Racial inequalities found across mental health services in Scotland

A new report finds differences in the ways the Mental Health Act is applied when people from ethnic minorities are detained for mental health care and treatment compared to white Scottish people.

A comprehensive new report examining racial inequality across mental health services in Scotland is published today by the Mental Welfare Commission.

The report called ‘Racial Inequality and Mental Health Services in Scotland; A Call For Action, looks at six themes: ethnicity and detention under the Mental Health Act; the views of people with lived experience, the experience and training of Scotland’s mental health services workforce; racial equality in that workforce, and recording and reporting of ethnicity across mental health services, including in the Commission’s own work.

The report found differences in the ways the Mental Health Act is applied when people from ethnic minorities are detained for mental health care and treatment compared to white Scottish people, particularly between black women and white Scottish women. It found that more people who were black or of mixed or multiple ethnicity were perceived as a greater risk to themselves and others, whereas all categories of white people were more often perceived as a risk only to themselves.

Gender was found to exert a role on risk perception, too. The greatest difference was between black women, 48.4% of whom were perceived as of risk to themselves and others, and white Scottish women, of whom 33.8% were considered to be both a risk to themselves and to others.

Half of the 32 people with lived experience of mental health difficulties who provided views were refugees. Many said they wanted greater awareness in primary care of the impact of the asylum system on mental health, and described the impact of micro-aggressions on their mental health.

The report found a real need and desire for training for staff on ethnicity and diversity, with over 70% of staff surveyed saying there were gaps in training available in Scotland’s NHS.

The report also found a need for better recording and reporting of information on ethnicity, including by the Mental Welfare Commission itself.

Dr Arun Chopra, medical director, Mental Welfare Commission for Scotland, said the events of the last 18 months had put the issue of racial inequality under a spotlight.

“The murder of George Floyd in the United States in 2020 and the subsequent resurgence of the Black Lives Matter movement focused attention on how people from minoritised ethnic backgrounds continue to be discriminated against across the world. The COVID-19 pandemic has also focused attention on health inequalities and particularly on racial disparities in health outcomes.

“With those two global events as drivers, we wanted to explore how well Scotland’s mental health sector performs in relation to racial equality.

Dr Chopra added that almost a third of the professionals surveyed reported that they had seen or experienced racism directed at their NHS colleagues.

The research also indicated that information on ethnicity had repeatedly not been recorded and reported.

“Poor quality data might seem simply a bureaucratic issue, but it is more than that – without gathering accurate information we cannot hope to properly understand whether or not policies are being delivered for people or understand the extent of the disparities in health outcomes and interventions,” Dr Chopra said.

As a result of the report, the Mental Welfare Commission for Scotland has made 30 recommendations across the public sector, including health boards and Scottish Government. Recommendations include consulting with representatives from ethnic minority groups in their areas to explore barriers for individuals from minority backgrounds in accessing psychiatric care and treatment, and reviewing protocols for dealing with racially motivated incidents.

“The span of recommendations in this report reflects that delivering a service that is truly fair for all will require a collective effort across civil society. We are not there yet,” Dr Chopra added.

“I hope this report leads to a series of actions within mental health services and is the start of a much wider discussion. We know that Scotland’s mental health services are under enormous pressure but we need them to never lose sight of the importance of serving all of our communities."