Tag Archives: mental health review

Theresa May’s mental health act reform: Warm words but scant action

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You may well have missed it under the Brexit deluge but Theresa May announced a major reform of the Mental Health Act this month – the first for 30 years.

Sir Simon Wessely, a tame report on reviewing the mental health act

She had commissioned Sir Simon Wessely, Regius Professor of Psychiatry at King’s College London and president of the Royal Society of Medicine to examine the legal state of Britain’s mental health system.

His report came out earlier this month. Frankly it is full of warm words but proposes scant action and dumps the problem of better treatment for mental health patients on the NHS.

The good part of his report is that it does give better rights for patients held under community treatment orders. and some useful changes when mental patients die in police custody including restoring non means tested legal aid to challenge the authorities.

The bad part of his report is that it fails to offer a solution to what is one of the most glaring problems in the mental health service – the vast number of Afro-Caribbeans who are sectioned compared to the majority white population.

It acknowledges it exists and in his introduction Sir Simon Wessely quotes the view of one ethnic minority person who told him “for a black person, a psychiatric hospital is seen as the place where they drug you up, and at worst even kill you”.

He goes on to confirm that nothing much has changed in 30 years.

“it is sad to record that little has changed. There does appear to be more consensus that this increase is real, and not an artefact, and also that it is related to experiences of discrimination, exclusion and racism. There is also consensus that even taking this into account, the use of coercion is far greater in this population, finding its most painful expression in the statistic that those of black African or Caribbean heritage are over eight times more likely to be subjected to Community Treatment Orders than those of white heritage. In other words, too often and in too many areas the experiences of those of black African and Caribbean heritage is one of either being excluded or detained.”

He then admits institutional racism exists even if it is unconscious but the main body of the 307 page report does not address the issue of why psychiatrists accept that Afro-Caribbeans are eight times more likely to be schizophrenic or suffer from psychosis than anyone else. Nor does it propose any remedies for this particular problem. You can read the report via this link.

institutional racism

As Suman Fernando,a psychiatrist and author of a major work on institutional racism , put it:

Suman Fernando. Pic credit: http://www.sumanfernando.com

” The first question to be asked is whether this report would have had the same approach to ‘race’ if the victims of institutional racism had not been ‘black and minority ethnic’ people but a white minority / majority group?   The issue here is about white privilege and power. And the question arises as to how this systemic failure of an official report has come about.  Second, who carries responsibility for the failure of this report to have race on its agenda for change? “

He concludes:” This Review has raised false hopes in the minds and hearts of many black people “

Consultations on this report will begin in the New Year with legislation to follow. But it will get nowhere without a big commitment to resources and a change of culture and attitudes by psychiatrists treating patients.

As Norman Lamb, Liberal Democrat health spokesman put it: “In the Government’s response to the Review, there must be a commitment to invest more money to support those at crisis point and help people before they reach crisis point. The Conservatives to date have failed to adequately invest in Mental Health. Without strong goals and commitments from the Government, rising detention rates will not be adequately challenged.”

tame conclusions

My conclusion is that both Theresa May and Simon Wessely are speaking from the same song book. They are prepared to speak warm words about the problem but are not prepared to take radical action to solve it. No wonder he can calmly state that no political influence was brought to bear on the report. It wasn’t necessary given its tame conclusions.

Race equality groups seek big changes to the mental health act to end stereotyping and over-medication

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Sir Simon Wesseley, planning to report on reviewing the mental health act later this year

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While Theresa May is battling to hold her line on Brexit her almost unreported initiative to reform the mental health act is leading to demands for the government to introduce radical reforms for treatment and new rights for patients.

A submission from Race on the  Agenda and the Race Equality Foundation to the review  by Sir Simon Wesseley, set up by Theresa May to look into why so many black Afro Caribbean people were being detained in mental hospitals and the need for changes to the Act. It also comes against a disturbing background of deaths in police custody.

The submission has been backed by the Runnymede Trust;Patrick Vernon OBE, Chair of the Labour Party’s Race Equality Advisory Group, writer Amy Kenyon and Professor Rachel Tribe, of the School of Psychology at the University of East London among others.

NEED FOR BIG CHANGES

The Downing Street interim report  contained many warm words but not a lot of action. It stated: “Experience of people from black African and Caribbean heritage are particularly poor and they are detained more than any other group. Too often this can result in police becoming involved at time of crisis. The causes of this disparity are complex.” The  full report  and details of its members  and terms of reference is available here.

