Five days ago, the Commission on Race and Ethnic Disparities published a statement by way of reply to early criticism of their original findings in their report published on 31 March 20211. Criticism included the report not going far enough to acknowledge institutional racism across a range of sectors such as education, housing, policing, and health.  As well as the part played in a person’s experience within the mental health system. 

Criticism also reflected the findings shifting responsibility away from institutionalised and structural racism and historic precedents creating a lasting culture of acceptability onto Black and ethnic minority communities themselves, denying that racism continues to impact on individuals.

Whilst the report found lack of racism in the field of psychiatry “The Commission does not believe that the evidence it reviewed offers support to claims of discrimination within psychiatry”. Data referenced within the document demonstrates the disparity of Black people and their white counterparts face within mental health treatment.

“The Wessely Review found Black people were 8 times more likely to be subjected to community treatment orders than White people, and 4 times more likely to be detained. Figures from the Race Disparity Unit show there were 306.8 detentions per 100,000 for Black people compared with 72.9 per 100,000 White people (not adjusted for age and deprivation)2

As a charity representing the interests of those affected by bipolar disorder in the UK, we have now had the opportunity to digest the 258-page Commission on Race and Ethnic Disparities Report. In short, we strongly believe that this report and the information within it failed to achieve the Commission’s desire to ‘approach the issues of racial and ethnic disparities in a balanced way’ suggesting that the lived experience of many Black and Ethnic Minority people is not underpinned by institutional racism.

Denial of real-life experience at this level is unhelpful and can add to racial trauma. Racial trauma can lead to various mental health issues including but not limited to, “depression, hypervigilance, chronic stress, fatigue, bodily inflammation, and symptoms like PTSD4”. For example, on page 223, the report acknowledges the existence and impact racism has on parental stress and resulting intergenerational mental health conditions clearly referenced here are structural concerns.

It’s counterproductive at best and destructive at worst to deny institutional racism exists in the UK today. We and many in our field are acutely aware that the experiences of Black and Ethnic Minority people in mental health services is often distinctly different than the experiences of White people accessing these same services. Black people are four times more likely to be sectioned or detained under the Mental Health Act than White people3. In addition, Black people are also more likely to be given psychoactive medication instead of a talking therapy4.

Black men in the UK are also 173 times more likely than White men to be diagnosed with a serious mental health condition such as schizophrenia or bipolar disorder. This evidence shows a differential experience at play in the experiences of Black men, which may include such contributing factors for instance structural inequalities, unconscious biases, and institutional racism. Whatever unease may occur in recognising this, the facts remain; these are systemic issues. On page 223, the report confirms evidence that Black and Asian people with mental health needs are less likely to be receiving treatment and in accessing treatment may come through more negative pathways such as the criminal justice system.

We too, believe that this publication ‘reinforces the need for informed debate on race based on mutual respect.’ However, we believe anti-racism and racial equality and parity cannot be realised if we do not comment on reports such as this.

To move forward hard and uncomfortable truths need to be recognised and properly addressed. This will start the process of dismantling racism in all its forms, in particular institutional racism, and racism within mental health.

“In the Commission on Race and Ethnic Disparities Report call for evidence, this view was apparent with individuals and organisations referencing mistrust with the mental health system as a barrier and cause of disparity among ethnic minority groups: ‘We’re also reluctant to admit mental health issues, because we lack confidence in the system, which can lead to incarceration instead of mental healthcare, or being classed and treated on the basis of a stereotype’.”.

Recommendation 11 of the report - promote fairness, suggests creating a new Office for Health Disparities, and for the government to establish this by way of tackling inequality and improving life expectancy in the UK.  Working alongside the NHS the aim of this body would be independent with a remit to create a level playing field, along with research into disparities in mental and physical health outcomes for different groups and to improve on these for everyone.

Bipolar UK are working to improve outcomes for people within the mental health system and  look forward to progress following dissemination of the Commission on Race and Ethnic Disparities Report.

As a charity  we will endeavour to keep fighting for those impacted by mental health conditions, including bipolar disorder, challenging all forms of discrimination in the mental health system.

 

1 https://www.gov.uk/government/organisations/commission-on-race-and-ethnic-disparities

 

2https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/778897/Modernising_the_Mental_Health_Act_-_increasing_choice__reducing_compulsion.pdf

 

3 Is there institutional racism in mental health care? - BBC News

 

4 https://www.bbc.com/future/article/20200804-black-lives-matter-protests-race-mental-health-therapy

 

Rosie Phillips, Peer Support Services Manager, Bipolar UK