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Ethnic inequalities in mental health care are 'persistent'

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Inequalities in access to services for severe mental illness persist in England despite efforts to improve policy and practice, according to new research which found people from ethnic minority backgrounds continue to be worst affected.

A study published in the journal BMC Medicine found black and Asian people with mental health problems are more likely to be compulsorily detained – a pattern that has continued for many years.

Meanwhile, compulsory admission to hospital for black patients is more likely to be via contact with the police or criminal justice system rather than through health services.

While outcomes do not seem to be improving, the analysis found they are not getting worse despite concerns about the impact of financial constraints on the NHS.

A team of researchers led by Queen Mary University of London examined 40 reviews mapping the evidence on ethnic inequalities in mental healthcare in England.

They also looked at up-to-date evidence from studies on care pathways in England between 2012 and 2017.

The researchers found that compared to people of white British backgrounds, black Caribbean, black African and South Asian patients have higher rates of compulsory admission, including when it comes to being detained under Section 2 of the Mental Health Act.

Black people have more police contact and criminal justice system involvement on their way into mental health care than white people. The same is true for patients identified as “white other” – which may include people from other European countries.

Compared to people of any white background, people from any black backgrounds are found to be less likely to have contact with a GP on their way into care. However, people from a South Asian background are more likely to have seen a GP.

These findings come after the publication of a major independent review into mental health legislation, commissioned by the government.

In October 2017, prime minister Theresa May pledged to reform the Mental Health Act due to concerns about the rises in the number of people being sectioned and the disproportionate detention of people from ethnic minority backgrounds.

The review, published earlier this month, highlighted the need for seriously mentally ill patients to have a greater say in their care and more opportunities to challenge treatment decisions.

However, the Royal College of Nursing said it had failed to recognise the pivotal role nurses could play in supporting people with severe mental health problems – including those from ethnic minority backgrounds.

As the largest and most diverse profession group in the mental health workforce, nurses should be “tapped into” to support, represent and advocate for ethnic minority patients, said Catherine Gamble, professional lead for mental health at the RCN.

Those behind this latest piece of research highlight the need for changes in policy and practice because current strategies do not appear to be making a difference.

“The finding of inequalities in access to mental healthcare in England is consistent over many decades and has not got worse with austerity,” said Professor Kamaldeep Bhui, corresponding author of the study.

“Yet, the inequalities we have observed have persisted despite investment in community care, race equality programmes, and awareness that the Mental Health Act needs reform and better standards of practice that consider cultural background,” he added.

He said more work was needed to understand inequalities in access to mental health care and how these could be tackled with inequalities linked to socioeconomic factors, geography, gender and age also taken into account.

“Inequalities that have been reported over many decades for patients from ethnic minorities need to be considered in the planning of any reform of the UK Mental Health Act, and future integrated care,” said Professor Bhui.

However, he said one challenge was the fact patients from ethnic minority backgrounds were less likely to take part in research projects.

Catherine Gamble, professional lead for mental health at the RCN, said: “It’s alarming to think that, despite concerted efforts by the health service to address the unequal and discriminatory treatment of black and minority ethnic mental health patients, too many people are still deprived of their liberty to receive treatment.

”It’s inevitable that some people will have to be detained to receive mental health treatment but that doesn’t explain why legal powers are used so often against black and Asian people, as this report makes clear.

“While the recent independent mental health review identifying that there are many societal factors in the disproportionate rates of BAME people detained under the Act, the experience of patients unreasonably detained must be seen through the prism of wider society and not just when they become a patient,” she added.

 “Nurses, the largest and most diverse professional group in the mental health workforce must be tapped into to support, represent and advocate for BAME patients,” Ms Gamble said. “Our cultural ambassadors play a key role in designing systems that call out bias and discrimination.”

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