Mental health is in crisis – more so for people from minority groups. How do we reach them before they drown? DDN reports from the Minority Mental Health conference
‘There is outrageous discrimination against people with mental health problems… there is an absolute moral imperative on all of us to do something about the situation,’ said Norman Lamb MP.
The shadow Liberal Democrat spokesperson on health was addressing the Minority Mental Health conference, Ending discrimination in mental health: turning the crisis tap off, held in London last month. The event brought together professionals from all areas of health and social care to look at ‘one of the deepest and most discriminatory social failures of our education, social, health and criminal justice services’.
In many cases substance misuse was identified as playing a crucial part in developing mental health problems, while others used substances to self-medicate their mental health issues. In all cases, people were being failed by a complete lack of coordinated care and a health and social care system in crisis.
‘People need diversion [into the appropriate support] when entering the system – but we need to do more than this,’ said Lamb. ‘We need to address the underlying causes of mental health problems, and we need to stop the dreadful flow into the criminal justice system.’
Among the headline statistics, Black African Caribbean men were up to 6.6 times as likely to be admitted as inpatients or detained under the Mental Health Act as the average population. While attending a recent event organised by the charity Black Mental Health UK, Lamb – who has long campaigned for better treatment and understanding of people with mental illness – said ‘the degree of anger, frustration and disadvantage I came across shocked me to the core. I came away feeling something had to be done to address the anger from people in that situation.’
The aim of this latest event was ‘not to call for more research, but to look at what we can do together to turn the crisis tap off,’ said Gill Arukpe, chief executive of the Social Interest Group, created by Penrose and Equinox to support people with a range of needs, including mental ill health and alcohol/drug dependence. ‘Why do so many black people end up in mental health services or prison?’ she asked. ‘Why do so many end up in a crisis situation?’
Ending discrimination needed a change of approach, to look at how we can make a difference to individuals’ lives, said Antony Miller, Penrose’s director of operations. Early intervention was important; The Sainsbury’s Centre for Mental Health said counselling should always be available, but people were having to wait six to nine months for access to talking therapies.
‘What do we do to make people feel they can access services and engage?’ he asked. ‘Early intervention has to be better than dealing with problems when they are fully entrenched.’
We also needed to be much more responsive. ‘It’s not about saying to people, “this is your journey, this is your pathway”. It’s about listening.’
At workshop discussions on ‘the service user’s voice’, a delegate from Camden and Islington Mental Health Trust commented, ‘We need to start listening to the service users who are the experts – take from them what works and go back to them. They are the ones who are feeling it… Just because people have mental health issues or substance misuse issues doesn’t mean they don’t have hope too. We need to catch these issues before it becomes a crisis.’ A director from Norfolk and Suffolk Foundation Trust added: ‘It’s about unity… people can’t afford to be little monoliths, doing things on their own.’
‘We need to understand what’s in front of us – there are people who are not mad, not bad, but need support,’ said Commander Christine Jones, the National Police Chiefs’ Council lead for mental health, addressing the conference on ‘the imperative for change’.
With the prospect of less money in the system, our joint health needs analysis needed to be a lot more sophisticated, instead of applying a ‘sticking plaster approach’ to people in crisis.
We were missing vital opportunities to coach young people ‘at the point when they’re most malleable, most recoverable,’ she said. ‘Damage caused by entry into the criminal justice system at the age of 14 means they’ll be involved into their 30s. Things are easy to spot at an early stage and intervention points can change a life.’
Police had a ‘huge part’ to play in this, as they were often the first contact point, ‘and if they don’t know how to respond, it can escalate’. There were many reasons why people hadn’t come into services before crisis point, including stigma, fear and embarrassment.
Going forward, we needed to think about more efficient options, she said. ‘We need to make decisions at the right place and the right time, to deal with a problem that’s been misunderstood and under-resourced for too long.’
‘It’s about joint working and joint training,’ commented a head of social care at question time. ‘The criminal justice system doesn’t work with local authorities and health as well as it could. If police and health colleagues had more joint understanding, we could move the agenda forward.’
The afternoon sessions were dedicated to ‘solutions’ and Luciana Berger MP offered insights from her visits to mental health projects across the country.
‘It’s worth reflecting that we have made some progress in the last three years, particularly on stigma’ she said, mentioning the recent World Mental Health Day. ‘Mental health is not a sign of weakness – we all have mental health.’
However, the BME community was disproportionately represented in our mental health wards, and the fact that you’re more likely to be sectioned or end up in prison if you’re black was ‘one of the most glaring examples of inequality in our society’. There was a gap in data from both physical and mental health services that was needed to collate a national picture, she said, and government was shirking its responsibility to know ‘so much more’ about BME mental health, to properly develop services.
The financial implications of not helping people early on were showing in mental health costs to the NHS of £105bn every year. Furthermore, Berger’s FOI request to every clinical commissioning group in the country had showed disinvestment in mental health.
The ‘fragmentation of our system’ needed to change to ‘seamless integration of mental health and social care,’ she said, and this relied on everyone working together: ‘If we’re thinking about these mental health issues through the prism of the NHS, we’re thinking about them too late. Our local authorities should be supported in keeping services going.’
Dr Geraldine Strathdee of the Mental Health Intelligence Networks said that there was plenty of data and ‘fantastic analysts working across the system’, but a lack of representative leaders from the target population – the best way to find out about the needs of each area.
‘We need to use data much more effectively and intelligently,’ said Cllr Jacqui Dyer of the Mental Health Taskforce. Everyday discrimination was ‘a great source of stress’, but there was ‘nothing as powerful as true commitment and collaborative work… solutions are possible in every level of the system, but what it takes is collaborative effort.’
And this effort needed to be made at a much earlier stage, according to Maria Kane, chief executive of Barnet, Enfield and Haringey Mental Health
‘We need to do services cradle to grave, sperm to worm!’ she said. ‘Turning the crisis tap off is about introducing services much earlier – perinatal services. Those first 1,000 days are key to your mental wellbeing.’
Mental health relied on having ‘somewhere to live, someone to love, something to do,’ she said. ‘We need to line up our services and outcomes to make sure this is what we’re giving to people’.
There were ‘fantastic’ projects going on in many areas, but they depended on short-term funding and needed ‘mainstreaming’.
In the Q&A session at the end of the day, there were questions relating to many aspects of discussion, from recruitment of the right staff to better integration and communication. Asked about the poor experience of many people with substance issues within services, Leo Downey, Equinox director of operations, said referral to the right services could be difficult when mental health and substance misuse were so separate, and suggested that many mental health staff needed more training on substance misuse issues.
‘We need to make sure we don’t keep this conversation to ourselves,’ commented one delegate – a point underlined by the panel’s chair, Antony Miller.
‘It’s about sharing the work now,’ he said. ‘We’ve heard of at least ten projects today that are making a change. We need to stop talking about this and start moving it forward.’ DDN