The Royal College of Psychiatrists (RCPsych) has warned that unless the Chancellor, Rishi Sunak, invests in the psychiatric workforce in next week's Spending Review, the Government will fail to deliver the much-needed reforms to the Mental Health Act and fulfil their commitment to tackling racial inequalities in mental health care.
This year, the much-awaited ‘landmark’ reforms to the Mental Health Act have been progressing through the white paper and public consultation legislative stages. The reforms aim to tackle racial disparities in detentions while also improving patient care and safeguards by ensuring that an individual's dignity, autonomy, and human rights are protected when hospitalised under the Act.
The Mental Health Act allows people to be detained and sectioned in a mental health hospital if they are deemed psychologically unwell and at risk to themselves or others. However, in practice, particular groups are disproportionately more likely to be sectioned, leading to accusations of discrimination, racial bias, and structural racism, as well as counterintuitively producing feelings of distrust in the purpose of therapeutic interventions in specific communities.
James, 37, from London, who’s been sectioned three times, described his experiences of being sectioned under the Act. He said: “I’ve lost my freedom so many times and have lost many years of my life because of being sectioned… To know I can have my freedom taken away based on accusation alone means I live in a constant state of fear. It’s also made it very difficult for me to move on from past mistakes and get on in life.”
Detentions under the MHA disproportionately affect racialised communities
Government figures show that Black people are more than four times more likely, compared to White people, to be sectioned under the Mental Health Act, particularly those identified in official figures as Black Caribbean who have the highest rate of detention out of all ethnic groups.
In response to the apparent disparity in the use of detentions, the Government has proposed significant changes, such as the integration of culturally appropriate advocates into mental health services and the use of 'advance choice documents' to ensure greater choice and autonomy in patient care. In addition to more regular securitisation and review of detention decisions under the Act, through a process of automatic referral to the Mental Health Tribunal panel, a specialist quasi-judicial body responsible for applications for discharges from hospital.
To deliver the aims of the reforms, additional funding is needed in next week's Spending Review
Similar to the concerns raised earlier this year by mental health professionals in the reform’s public consultation stage, a new report by the Royal College of Psychiatrists has highlighted the increased cost of these reforms.
In a statement, the Royal College said that to implement the “absolutely necessary” reforms, an additional 333 psychiatrists are needed by 2023/24, and a further 161 by 2033/34 to meet the increased workload. Consequently, the Royal College of Psychiatrists is calling on the Chancellor to use the upcoming Spending Review to commit to a cumulative £82m to pay for the additional 349 psychiatrists required over the three-years Spending Review period.
The Spending Review is a yearly allocation of public money between services and Government departments, announced by the Treasury, setting out firm expenditure limits and defining the shape of the key policies that the public can expect from the distribution of those resources.
Professor Subodh Dave, Dean of the Royal College of Psychiatrists, said: “The changes to the Act are absolutely necessary and must be delivered if we are to end this discrimination, modernise mental health law, and improve support for people in a mental health crisis.”
"The Government cannot break its promise to reform the Mental Health Act. The Chancellor must deliver the funding needed to increase the psychiatric workforce in next week's Spending Review, otherwise, discrimination will remain, patient care will be compromised, and the success of the reforms will be jeopardised."
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