Ending structural racism within mental health services requires Mental Health Act reform

National charities, Race on the Agenda and Mind hosted a conference earlier this month, with Garden Court Chambers to explore the structural racism within mental health services, and how the only real way to address this issue is to push for Mental Health Act reform.?

Written by Bryony Porteous-Sebouhian

Structural racism is a problem within mental health services, how can we address it?

The virtual conference reflected on the progress that has been made in the three years since the Independent Review of the Mental Health Act (MHA). This review made a series of recommendations to the UK government, with a particular focus on the outdated legislation that allows people to be held against their will.

“To see racial equity within mental health services there must be a heightened commitment to antiracism, which addresses systemic biases in how people are treated and challenges institutional racism head-on.” Rheian Davies, Head of Legal at Mind.

For the conference, Mind [1] released statistics pointing to the dire need for recommendations in the 2018 Review to be heeded:

• Mind reported that more than one in ten calls to their legal line in 2021 were in relation to the MHA as the ‘number of people detained under the Act increased by 12 per cent from December 2020 to December 2021.’
• In an analysis of NHS data, Mind found that there has been a 12 per cent increase in people detained under the mental health act since December 2020.
• As part of the same analysis they found that nearly 5000 people were given a Community Treatment Order (CTO) in 2021.

Mind and Race on the Agenda, expressed the urgent need for Mental Health Act reform, to achieve racial equity within mental health services at the conference, collating their thoughts in five recommendations:

• "Less need for compulsion – better services and making sure people have their rights respected.
• An end to Community Treatment Orders (CTO) which has increased disparity with use of the Act.
• Less ability to detain and impose treatment – tighter criteria and better engagement with people’s needs and preferences.
• Maximum dignity, safety and meaningful involvement in care, and ability to challenge poor care, through better advocacy.
• A commitment to tackle institutional racism head on"

The conference also featured multiple speakers with lived experience who have been or still are service users, many of whom had spent time in hospital whilst being sectioned under the MHA during the pandemic.

Service user experiences of racial bias and restraint

22-year-old Hannah, a young Black and White British woman who lives in London spoke about some of her experiences being restrained in April of last year, Hannah has a diagnosis of borderline personality disorder.

“I was last restrained in April 2021. Using restraint and restraint techniques is dehumanising, especially given that you’re meant to be in a place of safety, and it feels like you’re being physically punished for being unwell, with no control over your care. Rather than focussing on verbal de-escalation and sitting down with you, getting on your level, and asking how you can help, staff rely on calling the restraint team in, and once that happens there isn’t much you can do or say to stop it from happening.”

Hannah also articulated an important point, that when you’re unwell and possibly in crisis, being physically restrained is not helpful, it can actually cause further distress.

Speaking to the experience of Black people within mental health services, especially in-patient services, Hannah said:

“When I’ve been in hospital, I have spent time on mixed-sex wards, and I notice the over-representation of Black men and women in hospital. Black men are most likely to be restrained from my experience. People from non-minority backgrounds don’t seem to be restrained as much, staff would spend longer verbally de-escalating with them.”

Hannah also spoke about her experience being trained as a forensic recovery support worker in the community, noting that the training on restraint is not person-centred and that she noticed the impact of “huge” staffing problems, leading to agency workers taking on work who are not able to build up a relationship of trust with patients.

Head of Legal at Mind, Rheian Davies spoke at the conference saying: “A recent worrying rise in detentions further confirms the urgent need for fully funded reform of the Mental Health Act, to make sure anyone who is experiencing a mental health crisis and is a risk to themselves is treated in a safe and therapeutic environment.”

“Structural racism continues to pervade the Mental Health Act. Black and Black British people are still far more likely to be detained under the Act, restrained against their will, and be more likely to be re-admitted to hospital without getting the right support. When someone is experiencing a mental health crisis, they may be suicidal, self-harming, or in psychosis, and feeling very frightened or distressed. At the very least, their loved ones should expect that they will be kept safe, treated with dignity, and receive the care they need by the services which are designed to protect them. Part of this is making sure that people can make decisions about their care as part of standard clinical practice.”

Also there to speak was Maurice McLeod, Chief Executive of Race on the Agenda [2] (ROTA). Reflecting on their experience of the conference, they said:

“There was a lot of energy at the conference because inequality in mental health care is such an important issue. There were lots of people with lived experience of the system, as service users, carers, or mental health practitioners. This meant a wide range of different opinions were expressed. But the agreement (which was quite noticeable) was that things are bad and are likely to be made worse, or at least not improved, by this new Act.”

“Along with Mind, ROTA will continue to work for a mental health care system based on value and respect for all and which is accessible to those who need support.”

Mind and ROTA released this information and their findings in regards to MHA reform just days before the UK government’s response to the Commission on Race and Ethnic Disparities [3] which was published last year.

Commenting on this response [4], Paul Farmer, Chief Executive of Mind, said:

“While it is welcome that UK Government is willing to interrogate data to try and understand the complexities at play, it remains clear that there is systemic racism in our society and within our mental health services that they must do far more to address.”

The UK government continually misunderstands and misinterprets the impact of racism on Black and Minority Ethnic people; as well as continually undermining it’s presence in mental health services.

This May, we are hosting an in-person event: Mental Health Today Live in Cardiff, Wales. One of our main focuses for the event is improving accessibility for mental health service users who face various difficulties accessing the kinds of services they need.

As part of this event we will be hosting the session: ‘Facing the reality of racial inequality in services, and building a better one’ to bring together some of the leading minds on this issue. You can book your ticket and find out more about the event here .?

Reference list:

1. 'Government must go further to address structural racism and mental health in Commission response'
2. 'Race on The Agenda'
3. 'Commission on Race and Ethnic Disparities'
4. 'Reform of the Mental Health Act must come now if we are to see an end to structural racism within mental health services'