Now the submission to the inquiry proposes major changes to tackle the problem. The link to it is here. The main proposals are:

1. The Mental Health Act (the Act) should set out principles that define human rights, anti-discriminatory practice and a commitment to combat institutional racism.
2. The Act should be amended to include a clause that states explicitly that a diagnosis for a ‘mental disorder’ must take account of the patient’s social and cultural background. And the Act should allow for appeals against diagnoses via a Tribunal, with a panel that includes experts from BAME backgrounds.
3. Patients detained under the Act should be empowered to choose which carers or family members have a say in their care and can support them during an appeals process.
4. A new system of appeal whenever a new diagnosis is applied and/or continued, to a tribunal-like body, with the right of the patient concerned to have legal representation at the hearing.
5. All mental health service providers should be set targets to reduce the use of Community Treatment Orders and minimize racial inequalities in their use. This should be monitored by the Care Quality Commission  during inspections. Specific amendments in relation to supervised treatment in the community should be made to ensure this is statutory.
6. Statutory bodies should be regularly inspected by the CQC or other appropriate body to ensure that training of professionals working in mental health services addresses issues of racial bias and cultural competence.

The  submission  says: “:We were glad to see an emphasis on the urgent need to address the disproportionate number of people from black African and Caribbean backgrounds being detained under the Mental Health Act (MHA).

Equally, we were unsurprised that Black, Asian and Minority Ethnic (BAME) focus group participants highlighted a lack of cultural awareness in staff and a need for culturally appropriate care as paramount. We would express concerns about racism, stigma, stereotyping and overmedication. We hope that these findings will guide and underpin the recommendations made in the final report ”

It is to be hoped that Sir Simon and Theresa May do take action to remedy these many faults in the system. Otherwise it will be another case of political posturing  like help for the ” just about managing” which has so far amounted to warm words and little else.

There were concerns expressed at the recent conference organised by Rota at the University of East London that little would really be done to tackle this. If little happens it will only make matters worse and there is a need for strong campaign to make sure Downing Street does really listen.

Theresa May’s risky gamble with reforming an ” institutionally racist” mental health act

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Sir Simon Wessely, chair of the mental health review

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With very little publicity and dwarfed by Brexit  Theresa May has committed herself to a major reform of the Mental Health Act. Last year she convened a meeting at Downing Street and appointed a former president of the Royal College of Psychiatrists, Sir Simon Wessely. to conduct a review.

This month it published an interim report with a lot of warm words, some constructive proposals and a public admission that far too many people were locked up and a disproportionate number were from  the black and ethnic minority communities. A report in the Guardian on  May 1 highlighted some of the issues.

This Friday the charity Race on the Agenda  will host a conference at the University of East London on the  Stratford campus tackling the issues head on by addressing the issue of institutional racism in the mental health service.

They will have a lot to go from the interim review report which firmly  puts the case for change by highlighting the poor  and  often inhumane treatment of people of black African and Caribbean heritage in the worse case scenarios results in deaths in police custody.

It also appears to want to redress the balance between the role of the police and the NHS.

The interim report states: “Experience of people from black African and Caribbean heritage are particularly poor and they are detained more than any other group. Too often this can result in police becoming involved at time of crisis. The causes of this disparity are complex.” The  full report  and details of its members  and terms of reference is available here.

Among some of the salient points raised include phasing out the use of police cells to detain mentally ill people and using ambulances rather than police cars to transport mentally ill  people and increasing NHS involvement by looking at NHS England taking responsibility for  commissioning of health services in police custody.

This week’s conference will  go further than the report by looking at the culture and attitudes towards black people – the stereotyping, unconscious bias  and sometimes politically incorrect racism – as well as the role psychiatry has in defining who is mentally ill.

So why should this be a risky gamble for Theresa May ? The answer is the countervailing trends in society which could mitigate against reform.

First there is austerity. The state of some mental health hospitals , including one not far from the conference in Tottenham, have to be seen to be believed because there isn’t the money to provide adequate services. Thus all the reforms in the world could fall down because there are not the staff nor proper facilities to help people.

