BME groups still face significant barriers to mental health care

Stark inequalities in rates of access to mental health crisis care services for people from Black and Minority Ethnic (BME) groups indicates that many are still not getting the help they need, mental health charity Mind has said.

Data obtained through Freedom of Information Act requests to mental health trusts across England and Wales show significant variation in the referral rates to crisis services and hospital admissions between BME and white groups.

Mind found that, compared to the White British group, Indian and Bangladeshi groups had consistently lower referral rates, and the Pakistani group had lower referrals in all but three trusts.

The Chinese group had the lowest referral rates of all groups.

Black Caribbean and African groups had lower referral rates in some areas and higher in others, including parts of London. The ‘Other Black’ group had more consistently high referrals.

Once assessed, BME groups are generally more likely to be admitted to hospital, especially Black Caribbean people. In one trust, the proportion of people from Black groups in home treatment and in the inpatient population was 21 percentage points higher than in the local population.

Paul Farmer, Chief Executive of Mind, said: “Crisis and acute mental health services are a crucial part of mental health care, providing support and treatment for people when they are most unwell and vulnerable. Our research suggests that some groups aren’t getting help in crisis, while others may be let down by other parts of the system meaning they are more likely to reach crisis point.

“It is vital that mental health services are accessible to all communities. For too long, certain groups have been under-represented in primary mental health care and over-represented in secure care settings. As the responsibility for commissioning services passes to Clinical Commissioning Groups, there is an opportunity to commission the services that truly serve the local community.”

Mind made the Freedom of Information request following its yearlong independent inquiry into crisis and acute mental health services, which found that people from some BME groups seem to be treated more neglectfully or coercively by the crisis care system than other people.

The Mental Health Minimum Data Set, released last month, showed that more than 60 per cent of inpatients from the Mixed White and Black African, Caribbean, African and Any Other Black backgrounds were treated under a section of the Mental Health Act (‘sectioned’), compared with less than 40 per cent of the White British group.

Professor Sashi Sashidharan, Consultant Psychiatrist and Director of Mental Health Rights UK, who was on Mind’s crisis care inquiry panel, said: “We have known for a long time of significant ethnic inequalities in our mental health services. There are several factors that can limit access to services.

“Attitudes to mental health may vary between different communities and mental health services may not be seen as relevant or helpful. Language and cultural differences can also present challenges and this may prevent appropriate referral from primary care agencies to specialist services such as crisis teams. Appropriate information about the mental health system, what it offers and how to access it, as well as timely access to interpreters and psychological therapy in the person’s own language, are essential.”

Professor Sashidharan said there was need of considering how to make mental health services “culturally competent and improve the sensitivity of health professionals. This means paying close attention to the practices and procedures within mental health care and to ensure that services we provide do not discriminate against people from minority backgrounds. Experiences of racism both in the wider community and in mental health services are likely to make people mistrustful or even fearful and reluctant to seek help. It is obviously important that mental health services do not operate in discriminatory ways but also that staff understand the realities of what people are dealing with in their lives and the impact this has on feelings and identity.”

Mind has produced a briefing on the issues for Clinical Commissioning Groups and is calling on them to commit to consultation and engagement with BME groups in commissioning services.

They are also urged to commit to ensuring that staff are delivering person-centred care that takes cultural differences and needs into account.

Mind further urges the Clinical Commissioning Groups to commission a range of care options that meet a diverse range of needs, which may include crisis houses, sanctuaries and recovery houses, retreats/respite care, peer/survivor-led services, BME provided services, host families, and crisis-focused therapeutic programmes.

They should also empower people from BME groups by providing appropriate information, access to advocacy services, and ensuring that they are engaged in and have control over their care and treatment.