Closer to the grassroots

The subject of mental health has been getting significantly more attention in recent years. The Conservatives, Liberal Democrats and the Labour party say they want to tackle the current mental health crisis in Britain. But their policies do not properly take into consideration the needs and experiences of black and minority ethnic (BME) communities.

On the whole, BME communities have much higher rates of mental health diagnosis. Yet BME mental health service users consistently report poorer experiences and outcomes from mental health treatment than white communities. This was supported by the government’s own Race Disparity Audit in 2017 which highlighted that black people are four times more likely than white people to be detained under the Mental Health Act, with Asian people (apart from Indians) also more likely to be detained than white people. BME communities are therefore more likely to disengage from mental health services, which can worsen their wellbeing.

On top of this, it is widely believed by service users that mental health services do not take adequate account of the impact of racism and discrimination on the lives of BME people. This results in BME communities having a low level of trust in services and feeling reluctant to access help.

Theresa May said the Race Disparity Audit would give the government and public services “nowhere to hide” in tackling racial inequalities in mental health and other areas of life. But many of the 200 BME mental health service users I consulted in 2018 whilst writing the BME mental health service user led manifesto, A Call for Social Justice, were wary about hearing this from a government whose austerity policies have disproportionately affected marginalised BME communities and thereby increased levels of mental distress.

The BME mental health service users I spoke to consistently highlighted the multifactorial socioeconomic factors that were impacting on their mental health. They painted a picture of disadvantage and discrimination throughout many areas of life, including: high rates of school exclusion; high rates of unemployment and racism in the workplace; overcrowded housing; lack of trust in the criminal justice system due to heavy-handed policing; and the devastating effect of benefits cuts and reforms to the tax system that have disproportionately affected BME communities. The Race Disparity Audit reflected these experiences on a national level.

This confirms the need to politicise our understanding of mental health, rather than issue mere platitudes. In the words of a BME mental health service user who was consulted for the manifesto: “Racism is a political issue. Inequality is a political issue. Mental health is a political issue. We should hold politicians to account.”

The recently published Mental Health Act Review Report on the back of the Race Disparity Audit was a missed opportunity for the Conservatives to fundamentally challenge the Mental Health Act’s use of substitute decision making that deprive BME mental health service users of a voice, involuntary detention and compulsory treatment –  all of which are disproportionately used against black mental health service users.

So how does the Labour party measure up to the task of addressing BME mental health?

In general, Labour’s social and economic policies are most in line with the priorities and aspirations of the BME mental health service users and campaigners I consulted, when compared with Conservative party policies.

Whilst the Labour party wants to tackle inequality and improve mental health services, what is really missing from its vision for the future – and indeed, from Conservative and Liberal Democrat visions too – is a commitment to a concerted and ongoing (not time limited) race equality strategy, with ministerial level responsibility for reducing racial inequalities across different areas, such as employment. This would have a cumulative effect on bringing down high rates of BME mental distress by tackling the root causes that contribute to it. Anything less will have minimal impact.

Labour party policy also neglects a fundamentally important issue: mental health services ‘other’ and pathologise BME users. The system as it now stands is unsafe, culturally inappropriate and oppressive of BME communities – this must urgently change, particularly in relation to the use of substitute decision making, involuntary detention and compulsory treatment which deprive BME communities of their fundamental human rights. These factors have been highlighted by the United Nations Convention on the Rights of Persons with Disabilities. This is a truly radical document that Labour has pledged to incorporate into UK law.

But what happens all too often in practice, is that the pool of experts and consultants that political parties consult is restricted to the big mental health organisations like Mind and Rethink. Many activists believe such organisations sometimes do not challenge government policy robustly enough.

What is needed now are alternatives to the current mainstream mental health system, underpinned by a plurality of understandings of mental distress that BME communities can relate to and which they feel are culturally appropriate and not heavy handed.

These alternatives could include BME mental health service user led services and support; peer support groups; crisis houses and residential alternatives to incarceration on mental health wards. There have been numerous examples of good practice initiatives around the country in these areas, but these have been short lived due to inadequate, short-term funding, and have not been strategically linked up and replicated nationally.

Crucially, there needs to be a commitment to support BME mental health service users to develop their own powerful voice that is heard at the decision-making table of policy, practice and legislation. The strong voice of BME mental health service users, which did exist to some extent a decade ago, has been pulverised by austerity. This was starkly illustrated by the demise of Catch –A – Fiya, a national strategic network of BME mental health service users across the country some years ago. But funding from the current Conservative government to develop such a network is at present, non-existent.

This is highly regrettable, since BME mental health service user led activism has built up an impressive body of knowledge over several decades (on a shoestring budget) and given advice on what needs to be done to improve BME mental health and social justice for us. A lot of this is reflected in A Call for Social Justice. It would be a bold and encouraging step for the Labour leadership to publicly back this manifesto.

The Labour party – which proudly boasts of being a party of the grassroots – now needs to live up to its claims and listen to grassroots BME mental health service users.