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Sun 22 September 2019
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While promising legal support for those with mental health problems who die in police custody, the Government’s review fails to address claims of white privilege

While the country’s attention has been focused on Brexit, Theresa May last month announced a major reform of the Modernising Mental Health Act
– the first for 30 years.

The Prime Minister committed the Government to implement a report she commissioned last year by 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. The report is an attempt to fix part of the problem in yet another broken public service which has systematically been deprived of resources for decades.

“In other words,” Wessely concludes “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.”

The report gives better rights to patients held under community treatment orders and provides some useful changes when those with mental health problems die in police custody, including restoring non-means-tested legal aid to challenge the authorities. But, it dumps responsibility for improvements to services which will allow patients to get better treatment to the NHS.

Worse, the report 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.

In the report, Simon Wessley 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.”

Wessley continues: “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,” Wessely concludes “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 admits institutional racism exists even if it is unconscious. However, 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.

Suman Fernando, a psychiatrist and author of a major critical work on institutional racism, said: “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?

“This review has raised false hopes in the minds and hearts of many black people.”

Consultations on this report are due to begin at the start of 2019, 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 MP, Liberal Democrat health spokesman, has 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.”

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