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The UK’s mental health system is rife with racial inequality – so where is the action?

Written by Micha Frazer-Carroll

Four years after an independent review of the Mental Health Act made numerous recommendations to address the disproportionate number of Black people being detained as a result of the legislation, little has changed. Here, journalist Micha Frazer-Carroll takes a closer look at the steps being taken – and considers what else needs to be done to address racial inequality in the UK’s mental health system.

Content warning: this article contains discussion of the use of restraint and detention in mental health settings.

Black people’sexperiences of mental health are often inseparable from how we are racialised. Our material circumstances create psychological strain – our communities are disproportionately policed, disproportionately likely to live in poverty, more likely to be in precarious employment and housing and bear many of the impacts of increasingly hostile immigration policies. 

The daily mental bruises incurred in the shadow of colonialism and white supremacy, from discrimination at work to Eurocentric curricula, also accumulate over the course of our lifetimes. The statistics make this impact crystal clear: Black women are more likely to be diagnosed with mental health problems than their white counterparts and Black men are more likely to be diagnosed with what are called psychotic disorders. 

But despite this, Black people experience disproportionate harm at the hands of mental health legislation and mental health services. We are almost five times as likely to be detained under the Mental Health Act 1983 – legislation that makes it possible to hospitalise and treat people without their consent in England and Wales. And although the Mental Health Act works upon the principle that it prevents people in crisis from harm, in reality, it can often result in harm; one in 10 deaths in or following police custody are people who were detained (or ‘sectioned’) under this legislation. 

In particular, the treatment of Black people by the professionals put in place to help can be particularly damaging. As part of the Mental Health Act, people can be moved to police cells as a “place of safety”, which is dangerous for Black people in particular, who are at greater risk of police violence. When Black people under section are moved to mental health services, they are also more likely to be restrained, a dangerous and often traumatising practice that has resulted in a number of deaths, which have been reported in the media for decades. (‘Seni’s Law’, which was introduced in 2018, was designed to address this following the death of 23-year-old Seni Lewis in 2010). As well as being more likely to be detained, Black people are over 11 times more likely to be placed on Community Treatment Orders (CTOs), orders that mandate that people be treated outside of hospital and can be recalled into detention at any time, but often fail to reduce readmissions.

Rianna Walcott, editor of The Colour of Madness, an anthology collection that explores the intersection of race and mental health in the UK, says that punitive treatment at the hands of the Mental Health Act leads many Black people to avoid approaching services until their mental health has severely deteriorated. “Black people find themselves having to manage their interactions with healthcare services out of a fear that they might be sectioned or considered dangerous or violent,” she explains. “These issues get more serious when we look at the intersection of gender and race, where Black men may be more likely to be sectioned, detained and harmed when exhibiting mental distress.” 

Of course, none of this can be disentangled from the broader racism and criminalisation that Black people face in Britain. However, the often harmful impact of this legislation is particularly insidious in that it operates under the guise of care.

This is a reality that has long been documented. In 2017, then prime minister, Theresa May, announced that the government would be launching a review into the Mental Health Act in order to tackle the “injustice and stigma associated with mental health”. Chaired by the psychiatrist Simon Wessely, it was said that the review would specifically look into the disproportionate number of people from Black and minority ethnic (BME) groups detained under the Act, as well as the rising rate of people being sectioned and whether the Act is fit for purpose in the present day. Service users, carers and mental health charities were among those who fed into the review, and one-tenth of respondents were from BME groups themselves. 

Then, in June, the Department for Health and Social Care published a draft of the new bill. Rheian Davies, head of legal at the mental health charity Mind, said the publication of the draft bill was a “landmark moment” for Black people who experience mental distress. “In its current form, the Mental Health Act is systematically racist.” She adds: “The draft bill is long overdue and is an opportunity to create a step change for Black people with mental health problems, who have for far too long been let down by the system which is meant to protect them.”

Black women are more likely to be diagnosed with mental health problems than their white counterparts.

The draft bill includes a number of changes that service users, psychiatric survivors (a term that many people prefer to ‘patient’) and campaigners have welcomed. Some of these will clearly impact Black people, such as ending the use of police cells as “places of safety”. Others, for example – the introduction of a ‘nominated person’ (previously a close relative) to represent them under section, more say in treatment and tightening the conditions under which someone can be placed under a CTO – will increase patient autonomy more broadly, and will therefore have knock-on impacts on Black people, who are disproportionately detained under the act. The criteria for detention has also been tightened, which should, overall, reduce the number of people detained in the first place.

However, while these changes will undoubtedly decrease the harm done to Black people at the hands of mental health policy and services, many feel that they do not go far enough. In fact, Mary Sadid, policy manager at the National Survivor User Network (NSUN), described them as “lacking in ambition”, and Maurice Mcleod, who is former chief executive of Race on the Agenda (ROTA) and gave evidence for the draft bill alongside Mind, says the lack of work on early intervention is concerning. “There should be an enshrined right to [early] treatment,” he says. “Too often patients are turned away when they first come for help. This means they often only enter the system later and by much less comfortable routes (like the criminal justice system)”.  

Notably, the draft bill does not mention race once and fails to address many of the issues associated with CTOs, which both Mind and ROTA are calling for an end to. “At the policy level, there needs to be an understanding of how institutional racism impacts the Mental Health Act,” Walcott says. “We need to think carefully about who is perceived as threatening, a danger to themselves and others, and the ways that that perception creates significantly more danger for Black people.” Mcleod agrees. “Race equality [must] be a guiding principle of the bill and should therefore be embedded throughout,” he adds.

In a statement, a government spokesperson told Stylist: “We are committed to ending the unequal treatment of people from Black and other ethnic minority backgrounds with mental illness, and introduced Seni’s law to reduce the use of inappropriate force in mental health settings. Our draft Mental Health Bill is currently going through pre-legislative scrutiny and is designed to ensure anyone in a mental health crisis is treated with dignity and respect – regardless of their ethnicity – and are given greater control over their treatment.”

It feels clear that radical change can come as a result of a number of simultaneous approaches. Firstly, we need to continue to decrease the legal power handed to the criminal justice and mental health systems to override the autonomy of service users, psychiatric survivors and their communities. This is something we’ve already seen foregrounded by grassroots campaigns like #StopSIM, which resists coercion and police involvement in services. 

We also need radical changes to our material conditions outside detention, which means tackling racism, poverty and the systemic violence that leads to mental distress in the first place, as well as building up our community responses. But crucially, Black people’s demands also need to be centred in this process, when they have, for so long, been overlooked.

Micha Frazer-Carroll is the author of Mad World: The Politics Of Mental Health, which will be published by Pluto Press in 2023. It is available for pre-order here.

Images: Getty

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