Theresa May's mental health act reform: Warm words but scant action
You may well have missed it under the Brexit deluge but Theresa May announced a major reform of the Mental Health Act this month - the first for 30 years.
She had commissioned Sir Simon Wessely, Regius Professor of Psychiatry at King’s College London and president of the Royal Society of Medicine to examine the legal state of Britain's mental health system.
His report came out earlier this month. Frankly it is full of warm words but proposes scant action and dumps the problem of better treatment for mental health patients on the NHS.
The good part of his report is that it does give better rights for patients held under community treatment orders. and some useful changes when mental patients die in police custody including restoring non means tested legal aid to challenge the authorities.
The bad part of his report is that it fails to offer a solution to what is one of the most glaring problems in the mental health service - the vast number of Afro-Caribbeans who are sectioned compared to the majority white population.
It acknowledges it exists and in his introduction Simon Wessely quotes the view of one ethnic minority person who told him “for a black person, a psychiatric hospital is seen as the place where they drug you up, and at worst even kill you”.
He goes on to confirm that nothing much has changed in 30 years.
"it is sad to record that little has changed. There does appear to be more consensus that this increase is real, and not an artefact, and also that it is related to experiences of discrimination, exclusion and racism. There is also consensus that even taking this into account, the use of coercion is far greater in this population, finding its most painful expression in the statistic that those of black African or Caribbean heritage are over eight times more likely to be subjected to Community Treatment Orders than those of white heritage. In other words, too often and in too many areas the experiences of those of black African and Caribbean heritage is one of either being excluded or detained."
He then admits institutional racism exists even if it is unconscious but the main body of the 307 page report does not address the issue of why psychiatrists accept that Afro-Caribbeans are eight times more likely to be schizophrenic or suffer from psychosis than anyone else. Nor does it propose any remedies for this particular problem.
As Suman Fernando,a psychiatrist and author of a major work on institutional racism , put it:
" The first question to be asked is whether this report would have had the same approach to ‘race’ if the victims of institutional racism had not been ‘black and minority ethnic’ people but a white minority / majority group? The issue here is about white privilege and power. And the question arises as to how this systemic failure of an official report has come about. Second, who carries responsibility for the failure of this report to have race on its agenda for change? "
He concludes:" This Review has raised false hopes in the minds and hearts of many black people "
Consultations on this report will begin in the New Year with legislation to follow. But it will get nowhere without a big commitment to resources and a change of culture and attitudes by psychiatrists treating patients.
As Norman Lamb, Liberal Democrat health spokesman put it: "In the Government’s response to the Review, there must be a commitment to invest more money to support those at crisis point and help people before they reach crisis point. The Conservatives to date have failed to adequately invest in Mental Health. Without strong goals and commitments from the Government, rising detention rates will not be adequately challenged."
My conclusion is that both Theresa May and Simon Wessely are speaking from the same song book. They are prepared to speak warm words about the problem but are not prepared to take radical action to solve it. No wonder he can calmly state that no political influence was brought to bear on the report. It wasn't necessary given its tame conclusions.