This week’s final Count Me In census is the last report to record the inpatient experience of black and minority ethnic (BME) communities in the NHS and the private sector, and on community treatment orders. The results are taken from a snapshot sample of 32,000 patients, of 107,000, who are under the jurisdiction of the 2007 Mental Health Act. Although there has been a general decrease in the number of inpatients, this is not the case for black and mixed race people. What the census highlights is increased rates in detention and admission along with more people receiving community treatment orders, with some NHS mental trusts introducing tagging devices.
The report shows that over the last five years, the private sector has grown to be an important provider in looking after a large number of black people in the system. Currently, there are 169 private providers compared with 92 NHS mental health trusts. The issue of single sex wards is a still a major issue, particularly when considering the increase in black women receiving inpatient care.
The focus now that the census has reported should not be on what went wrong with the Delivering Race Equality programme, which between 2005 and 2010 was the main strategy to tackle inequalities in the mental health system, but instead whether the coalition government’s new plan, No Health Without Mental Health, will make a difference and tackle issues around over-representation, and improve the outcomes for BME service users and carers.
The Care Quality Commission (CQC) is correct in its analysis that we should be undertaking regular and more comprehensive surveys. The census was not designed to delve deeply into the quality of patient experience and the range of therapeutic services. But the annual census has provided one of the few opportunities to call to account the way mental health services and policy makers are working to tackle mental health inequalities and racial discrimination. The worry among mental health professionals, service users, carers, campaigners and academics is that future reporting will not have the same political and media impact or the clear mechanism of accountability to government and the NHS.
The CQC has a made a commitment to ensure that as part of its inspection regime data around ethnicity will be incorporated, and to call to account providers. However, the Count Me In survey along with other BME indicators – in education, housing, third sector funding and so on – have been downgraded or deleted by this government to create a colourblind approach in measuring outcomes in public sector delivery and reform.
With the health and social care bill in flux, a number of the key players in the mental health strategy – such as GP consortia, health and wellbeing boards, the NHS Commission Board and local HealthWatch groups – can now negotiate with a range of stakeholders, including Afiya.
Andrew Lansley, the health secretary, and social care minister Paul Burstow have a golden opportunity to engage and understand some of the key issues and factors why mental health services are still giving the worst outcomes to BME communities.
We need a new political and policy vision to end racism in the mental health system, which could act as a catalyst in dealing with wider issues of racism and social exclusion. We also need to change the language and thinking that tends to victimise black communities as being a cause of their misfortune. We should instead recognise the community assets and resilience of BME communities and not see them only as living in deprivation or single parent households. Finally, the vast majority of BME communities want to see real social justice and not a bland concept of fairness or social mobility which simply reinforces racial inequality.
This last Count Me In survey is the litmus test for the way in which ministers and senior leaders in mental health service delivery will address inequality in mental health and the realities of multicultural Britain.