The voluntary sector has a role to play in reducing BME mental health detentions
New commissioning arrangements see the voluntary sector playing a greater role in mental health services for ethnic minority groups, but there are barriers to overcome first
Kamaldeep Bhui
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Recent findings suggest a culture of care where detention for black communities is acceptable and expected. Photograph: Sarah Lee for the Guardian
Black people experiencing mental ill health continue to be at a higher risk of detention in hospital and are over-represented in forensic services and prison.
Despite investment in community services for treating mental illness, detentions for black people almost doubled from 2,731 (10.7 per cent of all those detained) in 2005-06 to 4,624 in 2009-10.
These findings suggest a culture of care where detention for black communities is acceptable and expected. All of which makes the Care Quality Commission's decision to stop collecting data under the Count Me In Census, due to a lack of improvement in outcomes, all the more incredible.
It is also surprising and worrying that the Department of Health has remained silent and not prioritised more research and services to both understand and tackle the problem.
This is why the role of the voluntary sector is so crucial. The sector has made progress in its work with those most at risk of detention by proposing alternative models of care.
These creative solutions have emerged through necessity, are rarely evaluated using randomised trial designs and offer hope and inspiration to service users facing systems of care that they either fear or find unattractive.
Five years ago, I set up the Enhancing Pathways into Care (Epic) project in four NHS trusts (Sheffield, Manchester, Birmingham and Easington) to improve the entry into and exit from care by collaborating with the voluntary sector. The project was part of the Department of Health's former delivering race equality programme.
In Sheffield, the project made an impact on voluntary sector and crisis services. This meant that the number of bed days for African-Caribbean patients dropped dramatically from 350 to 31 between 2005 and 2010.
Even if the voluntary sector is not directly involved in caring for inpatients, under the new commissioning arrangements it will play an increasing part in discharge planning, advocacy, after-care and housing.
However, there is a stumbling block. Many staff in the voluntary sector are unfamiliar with the Mental Health Act 2007, and the protections and rights it offers.
This month the Mental Health Providers Forum, an umbrella body of 50 voluntary sector service providers responsible for an £800m spend on care services, launched much needed guidance on the act to deal with this challenge.
The mental health legislation resource for health and social care practitioners sets clear standards on how to use the Act in the promotion of good mental health care. It also provides case studies, including ones that cover race and equality concerns.
I have gone a step further by helping to develop a new MSc in mental health and law at Queen Mary, University London. It will be jointly delivered by the Wolfson Institute of Preventive Medicine and the university's law department, and will be open to applications from January 2013.
There are also a series of workshops and continuing professional development events on homicide and mental illness being run by the Cultural Consultation Service, which will use the mental health legislation resource to promote a better understanding and application of mental health law.
The changes in the commissioning arrangements and the reorganisation of health and social care means that greater attention will be paid to the prevention of mental health problems, mental health promotion and, of course, legislation.
There is an incredible opportunity to improve the quality of personalised care that mental health service users receive through the voluntary sector. Services that are flexible, more closely linked to community agencies and grounded in less institutionalised approaches to mental health care.
In this new climate of provision that is cost effective, more humane and less institutionalised, we are on the brink of a potential revolution in care commissioning and provision, particularly for black communities. That is if the voluntary sector steps up to the challenge.
Kamaldeep Bhui is professor of cultural psychiatry and epidemiology at Wolfson Institute of Preventive Medicine, and director of the cultural consultation service, which are both based at Queen Mary, University of London.
Despite investment in community services for treating mental illness, detentions for black people almost doubled from 2,731 (10.7 per cent of all those detained) in 2005-06 to 4,624 in 2009-10.
These findings suggest a culture of care where detention for black communities is acceptable and expected. All of which makes the Care Quality Commission's decision to stop collecting data under the Count Me In Census, due to a lack of improvement in outcomes, all the more incredible.
It is also surprising and worrying that the Department of Health has remained silent and not prioritised more research and services to both understand and tackle the problem.
This is why the role of the voluntary sector is so crucial. The sector has made progress in its work with those most at risk of detention by proposing alternative models of care.
These creative solutions have emerged through necessity, are rarely evaluated using randomised trial designs and offer hope and inspiration to service users facing systems of care that they either fear or find unattractive.
Five years ago, I set up the Enhancing Pathways into Care (Epic) project in four NHS trusts (Sheffield, Manchester, Birmingham and Easington) to improve the entry into and exit from care by collaborating with the voluntary sector. The project was part of the Department of Health's former delivering race equality programme.
In Sheffield, the project made an impact on voluntary sector and crisis services. This meant that the number of bed days for African-Caribbean patients dropped dramatically from 350 to 31 between 2005 and 2010.
Even if the voluntary sector is not directly involved in caring for inpatients, under the new commissioning arrangements it will play an increasing part in discharge planning, advocacy, after-care and housing.
However, there is a stumbling block. Many staff in the voluntary sector are unfamiliar with the Mental Health Act 2007, and the protections and rights it offers.
This month the Mental Health Providers Forum, an umbrella body of 50 voluntary sector service providers responsible for an £800m spend on care services, launched much needed guidance on the act to deal with this challenge.
The mental health legislation resource for health and social care practitioners sets clear standards on how to use the Act in the promotion of good mental health care. It also provides case studies, including ones that cover race and equality concerns.
I have gone a step further by helping to develop a new MSc in mental health and law at Queen Mary, University London. It will be jointly delivered by the Wolfson Institute of Preventive Medicine and the university's law department, and will be open to applications from January 2013.
There are also a series of workshops and continuing professional development events on homicide and mental illness being run by the Cultural Consultation Service, which will use the mental health legislation resource to promote a better understanding and application of mental health law.
The changes in the commissioning arrangements and the reorganisation of health and social care means that greater attention will be paid to the prevention of mental health problems, mental health promotion and, of course, legislation.
There is an incredible opportunity to improve the quality of personalised care that mental health service users receive through the voluntary sector. Services that are flexible, more closely linked to community agencies and grounded in less institutionalised approaches to mental health care.
In this new climate of provision that is cost effective, more humane and less institutionalised, we are on the brink of a potential revolution in care commissioning and provision, particularly for black communities. That is if the voluntary sector steps up to the challenge.
Kamaldeep Bhui is professor of cultural psychiatry and epidemiology at Wolfson Institute of Preventive Medicine, and director of the cultural consultation service, which are both based at Queen Mary, University of London.
