Over the past several years there has been a growing political consensus and convergence by the mainstream political parties in a shared perspective in how to tackle issue mental health and the poor health outcomes experienced service user and their carers from health and care services in a number of areas:
- Parity of esteem recognising that physical and mental should be the same (but disagreement by the parties regarding cuts in mental health services)
- Need to improve child and adolescent mental health services
- Waiting times targets for appointments for access to psychological services
- Ongoing support for Time to Change the national social marketing campaign in tackling stigma and discrimination
- Importance of public health interventions for mental wellbeing
- Current approach in the development and funding of Improving Access to Psychological Therapy services
- Crisis care and greater partnership between police and mental health services professionals.
However, there is one clear absence by all the political parties: the issue of race. This raises fundamental questions such as why is race equality off the political agenda? How can black mental health issues can be part of the parity of esteem?
The challenge we have in 2015 is that current mental health policy and services are failing to meet the needs not just of black community but other minority communities like the Irish, South East Asian, Chinese, Turkish and Kurdish, along with women and the LGBTI (lesbian, gay, bisexual, transgender and intersex) community.
The recent Care Quality Commission (CQC) annual monitoring report of the Mental Health Act, which has also incorporated the learning since the inception of the Act in 1985, further highlighted the over-representation of African and Caribbean men and women who are sectioned in secure wards or on Community Treatment Orders (CTOs) in the psychiatric system. The CQC has also revised the code of practice that recognises issues around race equality as part of wider perspectives and principles of human rights.
But we have had 30 years of piecemeal race equality training, strategies, pledges and indicator sets that have failed to shift the agenda, much to the dismay of many service users, frontline staff, senior system leaders, activists and politicians. This further adds to the malaise and perception that ‘BAME [Black and Minority Ethnic] and black mental health’ is an intractable issue that is impossible to address again reflecting the demise of the Delivering Race Equality programme in 2010.
In the meantime, new trends in psychosis and mental ill health are emerging within BAME communities, and which current austerity measures will only serve to exacerbate, as the marginalised are pushed to the extremes in all aspects of their lives. Thus we need to create a new agenda by exploring structural racism in society and its impact on services by coming to terms with many of these historical inequalities in order to create the right conditions around reconciliation and trust between service users and the leaders of mainstream institutions that have the potential to transform policy making and service development.
Since the demise of the Delivering Race Equality strategy under the last Labour government and with the coalition at times adopting a ‘colour blind’ approach to race and health this reflects lack of political will and/or energy to do this.
This is sadly being mirrored by the marginalisation of servicer user and grassroots networks, activists and campaigners in policy and service change along with impact of cuts in funding of BAME-led voluntary sector. The only exceptions has been the development over the past five years of National Service User Survivor Network, which has created a space and opportunities for BAME service users to influence national policy, and campaigns led by the families of Sean Rigg, Christopher Alder and Black Mental Health UK, which are now part of the wider international campaign of Black Lives Matter.
However, in the past several months there has a growing recognition that the issue of race equality cannot be avoided any further. The government has given further funding to Time to Change in exploring issues around stigma for BAME communities in mental health. For instance, the 300 Voice project is targeting young black men in Birmingham. The Home Office Minister, Theresa May is leading work around examining the issue of deaths in custody and crisis intervention and also Charles Walker, Tory MP and former chair of the All Party Group for Mental Health has been a welcome ally in championing race equality and mental health along with sharing his own experiences of mental ill health.
This has created an environment for parliamentarians to be open about their experiences. Former Labour spin doctor Alistair Campbell in his forthcoming book recommends all MPs should consult a psychiatrist on a regular basis for support to manage their stress levels.
The Liberal Democrats were in many ways the driving force through first Paul Burstow and then Norman Lamb in developing government mental health policy. This was reflected in the membership of the Ministerial Advisory Group and the Equalities Group on mental health which advises the government on mental health policy. In addition, the Lib Dem think-tank Centre Forum Mental Health Commission, which was chaired by Burstow, launched its report called The Pursuit of Happiness in July 2014. The report recognised that more work is required to tackle issues on race equality as part of a national wellbeing programme around self-care and recovery.
With regards to Labour, Ed Miliband’s Independent Taskforce launched its report in January, The Mentally Healthy Society, that could form the basis of a mental health strategy for a future Labour government.
The report has more than 40 recommendations covering a range of issues from children, education, employment, housing, early intervention and equalities. The Taskforce report makes a specific recommendation for race equality: “The previous government’s action plan on BAME mental health, Delivering Race Equality, ended in 2010 and has not been renewed or replaced. We want to see a renewed focus and leadership on tackling race inequality in mental health services for both young people and adults…. the Department of Health should develop a new national strategy to tackle race inequality in mental health services, including on workforce development and leadership, and improve outcomes for BAME communities. It must be clear about what indicators will be used to measure progress, and what success will look like. This should include a national framework through which commissioners and providers at local level can be held more accountable for developing and delivering their own plans to achieve this.”
The report recommendations, if delivered, would make a difference to all communities and especially to the black community. This is a major achievement, which backed up Ed Miliband’s pledge in tackling race inequality issues in a recent interview with The Voice newspaper at an event organised by Operation Black Vote during Black History Month in 2014.
I hope that race equality will still be on the agenda along with resources, action plan and clear lines of accountability by Minsters and system leaders.