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The subject of race inequality in mental health has been scrutinised by policy makers and researchers for decades. Despite government initiatives such as ‘Delivering Race Equality in Mental Healthcare’, there seems to be an intractability in relation to the closing equality gaps. In the midst of this, one of the decision makers in compulsory mental health work – the Approved Mental Health Professional (AMHP) – is at the sharp end of the data that attracts the sternest criticism: the higher-than-average rates of detentions of racialised minorities. Though solutions may be found in attending to socio-economic obstacles to equality in mental health, practising AMHPs need to have the skills to critique and amend their own practice so that they can take account of the antecedents of poorer mental health in the lives of racialised people whom they assess, and to mitigate against the impact of their own unconscious bias and prejudices. This chapter revisits the data in relation to ethnic inequality in referrals, pathways and outcomes from Mental Health Act (MHA) assessments for racialised minorities. Drawing on the latest research, key decision-making points are analysed to identify where biases may be affecting practice. Attention is given to unconscious bias and individual skills in challenging models, practice and policies that institutionalise the disadvantage of racialised minorities.
A paradox of implementing race equality policy is that continued use of the term ‘race’ further embeds the word in language. Race is usually referred to as a set of genetic differences that denote discrete sub-categories of the human race. Alongside this process of categorising is the ascribing of attributes associated with races. Bamshad et al (2004) analysed the genetic basis for race and pointed out that the genetic differences between groups of people are small, around 1%. Sometimes the genetic differences within so called races are wider that those across what are considered to be separate races.
An alternative approach is to focus on the process of racialisation. Garner (2010) described the process by which people are described as being racially different based on a notion that ‘White’ is the norm and non-white people belong to an ‘other’ race. Racialisation shifts the focus from an assumption that behaviours and inequalities are biologically or culturally determined to an analysis of social and structural factors that drive inequality.
I have been involved in implementing race equality policies at the national and local level within the statutory sector and working independently. I will explore three challenges that manifest themselves in three contexts in which I have worked.
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National policy implementation
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Local policy implementation
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Supporting race equality policy as an independent consultant
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Maintaining integrity in role
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The subordination of system approaches
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The avoidance of racism in implementing race equality
The three challenges to be explored in this chapter reflect those that have been discussed elsewhere in published literature. As such there is already reference material that expands what is summarised in the following four paragraphs.
