Mental Health Act review: 'BAME fears of disappearing into a hospital "black hole" are genuine concerns'

A senior member of the Mental Health Act review team with Caribbean heritage has spoken to Mental Health Today about the impact over-medication had on members of his own family.

"At the heart of this, we have people who are very vulnerable who need our care."

Suicide survivor Steve Gilbert is vice-chair of a panel appointed by prime minister Theresa May tasked with producing recommendations for reducing the over-representation of BAME communities among hospital detainees.

Today's 'half-way' report from the review team shares a desire to "rescue the notion of the informal patient who is not subject to legislation".

Corroded trust

The aspiration reflects a widening awareness of the trust issues that play a large role in undermining mental health care outcomes for black men. 

The treatment minorities have faced in Britain's hospitals has at times been as abusive as it has been therapeutic.

"With mental health care and the black community, things haven’t been done well in the past," Mr Gilbert says.

"My own family, older members of my family would go off to hospital and come back very drugged up and just not the person that they used to be."

Cases similar to those experienced by Mr Gilbert's family are far from isolated, as has been documented before.

The 34-year-old leads an African and Caribbean working group within the review and it has been regularly exposed to the damage done to community relations by malpractice.

"There is this fear that we’ve heard through various focus groups of going into a ‘black hole’, Mr Gilbert adds.

“What’s going to happen to me? Am I going to end up in hospital for a very long period of time. These are genuine concerns."

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Black men are four times more likely to be detained in hospital than white men.

It's understandable that minorities are often reluctant to turn to GP surgeries or statutory support services earlier than crisis point as outcomes are often different to those experienced by white people.

No-one wants to live in hospital

"I spent time in two hospitals," Mr Gilbert recalls of his own experiences in crisis care. "The first hospital was new and the staff were very good. I had a good medical team. The second hospital was older and it was very different."

"With bipolar disorder it can get away from you and you can end up in hospital. What was scary with the second hospital was that it wasn’t therapeutic."

"What I’m advocating for is that we give people the best possible care. If we are going to take what I think is quite a dramatic step, deny people their liberty, put them on a locked ward, deny them doing them seeing their friends and family, we have an obligation to make sure that that experience is as therapeutic as possible. I’m not sure that we’re doing that by any stretch of the imagination at the moment. At the heart of this, we have people who are very vulnerable who need our care."

'Racism has become less overt'

Mental Health Today asks if racism exists in mental health care. "Racism exists everywhere," begins the response.

"It’s changed in that 30 years ago someone might call you a specific name or behave in a specific way. I’m 34. I caught the back-end of overt racism."

"Sometimes people might say ‘I don’t treat anyone differently’, when actually perhaps we should be treating people differently, so as to be working to an equality of outcomes. We might need to be offering slightly different ways of caring for people, to take into account their cultural needs."

"Nowadays it’s less socially acceptable to behave in that way but those views probably still exist. But they exist everywhere. We are having to think through specifically as the African Caribbean community, what’s going on at school. How is the way a young black boy behaves at school being judged; how is behaviour being judged by the criminal justice system? We are trying to understand the degree to which this is conscious, or unconscious bias. We’re confident that over the next six months we’ll have more substantive answers to some of these questions."

What is unconscious bias? 

"A lot of people tell me they don’t see colour. And they can say that to indicate they’re not racist. But what not seeing colour can mean is you’re potentially not understanding the specific circumstances of that person."

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"Sometimes people might say ‘I don’t treat anyone differently’, when actually perhaps we should be treating people differently, so as to be working to an equality of outcomes. We might need to be offering slightly different ways of caring for people, to take into account their cultural needs."

"I live in Birmingham. There’s a lot of ethnic diversity here so I’d expect mental health services in Birmingham to have a good understanding of the different communities that exist here. If someone presents as hearing voices and they perceive it as a gift, then we should have a level of respect for that and not dismiss it."

Today's report proposes the advocacy workforce should be expanded and become more diversity aware. 

"If you've got an advocate who understands what that person is going through, then that is culturally appropriate advocacy. That can really help them. Your ethnicity should not be a barrier to you getting the help that you need. That is the fault of the service not the individual. It’s services’ responsibility to serve all of their community, not just the ones that they feel comfortable with."

Windrush

The Windrush scandal has thrown into light one of the many ways in which the NHS is currently not serving everyone who is entitled to its care. Speaking before the resignation of Home Secretary Amber Rudd, Mr Gilbert was clear that the focus of collective energies should be on reconciling the needs of the Windrush generation rather than party politics.

"My grandparents came from the Caribbean. My nan is from Jamaica. My granddad is from St Kitts. My granddad is dead now but they were very integrated into British life. They were always very proud to be British. I hope there is a resolution to this sooner rather than later. People who are here legally, especially those later in life, should be afforded the healthcare they need. This shouldn’t really even be up for debate." 

The Home Office has had a data sharing agreement with the NHS for over a year. Testimonials suggest that hundreds or even thousands of black British people without documents - a group already wary of the 'black hole' in mental health hospitals alluded to earlier - will 'go underground'. Individuals devastated by the persecution they've received will carry the mental baggage from Windrush or other issues alone, rather than seek help from institutions they have lost trust in.

"We live in quite difficult times," Mr Gilbert concedes. There’s certainly a lot going on: Brexit, a Windrush Scandal... My focus is on the review. I don’t concern myself with the politics [of The Windrush Scandal] because I don’t think it would do me any good."

"We are taking the review extremely seriously. We are engaging with political parties on all sides. The All Party Parliamentary Group has been well attended."

"We have a responsibility to produce the best set of recommendations that are workable, so that whichever government is in place, whether it’s Theresa May’s govt or another, have the confidence to implement them. I hope sincerely that Theresa May is genuine and I hope that when the government receive our recommendations that they follow through."

Repealing Community Treatment Orders

Early ideas outlined today include the repeal of community treatment orders, which in 90 percent of cases are applied to minorities. There is no evidence to suggest requiring people to take medication in the community leads to reduce detention rates and removing the orders could break down one manifestation of what some allege is structural racism.

"We now have a moment in time, Mr Gilbert continues. "Attitudes towards mental health have changed dramatically. When I get in the taxi I can talk about mental health in a way that wouldn’t have been the case 10 years ago."

"We’ve got a £105 billion annual bill for mental health and wider costs for social care. [Reforming the Mental Health Act] is not something that’s political; it’s something we have to do as a country."

Mr Gilbert's ability to blend passion with cold objectivity will serve as an asset as the review team looks to move beyond analysis and towards sketching out concrete solutions by the end of the year.

"There are a lot of historical issues that are not necessarily that easy to repair," he concludes. "Black-specific services is not something that we are pursuing. This is about wider society... One of the things we want to test is the hypothesis that diversity of workforce leads to improved outcomes for minorities."

"We’ve got a very narrowly focussed mental health service that pathologises certain behaviours and we’ve got a very Euro-centric way of thinking. For me the question is to do with the individual. They can be from different ethnicities and communities. It’s about whether that person is putting themselves at risk, not taking care of themselves or unable to function in the way that they want. Their ethnicity, whatever it is, should not be a barrier to them getting the help they need. We need to have a mental health service that is more responsive to different communities."

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