Modernising the Mental Health Act: A missed opportunity to address ethnic inequalities?

Ethnic minority people have a greatly increased risk of being detained under the Mental Health Act 1983, even when accounting for their increased risk of receiving a diagnosis of a severe mental illness.

This fact was one of the issues that the Prime Minister Theresa May used to frame the Independent review of the Mental Health Act, which reported on Thursday 6 December 2018; a situation the review described as ‘unacceptable’.

However, while there are many positive aspirations in the recommendations made by the review, there is nothing within it that explicitly sets out to address this inequality.

While all of the provision for more patient-centred care, rights to a second opinion and to appeal, and to have an advocate, are positive (if partial) moves towards a more therapeutic approach, none of this addresses the over-representation of ethnic minority people detained under the Act.

To tackle this, the review would have needed to thoroughly consider the causes for this inequality, something that it hasn’t done. And although the review bravely raises questions of racism and discrimination, it does nothing to consider how they might be addressed, and mistakenly portrays the operation of such inequalities within mental health care as of a similar nature and extent to that in other domains of life – which is simply not the case.

It is within mental health care that these inequalities are most stark. And staff training and monitoring alone will simply not address these fundamental issues as there is more than unconscious bias involved.

In the process of taking the reform of the Mental Health Act to the next stage, we urge that there be a thorough consideration of the factors that lead to the over-representation of ethnic minority people detained under the Act and how they operate.

We also urge that these factors are taken into account in the reform of the Act to directly address this profound and significant inequality.

Addressing these concerns is a vital next step if the Prime Minister’s ambitions to address this stark inequality are to be achieved.