Deaths in custody inquiry is a game changer for mental health services
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Version 0 of 1. The home secretary’s announcement of an independent inquiry into police deaths in custody has significant implications for black Britain. Even though there isn’t a higher prevalence of mental illness among this group, people from the UK’s African Caribbean communities in particular are 50% more likely to be subject to detention under the Mental Health Act via police referrals than their white counterparts. Theresa May highlighted, in her speech in Brixton last month, that this has resulted in too many tragic and preventable fatalities in police custody of those who have been failed by mental health services. This new independent inquiry could reform the way mental health care is delivered and has significant implications for clinical commissioning groups’ (CCGs) 2016/17 commissioning intentions and mental health providers as, for the first time, alternatives to statutory health detention will need to be prioritised. May has made it clear that people with mental health problems are not the police’s responsibility, and changes proposed in the policing and criminal justice bill that will be presented to parliament in the autumn will reduce the 72 hour maximum period in police custody. This comes on the back of the home secretary’s commitment of an allocation of £15m for health and alternative community based places of safety. Changes to this legislation will allow third sector community based mental health services to provide places of safety, as an alternative to statutory mental health services and police custody for those subject to detention under the Mental Health Act. This is a breakthrough that Black Mental Health (BMH) UK has been lobbying for to see an end to the way people from the community become locked in a lifetime cycle of institutionalised care after just one admission to hospital. The hope is that this change will bring an end to unwanted contact with the police, sectioning, restraint and high doses of antipsychotic medication that black people who come in contact with mental health services routinely face. CCGs hold the key to any improvement in this area. As the agency responsible for commissioning primary and secondary healthcare, they effectively have the power over service provision in any part of the country. In November, CCGs will begin to review commissioned contracts and so as early as April next year, new community based alternatives to statutory mental health based places of safety and police custody could be up and running. Historically, improvements in service provision for those subject to detention or in need of mental health care, particularly from the UK’s African Caribbean communities, has, at best, been nonexistent. As far back as 2005 there was a government commitment to reduce the numbers of people subject to detention under the Mental Health Act, but since this date the numbers nationally for all groups have gone up by 40% and the act was used 53,176 times during 2013/14. Patient bed capacity for acute mental health care in some parts of the country is now at 110%. Large parts of the country, such as London, have effectively abolished voluntary admission to mental health facilities, so only those referred involuntarily via S135 and S136 of the Mental Health Act, will be admitted to hospital. This has made the police the gatekeepers to mental health services across the capital without informing them. The home office’s focus on what Theresa May described as one of the “thornier issues” has put a spotlight on crisis care and the clear need for therapeutic community based early interventions that people trust. The will and expertise to provide these services has always been there; what is needed now is an investment in black led services run with specialist community knowledge to ensure that properly staffed 24/7 community based alternatives to custody are established where the need and demand is greatest. Related: Black and minority ethnic people are shortchanged by mental health services If the CCGs, particularly in areas where detention rates are highest, are not able to commission 24-hour, seven-day-a-week community based places of safety in this next commissioning round, then NHS England has the power to include this in the standard contracts that are given to every hospital, which would then inform the minimum standard service provision. CCGs need to take the bold and much needed step of investing long term in alternatives to the clinical model with its heavy reliance on the police to supplement staff shortages. Progress is doing something new. A long-term investment in frontline 24/7 safe houses in the heart of the community will take policing out of mental health care and end the process of institutionalising many people from ethnic minority communities, which comes at a very high price, both personally and to the public purse. Join our network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views. |