Racial inequality in mental healthcare

As a firm, we have had many discussions about Black Lives Matter and how we can make a difference to the movement. In the sixth blog in our series,  Satvir wants to shine a light on areas that are often overlooked because he relates to the most vulnerable and least represented. He looks at racial inequality in mental healthcare and explore the reasons for this inequality.

Government statistics reveal that “profound inequalities exist for people from ethnic minority communities in accessing mental health treatment, their experience of care and their mental health outcome”. The disparity in the standard and type of care and treatment provided, particularly to individuals from black African and Caribbean communities, in comparison to their white counterparts, is stark and very worrying. In the wake of the Black Lives Matter movement, we share our thoughts on this disturbing reality.

Recent research and government statistics reveal:

• Black people are four times more likely to be detained under the Mental Health Act than their white counterparts.
• Out of the 16 specific ethnic groups, black Caribbean people had the highest rate of detention out of all ethnic groups (excluding groups labelled ‘Other’)
• Black and white men experience similar rates of common mental health problems.  However, black men experience psychosis ten times more frequently than white men.  Despite this, white people are twice more likely to receive treatment for their mental health problems than black people are.
• In terms of routes to treatment, people of black African and Caribbean heritage are 40% more likely than white British counterparts to come into contact with mental health services through the police or criminal justice system, rather than their GP or talking therapies. 
• People of black African and Caribbean heritage are less likely to receive psychological therapies and more likely to be compulsorily admitted for treatment in a medium to high secure wards, and subject to seclusion or restraint. 
• Black patients are subject to Community Treatment Orders at eight times the rate of white patients in comparison to their representation in the general population.  Community Treatment Orders are a legal measure that allows mental health teams to impose compulsory supervision on patients and patients also have to adhere to specified conditions. If the Community Treatment Order is not adhered to, the patient risks being admitted back to hospital.
• A disproportionate number of people from black African or Caribbean heritage experience deaths while in custody or under mental healthcare.  An example of this includes the death of Olaseni Lewis, who was aged 23 when he was voluntarily admitted to Bethlem Royal Hospital for mental health treatment in August 2010.  When Mr Lewis became agitated medical staff called the police. Over a period of 30 to 40 minutes eleven police officers subjected him to restraint for two prolonged periods – 10 and 20 minutes. Mr Lewis was held down, face first, on the bed and then the floor. He died as a result of his brain being starved of oxygen.  An Inquest was held into Mr Lewis’s death found multiple failings and that police officers contributed to his death.  The court ruled that “the excessive force, pain compliance techniques and multiple mechanical restraints were disproportionate and unreasonable”. 

The government carried out an Independent Review of the Mental Health Act, which was published in December 2018. The Review concluded that a disproportionate number of people from black and minority ethnicity backgrounds are detained under the Mental Health Act and the use of the Mental Health Act appears to vary between different ethnic groups. The Review was particularly concerned by the “excessively poorer experiences and outcomes of individuals from black African and Caribbean communities”. 

So why is there such a disparity? The answer is multi-factorial. For many years individuals from black African and Caribbean communities have been subjected to second class treatment which has led to fear and mistrust of public services. Dr Frank Keating in his report ‘Breaking the Circles of Fear’, concluded that black people have a strongly grounded fear of mistrust and therefore resist seeking help. Dr Jacqui Dyer MBE, Mental Health Equalities Champion, expanded on this further and found many individuals in the black community believe that if you seek help from mental health services, you don’t go for recovery but go there to die. What is supposed to be a therapeutic recovery process is perceived as chemical and physical containment.

In addition to the above, the Independent Review acknowledged that racism experienced by individuals in everyday life compounds already poor experiences and outcomes from health services. Research has shown a direct link between health inequalities and racism.  Socioeconomic factors also contribute to health inequality such as inequalities in housing, local neighbourhoods, education and employment.

Research has also shown that those making clinical decisions may hold racially biased views against those from minority ethnic backgrounds, which will directly impact upon a clinician’s decision regarding treatment options. The unconscious bias of those that are responsible for treating patients with mental health conditions lead to excessive use of compulsory detention, seclusion and restraints.

The government’s Independent Review is a step forward in recognising the inequality provided to minority ethnic groups in the treatment of mental health problems. However, there is a lot that needs to be done to tackle racial prejudice and unconscious bias in order to ensure mental health services are provided equally and fairly.

OUR BLACK LIVES MATTER / BAME BLOG SERIES

About the author

Satvir Sokhi specialises in clinical negligence and has experience of working with clients who have sustained a range of injuries, including brain injuries, injuries arising from birth, orthopaedic injuries and gastrointestinal injuries.