Anna’s Blog – Racial Bias in Mental Health Units
As discussed in my last blog, on September 3rd 2010, 23 year old Olaseni ‘Seni’ Lewis was killed by excessive use of force while being supported by Bethlem Royal Hospital in London. This day changed the Lewis family’s lives forever, and began a decade long fight to improve the rights of people in mental health units which has culminated in the implementation of ‘Seni’s Law’.
After years of campaigning, multiple inquests and inquiries, the Mental Health (Use of Force Act) comes into effect in March this year, but it wouldn’t have happened without the Lewis family’s tireless determination and strength to create change for the better. This change is obviously welcomed by the health and social care sector, but there is still more to be done to protect the rights of people in mental health units, especially for Black, Asian, and minority ethnic people.
The news of Seni’s death highlighted the bias against Black people in mental health treatment in the UK. The Government published its ‘Mental Health and Wellbeing JSNA toolkit’ in 2019, which states Black and minority ethnic groups are identified as being of high risk of mental health problems. According to Rethink, rates of mental illness for Black people are greater than for white people. Black women are more likely to experience anxiety or depression and Black men are more likely to experience psychosis, yet more white people receive treatment for mental health issues than people from Black, Asian, and minority ethnic backgrounds, and have better recorded outcomes.
Despite increased prevalence of mental illness in some communities, the scale of difference in detainment under the Mental Health Act isn’t comparable. In 2021, the Government published statistics relating to ‘Detentions under the Mental Health Act’, which showed in the year from March 2019 to March 2020, Black people were four times more likely to be detained under the Mental Health Act than white people. These statistics show that year on year, detentions increase by an average of less than 1 for white people, and by significantly more for Black, Asian, and minority ethnic people, with Black people in particular seeing the largest growth. Between 2017 and 2020, the rate of detention increased from 288.7 to 321.7- an increase of 33 per 100,000 people. In comparison white people have a rate of 73.4 per 100,000 people.
The charity Inquest which looks at state related deaths, found that the proportion of Black, Asian, and minority ethnic people’s deaths in custody where mental health-related issues are a feature, is almost two times greater than it is for other deaths in police custody. They also found that Black, Asian and minority ethnic people are twice as likely to be restrained than white people, and deaths from the use of force on non-white people is two times greater than other deaths in custody. There is a lack of accessible data in regards to deaths of Black people in mental health units. One of the elements of the Mental Health (Use of Force) Act is that these statistics will be published yearly by the Secretary of State, and also include injuries which have come from the use of force too. This data will help shed a light on the potentially biased mistreatment of Black and Asian and minority ethnic people in mental health units, and if this is proportionate with the racial bias found in police custody,
Policy introductions and legislative changes such as the Mental Health (Use of Force) Act are very welcome, and will work to ensure that what happened to Seni will not happen again. This Act in particular will add a series of checks and balances against such things as internal bias and against the use of force as an immediate response to challenging situations. Subsequently, this Act will make mental health units a safer and more individually supportive space for people going forwards. However, the absence of empowering and educational policies like these for such a long time, has fostered closed cultures, where people haven’t felt able to come forwards and safeguard the vulnerable individuals in their care because of a lack of transparent internal processes and a lack of support from upper management.
Open cultures in workplaces create an environment that allows people to feel confident to actively challenge bad practice. The staff at Bethlem Royal Hospital that day in 2010 were part of institutional abuse, and the absence of legislation such as this Act has prevented staff from feeling empowered to challenge and report bad or dangerous practice, much to the detriment of themselves and the people they support, like Seni.
Making sure that people understand and engage with bias, whether internally or at an organisational level, is so important to ensure the safe and fair treatment of people in a mental health unit. There is a clear disparity in the mental health treatment offered for Black people compared to white people, and the introduction of policies such as the Mental Health (Use of Force) Act will hopefully work to create more equal and considerate support going forwards. The impact of policy like this, which directly addresses long term inequalities in mental health units, cannot be understated, and such as in the story of Seni, could mean the difference between life and death in some cases.
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