David Brindle, Guardian (London), April 6, 2011
A five-year race equality action plan has made little impact on the disproportionate number of black people admitted to mental hospitals and subjected to compulsory treatment, an official survey has shown.
Black and mixed-race people remain far more likely than average to be admitted to psychiatric hospitals, to be detained under the Mental Health Act and to be confined in seclusion, according to the survey. The picture has “not altered materially” since 2005.
The findings will dismay campaigners who had hoped that the action plan, Delivering Race Equality in Mental Health, would bring a step-change in the treatment of people from black and minority ethnic (BME) groups in the mental health system, following a high-profile inquiry into the death in hospital of David “Rocky” Bennett, a Rastafarian.
Paul Farmer, chief executive of mental health charity Mind, said it was “inexcusable” that so little progress had been made in ensuring uniform mental health care for all, irrespective of racial background.
“It is unacceptable that people from some BME groups are six times as likely to be admitted to hospital,” Farmer said. “Such gross inequalities within the system cannot go on.”
The death of Bennett highlighted the issue of disproportionate and sometimes deficient care of black people in the mental health system. He died in a medium-secure unit in Norwich in 1998 after being held down on the floor for 28 minutes by at least four members of the nursing staff.
The subsequent inquiry made 22 recommendations, including one calling for acknowledgement of “the presence of institutional racism” in mental health services. The then Labour government declined to do so.
Alongside the action plan, launched in response to the Bennett case, the Department of Health ordered an annual census of patients to monitor progress. The new survey is the sixth and last such census, organised by the Care Quality Commission (CQC) across 261 mental health care providers in both the NHS and independent sectors across England and Wales, covering almost 33,000 patients.
The exercise, carried out last year, found that people from BME backgrounds comprised 23% of all patients either in hospital or subject to community treatment orders. In 2005, the equivalent proportion had been 20%.
Rates of compulsory detention were between 25 and 38 percentage points higher for BME groups than for white British people, while use of seclusion was anything up to 99 percentage points higher.
The survey found also that use of mixed-sex wards remained widespread in mental hospitals last year. As many as 61% of male patients and 77% of women were not in a ward designated for single-sex use–a picture described by Mind as “alarming”.
Dame Jo Williams, CQC chair, said the findings did not necessarily show that BME patients’ needs were not being met. But they did suggest that the mental health system could not solve the problem of unequal treatment on its own. Other agencies, such as police and education authorities and the voluntary sector, needed to share the challenge.
“There is a need to move on from counting patients to understanding more about the factors that lead to hospital admission, such as ethnic differences in the rates of mental illness, the socio-economic and other disadvantages faced by some black and minority ethnic communities and the ways in which patients enter the care environment–for instance, patients from some ethnic groups are much more likely to be referred from the criminal justice system than are other groups,” Williams said.
Paul Burstow, care services minister, admitted: “Not enough progress has been made to address the over-representation of black and ethnic minorities in our mental health system.
This is a legacy that must act as a spur to redouble our efforts to tackle inequalities in mental health.”