Mental Health Alliance consultation response

Race Equality Impact Assessment on the Mental Health Bill (ref. 5796)

It is widely acknowledged that under the 1983 Mental Health Act, people from Black and Minority Ethnic (BME) groups are over-represented as compulsory patients. There are many reasons for this, some of which do not relate to the legislation itself. However, this review of legislation offers a vital opportunity to ensure that any person who may find themselves subject to compulsion, and their family, receive an equal and fair treatment, regardless of their race or ethnicity. A robust and comprehensive Race Equality Impact Assessment is, therefore, an extremely important part of the review of legislation and it must be given full consideration. It is equally necessary to allow those most affected to have an opportunity to contribute, and to allow full consideration of those responses so that alterations can be made before the Bill is introduced into Parliament.

In response to the consultation document that was published on the DH web site on 14 November, I would like to put forward some of the key points the Mental Health Alliance believes would help to make the new Bill more equitable.

1. A Right to Assessment

One of the common concerns expressed by Black service users and carers is the difficulties experienced in finding help at an early stage. This often means that the condition of an individual declines to such an extent that compulsory treatment becomes the only option. The Pre-Legislative Scrutiny Committee supported the idea that an individual should be able to request an assessment for services, and that there should be a duty on authorities to give written reasons if they do not agree to do this. The inclusion of this in the legislation would significantly help people access the help they need before compulsion becomes necessary and promote greater equality for groups who currently find the mental health system daunting or unhelpful.

2. Principles

The Alliance believes an explicit statement of non-discrimination and respect for diversity should be included on the face of the Mental Health Bill. This will remind professionals when taking important decisions under mental health legislation of the need to give respect to the qualities, abilities and diverse backgrounds of individuals and the need to avoid making general assumptions on the basis of, for example, ethnic, cultural and religious stereotypes.

3. Control and Restraint

The Alliance believes that the Bill must include a statutory framework for the use of control and restraint. In particular, legislation must provide safeguards for the use of prone restraint to ensure it is only used in exceptional circumstances and for a minimal time period. We believe that the Government must fully consult BME groups on this issue before the Bill is introduced and that they must take into account the relevant recommendations of the Bennett inquiry.

4. Use of medication

We call for a requirement in the Bill to adhere to the British National Formulary limits on medication and that doses above these limits should only be given with the fully informed consent of the patient or to prevent serious risk to the life of the patient. In this case a Tribunal should be notified and its approval received in order to continue with treatment for a limited period.

5. Conditions for compulsion and non-resident orders

We are concerned at the draft Bill’s emphasis on perceived ‘risk to the public’ and ‘dangerousness’. The conditions for compulsion and the determination of what is called ‘substantial risk of causing serious harm to other persons’ in particular, will have a disproportionate impact on people from BME communities. The wording of the conditions must be as objective as possible to avoid the use of subjective criteria disadvantaging any group of people.

We believe the Government should commit sufficient resources to providing alternative forms of treatment, such as talking therapies, for people from BME communities as an alternative to compulsory care. In addition, all clinical staff should be required to have training in how to assess BME patients with reference to the effects of racism on their wellbeing. We believe there should be compulsory ethnic monitoring and annual reporting (nationally, through the Healthcare Commission) of the numbers of people sectioned.

The Alliance believes that if non-residential orders are to be used, the criteria for their application must be made explicit and stated in the Bill, to ensure that in all cases compulsory non-resident treatment can only be imposed on a clearly defined and clinically identifiable group of patients - and to limit the scope and potential duration of these orders. This is an issue for all service users, but people from BME communities are likely to be over-represented and this is one essential step towards reducing the risk of that.

6. Advocacy

The right to advocacy is particularly important in the case of people from BME communities. Wherever possible, people from BME communities should have access to an advocate with appropriate language skills, and from a similar cultural background if they so wish. We consider that patients should have the right to have access to appropriately trained advocates and this should include high quality training in cultural diversity. The government must provide a commitment to appoint a sufficient number of people from diverse communities with adequate training before the Bill is introduced.

7. Involvement of police

The Alliance is opposed to the new police power to enter premises and forcibly remove a patient from their home without a warrant. We believe it is highly likely that this power will be disproportionately used against people from African and Caribbean communities who are already subject to over policing and that it would further damage the relationship between BME communities and the police.

We are also concerned by the use of police stations as a ‘place of safety’. Police cells are currently used in about 80 per cent of occasions when section 136 powers are evoked. While we welcome the additional investment in more appropriate ‘places of safety’, we believe that the Bill should include a requirement that the place of safety must always be a therapeutic environment.

8. Tribunals

Membership of the Mental Health Tribunal does not specifically include people from Black and Ethnic Minority groups and we believe this is crucial to ensure that the Tribunals are able to take full account of a person’s culture and circumstances. We therefore recommend that Tribunals should include BME representation where appropriate, and that all Tribunal members are trained in cultural competency.

9. Family Involvement

In line with the recommendation of the Bennett inquiry, families and patients should be made aware that they have a right to ask to move from one hospital to another: applications should be recorded and reasons for refusals given.