Lord Boateng: PM's recognition of institutionalised racism in the NHS mental health system is long overdue
We need to build on the Prime Minister's excellent initiative and her praiseworthy Race Disparity Audit to help tackle institutionalised racism in the NHS mental health system, says Lord Boateng.
Theresa May had one good line in her last conference speech which like so much else got over looked in the difficulties surrounding its delivery. She announced an independent review of the MHA 1983 to “tackle the longstanding injustices of discrimination in our mental health system once and for all.” This was important not only of itself but in representing a long over due recognition never given in the past by governments of any political persuasion of institutionalised racism in the NHS mental health system. This was identified authoritatively way back in 2004 by Mr Justice Blofeld in his report into the death when in a secure health setting of David “ Rocky “Bennet but shamefully never given the same recognition as that same phenomenon in relation to the police after the McPherson report.
The result has been despite numerous subsequent initiatives and reports partially implemented and inadequately resourced over many years that there has been little or no improvement in the position of BAME patients in the system. Arguably it has got worse.
My first experience of this issue way back in the 70s was as a young articled clerk called by a client to a locked ward at St Georges in Tooting. I was admitted to see the patient in the mistaken belief that a young black man with an Afro and flares could only be a relative or friend of the black patient. It was discovered subsequently when I brought out my Stone’s Justices Manuel that I was a lawyer. I was summarily ejected.The issue of availability of independent legal representation and advice to patients subjected to coercive orders remains to this day.
His was a fairly typical case an altercation with a landlord by this “angry young black man ‘where issues of depression and anxiety arising from his poor social conditions had escalated and in the absence of any offence he was taken by the police to St George’s. I saw there too the impact on my clients overall state of health and demeanour of heavy doses of anti-psychotic medication. He was never offered any of the talking therapies even after I had secured his release.
The repeated failure of the profession to make available non pharmaceutical based options for BAME patients was a subject I returned to many years later when visiting as Minister for Mental Heath the Institute of Psychiatry at the Maudsley in Denmark Hill. This and the marginalisation of BAME clinicians and the failure to recruit train and promote enough of them is one of the “unpalatable truths” that the profession is reluctant to own. This must change and the Review of the Act provides a welcome opportunity for a rights based legislative response.
The Mental Health Foundation's work in reviewing the overwhelming weight of research evidence reveals that people from BAME groups living in the UK are more likely to be diagnosed with mental health problems, more likely to be admitted and forcibly detained in hospital, with worse outcomes and a greater chance of disengagement from main stream services.The position of young black men lately and often misdiagnosed and treated and Asian women suffering from depression and stigma is particularly dire.
We need to build on the PM's excellent initiative and her praiseworthy Race Disparity Audit whose findings support what I have described here.We should of course look forward to the legislative outcome of the review and commit to implementing its recommendations. We need however to act now to stop yet more lives being blighted. This means insuring support by NHS commissioners for local black community voluntary organisations as providers, a stronger voice for patients, better data collection, early intervention, culturally specific services and the proper resourcing and rolling out in practice of what existing research already tells us can make a difference and improve patient outcomes. I don’t underestimate the complexity of this issue. I have played my own part in previous inadequate responses by government. We surely don’t have to go on repeating these mistakes indefinitely. Frantz Fanon was one of the earliest Black psychiatrists to highlight the inequalities in psychiatric care on the basis of race, culture and religion. He also spoke of the dangers of “cognitive dissonance”. A feeling of extreme discomfort when confronted with evidence that challenges a “core belief”. The overwhelming evidence is that we are not all equal when it comes to the treatment of mental health however much it is our belief that we should be. The only known treatment for the condition Fanon identified is to accept the evidence and change the realty of the patient experience “once and for all”.
Lord Boateng is a Labour peer in the House of Lords