Then there is current hostile environment which led to the Windrush scandal , the rise of Islamaphobia and the Prevent strategy  which creates a climate of fear and fuels latent racism and fear among the white community of “the other”. The fight against terrorism can morph into discrimination against  particular ethnic groups in society.

So in the worst case scenario all Theresa May will be left with is warm words and no action – which, given the hope rising from the mental health act review, could make matters worse than they are now.

That is why it is important that conferences looking at issues the report may find difficult to confront – such as institutional racism – are being held and issues thoroughly aired.

 

 

A psychiatrist’s damning indictment of 500 years of racism – now revived by Trump and 9/11

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Suman Fernando. Pic credit: http://www.sumanfernando.com

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Suman Fernando is a gentle soft spoken  consultant psychiatrist, lecturer and honorary professor at the London Metropolitan University.    The 85 year old is not the sort of person at first sight to produce such a searing critique of racism in the UK and the US and the baleful role psychiatrists have had in treating ethnic minorities in both countries.

His book released at  the end of last year and launched by ROTA – Race on the Agenda – looks at both the history of racism which he dates from 1492 when the Spanish finally  removed the Moors from Europe and the role of psychiatry in treating ” mentally ill”  black and brown patients over a very long period.

The book is particularly relevant as Theresa May has  quietly decided to review the UK’s mental health laws  which cover some of these issues – signalling her intent by  holding a meeting of psychiatrists at Number Ten Downing Street.

It also comes at a time when the election of Donald Trump, the rise of Islamophobia in the wake of 9/11 and to an extent, the worst excesses of some people supporting Brexit, has seen a revival of popular nationalism and in the US, white supremacists.

He traces racism from the bloody Inquisition in Spain through the development of the slave trade, the rise of eugenics leading to Nazism,  the Imperialist destruction of other cultures by colonisation to the ” rivers of blood” speech of Enoch Powell as Britain faced an immigration wave in the 1960s and 1970s.

His  thesis is that – mainly because of the 1970s race relations legislation in Britain – overt racism has until recently been replaced with a form of institutional racism and psychiatry is no exception to the rule.

Indeed some of the worse psychiatric theories to treat people as seen by superior whites as ” the other” came from this profession. This was the profession that applied the concept of  ‘Drapetomania’  to slaves in the USA, the primary symptom being a persistent urge to run away.  The implication was Black Afro-Caribbeans were supposed to be happy and content as slaves  and had mental problems if they wanted their freedom.

In Britain the book provides numerous examples of how different ways of dealing what is an obvious imbalance in the number of Afro-Caribbeans being sectioned compared to white Britons. Attempts to change treatment or properly research the issue by black psychiatrists were undermined in a typical British way – their work was subsumed by more conventional psychiatrists or their findings were ignored.

He also reveals  how attempts to change matters politically were undermined. Tony Blair  appointed Paul Boateng – now Lord Boateng- as the first minister for mental health in 1997. At the time he was known to be  strident in wanting to change the treatment of black Afro Caribbeans like himself- but within months he was squashed.

Since 9/11 the danger is that racism is on the rise with Muslims rather than Afro Caribbeans as the main target. That is why the timing of this book is relevant in the context that the mental health legislation is being revised. Already psychological research is being used as a basis in the Prevent programme to decide whether teachers or NHS staff, their pupils and their patients, should be reported to the authorities if they show signs of radicalism.

The next slippery step would be to decide that these people are insane – and should be sectioned rather than prosecuted. This is not as fanciful as it sounds. Under  Labour there was a move to classify stalkers of VIPs as a mental illness and Jack Straw when he was home secretary is said to have considered whether paedophiles should be classified as insane rather than criminals.

That is why this book is so interesting because it tells how deep seated racism is among white Europeans  and how insidious the present system is in dealing with the ” other” – from stop and search to sectioning.

The one sad thing is that the book itself has been “Ghettoised” – it has been pigeon holed by the publisher  as part of ” contemporary black history ” when it is much more of an account of how contemporary British and US society has reached such a view on black and brown people.

The German publisher has created another ghetto by price – Palgrave Macmillan have priced it at a ridiculous £67.99 or £53.99 as an e-book. Amazon have a Kindle version at £45.19. So I suggest you try and get it in a public library or if you are a student make sure your university library has got one.

Institutional Racism in Psychiatry and Clinical Psychology. Suman Fernando