Back in March, the Department of Health published a report, Inside, Outside on improving mental health services for black and minority ethnic communities in England.
For 30 years before this important national report, African-Caribbean people have been over-represented in our psychiatric hospitals. Although they make up less than two per cent of the British population, African-Caribbean people formed 25 to 40 per cent of the inpatient population. Their admission to hospital was two or three times more likely than white patients to be on a compulsory order and twice as likely to be under Section 136 of the Mental Health Act 1983. In addition African-Caribbean people were twice as likely to have been referred to psychiatric services by GPs. African-Caribbean young men were more likely to receive treatment in secure facilities. The admission rates for schizophrenia have been seven times the rate in men and 13 times for women in African-Caribbean communities.
The experience of Asian and Chinese communities in mental health services has been hindered by language and cultural barriers. Presentation of mental illness tends to be through physical symptoms such as loss of energy, poor appetite and dizziness. Whether these symptoms are determined by the stigma of mental illness among ethnic minority communities or by cultural factors has not been conclusively determined. Bilingual professionals who understand the culture and speak the same language as patients are needed to cross the cultural and linguistic divide. Suicide rates are also higher in young Asian women and among Irish-born people living in the United Kingdom compared with the majority population.
Against these experiences of black and minority ethnic people in Britain, mental health advocates have developed in these communities in order to argue for culturally appropriate services in mainstream mental health.
The government's National Service Framework for Mental Health and the NHS Plan surprisingly have only limited references to black and minority ethnic patients. The NHS Plan identifies the need for crisis resolution services for acute mental illness among ethnic minority patients to be in place by this year - 2003. It does not adequately address the particular needs of black and minority ethnic groups.
The report Inside Outside acknowledges that problems experienced by minority ethnic groups within our mental health services may be worsening. It sets out to tackle ethnic inequali ties within mental health services, including tackling racism and institutional discrimination within the services.
Extensive consultation has taken place among ethnic minority communities across England in the production of the report. That exemplar of best practice must be welcomed and continued for other service issues.
Proposals for improving the service experience and outcome of black and minority ethnic groups who experience mental illness is to take place within mainstream services in primary care, hospitals, the community and in prison. For that to become a reality clinical leadership should be identified to implement that progressive objective.
Death certificates in the UK do not record ethnic data. That deficiency needs to be corrected to include the ethnic group of the deceased to replace place of birth in all UK death certificates to improve mortality data particularly on suicides
In primary care, the capacity of general practitioners to recognise psychiatric disorder in black and minority ethnic patients appears to be more limited than in others. That has not improved since 1996-97 when I conducted focus groups to listen to GPs from seven inner city locations in England when I was Director of the NHS Ethnic Health Unit. I am pleased to note the report suggested standards for all GPs to have training in cultural awareness and for culture and mental health to become part of GP training.
Death certificates in the UK do not record ethnic data. That deficiency needs to be corrected to include the ethnic group of the deceased to replace place of birth in all UK death certificates to improve mortality data particularly on suicides.
The report recommends the recognition and use of community development workers to improve the capacity of communities to support members with mental health needs. That is a long-awaited recognition of voluntary groups which have been developed over at least three decades among ethnic minority communities. But those workers need to be part of the mainstream mental health services if the scheme is not to be marginalised.
Professor the Lord Chan MBE is a Crossbench Peer
