of deaths in psychiatric hospitals and police custody secondary to restraint, including Seni Lewis, who was only 22 when he died while being restrained by police on a psychiatric ward. He is one of 46 mental health patients who died following restraint between 2000 and 2014. I am optimistic that the Mental Health Units (Use of Force) Bill making its way through the Houses of Parliament will begin to improve the situation by standardising and allowing scrutiny of practice, but it will be a drop in the ocean compared with the cultural and systemic changes required to improve this complex issue.

However, it is important to acknowledge the positive steps being taken and improvements in good practice that already exist—for example, the street triage schemes, in which a mental health professional, usually a psychiatric nurse, accompanies police to incidents where a subject may need mental health support. Initiated in 2013, these schemes have been effective at reducing Section 136 emergency admissions to hospital and may benefit ethnic minority patients who may otherwise be detained unnecessarily in a police cell or at a place of safety.

I was impressed to hear about the Black Thrive scheme, an initiative led by the Afro-Caribbean community in Lambeth to create a positive dialogue around mental health. It is linked to Healthwatch and the local health and well-being board, and aims to help in prevention, access to support and experience.

On workforce and staffing, it is vital to have a workforce that reflects the diversity of the community it serves. The NHS is the largest employer of BME people in the UK, and since its formation has prided itself on employing BME staff from both the UK and around the world. In 2008, 25% of successful applicants to nursing courses identified as BAME, and this number increased to 30% in mental health nursing. Since the scrapping of bursaries for student nurses, the number of applicants to nursing has fallen. Work needs to be done to make nursing an attractive option to minority ethnic students from the UK, particularly in the context of the drop in overseas nurses coming to work here. I have talked before about the importance of continued professional development, and a key part of this is cultural competence. The European Psychiatric Association recommends mandatory training on cultural competence and sensitivity in areas where it is needed.

There is a well-established link between staff satisfaction and subsequent patient experience—when people understand each other. However, BME staff consistently report higher levels of discrimination and bullying in the workplace and are afforded less opportunity to advance their careers. For example, over two-fifths of London’s population and its NHS staff are from BME backgrounds, but only 8% of trust boards and 12% of senior management are from the same background. Will the Minister give due consideration to investing in a diverse and culturally competent NHS workforce that, at all levels of seniority, reflects the multicultural society in which we live and is trained to be culturally sensitive and able to empower patients?

[Viscount Younger of Leckie (Con)]

My Lords, timing remains particularly tight for this debate. I know that we have only three more speakers but I respectfully ask that they stick to eight minutes and conclude their remarks at eight minutes.

Student Loans: Interest Rates

Debate between Viscount Younger of Leckie and Baroness Watkins of Tavistock

Monday 11th September 2017 Lords Chamber

[Viscount Younger of Leckie]

The interest rate system ends up being a subsidy. If we think of one-third of students going to university, a third is written off. The whole complex system is designed to ensure there is an effective balance.

[Baroness Watkins of Tavistock (CB)]

My Lords, could the Minister explain how we have got to a position whereby once graduates earn over £21,000, they effectively face a marginal tax rate of 41% after loan repayments are included, irrespective of any rise in the interest rates being charged?

[Viscount Younger of Leckie]

To answer the question about the £21,000, the issue was discussed at length during the passage of the Higher Education and Research Bill. When the current system was introduced, the threshold would have been around 75% of the projected average earnings for 2016. Since then, updated calculations based on ONS figures show the figure is now 83%, reflecting weaker than expected earnings.