Addressing inequalities in mental health care: are we there yet?

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It is clear that certain communities in our society suffer disproportionally in relation to outcomes in health, education, housing and access to opportunities and career progression because of their ethnicity.

The systemic nature of discrimination is becoming harder to ignore and the work of writers such as Reni Eddo-Lodge is beginning to change the national conversation around this issue. This is leading to a greater understanding and acceptance that discrimination is not normally an individual issue but a consequence of systems and structures that have been established and continue to operate in a particular way, that leads to negative outcomes for those from certain backgrounds. Most noticeably, those from a black or minority ethnic background.

The term ‘institutional racism’ was defined in the McPherson Report on the Stephen Lawrence Inquiry in 1999 as:

[Institutional racism is] the collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture or ethnic origin. It can be seen or detected in processes, attitudes and behaviour which amount to discrimination through unwitting prejudice, ignorance, thoughtlessness and racial stereotyping.
McPherson Report on the Stephen Lawrence Inquiry, 1999

Though this phrase was coined almost 20 years ago it is still very relevant today – both in understanding recent high-profile scandals such as Windrush and in understanding the health inequalities experienced by those from minority ethnic backgrounds.

Jacqui Dyer, vice-chair of England's Mental Health Taskforce and founding member of Black Thrive – a partnership-based, cross-sector organisation based in Lambeth – recently gave an interview on Channel 4 news on the inequalities experienced by the black community in mental health services. It sparked some interesting debate and discussion on social media about mental health services with many recognising the discrimination experienced by black people, and others arguing that they too have experienced poor services but didn’t belong to the black community. The inference being it’s not just this community who experience poor mental health services.

To understand the issue more deeply it’s worth looking at the data presented on the Black Thrive website which tells a compelling tale. Black people are over-represented in the acute end of mental health services and more likely to die under restraint in police custody. They are also less likely to receive preventive services, a disproportionate number of black people are sectioned and they have a worse experience in detention, as was highlighted in the recent interim report of the Independent Review of the Mental Health Act.

From this data, we can see that black people have repeatedly experienced worse treatment by the system than other ethnic groups. This needs to be addressed systematically because it is a systemic issue that requires a move away from personalising the issue and looking more closely at how structural racism manifests itself in health, and in particular mental health, outcomes for marginalised groups. Reni Eddo-Lodge puts it very eloquently in her book, Why I’m no longer talking to white people about race:

Structures…are made out of people. When we talk about structural racism, we are talking about the intensification of personal prejudices, of groupthink. It is rife. But rather than deeming the current situation an absolute tragedy, we should seize it as an opportunity to move towards a collective responsibility for a better society…
Why I’m no longer talking to white people about race, Reni Eddo-Lodge

Black Thrive has developed an approach to engaging the community in working towards preventing mental ill health and promoting positive mental wellbeing.

Some examples of the organisation’s work include the development of a whole-school programme to build mental health resilience in school-aged pupils, especially designed for pupils of black, African and Caribbean descent; a community champion programme that supports the black community to have the resources it needs to deliver/direct access to services that people trust and feel comfortable with; influencing strategies on wider determinants (tackling structural inequalities) via borough plans, housing strategy and tacking poverty.

While community groups are significant partners in resolving these issues, this does not absolve those who work in health and care from taking an honest look at the pattern the data is pointing towards (and themselves) and how their policies, processes and procedures are structured, which is contributing to marginalised groups being treated unfairly. This should be addressed systemically looking at issues of unconscious bias and institutional racism and working alongside communities that have first-hand experience of both the issues and the possible solutions which will lead to better services for all.

Hear more from Jacqui Dyer, Founder of Black Thrive, at our mental health conference in June.

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