Rt Hon Norman Lamb MP speech at Home Office and Black Mental Health UK joint summit on Policing and Mental Health, Thursday 23 October 2014
Thank you for inviting me to speak, and to take part in what was just a very stimulating panel discussion.
I'd like to thank all speakers and participants, and particularly the Home Office and Black Mental Health UK for organising today's Summit.
Our aspiration is to live in a fair society.
From our discussions today, it is clear we have yet to fully realise that aspiration. But, the prejudice that's been spoken of – that black and other minority ethnic communities believe they are unfairly treated – extends beyond the police force. It exists in mental health services, too.
I was invited to speak at ACCI (African Caribbean Community Initiative) and BMH UK's national conference entitled 'Policing and Mental Health: Coercion or Care' looking at the African Caribbean experience of mental health services.
It was undoubtedly one of the most challenges conferences that I have spoken at and the sense of injustice within the room was palbale. I met the family members of Kingsley Burell-Brown, Kedisha Burrell and also relatives of Mikey Powell both of whom lost their lives while in the care of mental health services after contact with the police. This is unacceptable and not something we can allow continuing to happen.
I have said before that if we want a fairer society, then we need to put mental health on an equal footing with physical health – and we need to eradicate all forms of discrimination.
Over the years, physical health has been given priority. If you break your arm or suffer a physical crisis like a road traffic accident, the health service swings in to action. You will have a maximum waiting time for treatment and you will get a choice of team who will treat you.
For mental health, nothing like this exists. No waiting times – until April next year – no choice – until earlier this year.
It is nothing short of an injustice that this has been able to continue for so long, and we are working to correct this.
How can it be right that if you have suspected cancer you will see a specialist within a fortnight, yet if you suffer a first episode of psychosis you have no such right?
This is outright discrimination at the heart of the NHS.
My Department has done a lot in the past year to challenge this discrimination.
However, within that injustice is a further injustice: one that we're talking about today.
Black people's experience of our mental health services are often reported as far worse than any other ethnicity.
People from Black Caribbean backgrounds are more likely to be dissatisfied with their mental health treatment.
But... Beyond such assertions are the striking personal stories I have heard, whether via Matilda MacAttram, Director of Black Mental Health UK and the meetings she has arranged, via meeting people when I visit services across the country or via anecdotes that my officials have shared with me following the consultation on revising the Mental Health Act Code of Practice - it is often a similar case.
When black people have told me about their experiences, they often feel that they receive poorer care in comparison to white people.
My officials heard from one woman who had been detained in hospital for a number of years.
When she left the meeting, she had to go back to her ward. This was her day out – to complain about how bad the treatment was in the place she would inevitably return to and stay.
The similarities between the experiences of black people when coming into contact with the mental health and policing professions are obvious, and unfortunate.
Unsatisfactory, unacceptable, and, sometimes – frankly unbelievable.
However, I do believe that things are just starting to change.
Recently, the Deputy Prime Minister recently announced an extra £120m to cut mental health waiting times and, for the first time ever, to introduce access and waiting times standards for mental health. This is a watershed moment.
The imbalance between physical and mental health rights determines where the money goes. And mental health always loses out.
But, our mission also has to be to provide better care for black and other minority ethnic people. And I sincerely hope that the changes we are pursuing will help to achieve that.
Closer working between the health service and the police could lead to a better understanding of mental health and improve care – and we know in many areas that this is already happening.
Right now, many police officers will have first-hand experience with dealing with mental health issues. – but not necessarily the training or understanding to respond appropriately.
A great deal of police operational time is spent responding to incidents that involve people with mental health problems.
I know it is a major frustration when mental health services are not available - or when A and E departments are unable to look after someone having a mental health crisis.
We need the police and mental health services to work together.
Some of you may remember that, when I spoke to you in Wolverhampton last year, I mentioned the introduction of Street Triage – health professionals assisting police officers with people experiencing a mental health crisis.
We have been piloting the scheme over the last year, based on the first two pilots in 2012 in Cleveland and Leicester, and which showed how effective such collaboration can be.
It is from their work that the rest of the pilots have stemmed – and we in the Department of Health have funded and encouraged them to see if the practice could be spread.
Now, over a quarter of the country is covered by this new service, with:
• better advice and support for officers, when they decide whether or not to detain a person in crisis;
• immediate joint work with mental health services, so people do not need to be taken to police cells; and
• appropriate and vital information being shared about individuals – to help keep them safe and get them to the right services – with a proper follow-up to check that they get the help they need.
In short – better, more joined-up public services and better care.
Where the 9 centrally-funded pilots are operating – the number of people being detained under section 136 has dropped by an average of 25 per cent.
Because of this work, police time is being saved – West Yorkshire report that the time spent by Police Officers in dealing with Section 136 MHA is on average 2 hours, compared to an average of 5 hours in a neighbouring Division.
These improvements aren't only being seen in the pilots we have funded from Whitehall.
There are another 17 police forces in England and Wales that are now running a street triage service in one form or another. I am delighted that these schemes have surfaced organically as commissioners elsewhere have seen the obvious benefits.
Places like Cheshire, Dorset and Staffordshire are supplying a 7-day-a-week triage service, and some are already seeing great results.
Nottinghamshire have seen the number of people being detained under the Mental Health Act down by a quarter.
This wouldn't be possible before Street Triage, and I've been really impressed by the leadership from the police in changing the way things work.
So the aim is to intervene early – through street triage – and even preventing a crisis in the first place. But sometimes people come into contact with the criminal justice system.
Crisis Care Concordat
Crisis care is perhaps where the gap between physical health and mental health is most stark.
So when the Government revised its Mandate to the NHS last November, I personally ensured that we included an expectation that the NHS recognises that mental health crisis services must be accessible at all times - and are as vital as other health emergency services. They equally deal with potential 'life or death' situations.
We published the Crisis Care Concordat in February which for the first time sets standards for good mental health crisis care, including:
• fast responses from police officers, trained to understand the needs of people with vulnerabilities;
• ambulances responding quickly to provide transport to hospital;
• mental health services ready to support the police, receive patients in a place of safety, and provide assessments in good time; and
• ending use of police cells for children – and radically reducing their use for adults.
I've been impressed by the progress in many places, but this is a journey, and there is still work to do.
I want every area signed up to a local Crisis Declaration by the end of the year and I urge each of you to do everything in your power drive this agenda in your organisations and localities.
Focus on recovery not imprisonment or containment
I met Dan Thorpe recently from the Metropolitan Police. He told me that last year, out of the 1600 people detained under an s136s, the majority went to a health based place of safety and only 87 of them went to a police cell.
Up to September this year, this number has reduced to 17 people. And they want to make the use of cells in London a 'never event'.
What is essential to improving crisis care is working together – everyone has their part to play.
In particular, I expect to see a focus on eliminating the use of police cells for people who are picked up if they are in mental health crisis.
The Crisis Care Concordat sets the ambition to reduce this practice by 50% this year – and for it to not happen at all to children and young people.
I know from discussions facilitated by and involving Black Mental Health UK that ending up in a police cells is a common occurrence for black people suffering from a crisis – to be locked up first and treated later.
This can deeply damage someone's mental wellbeing – and it needs to stop now.
I have long said that we need to have a focus on recovery – not imprisonment or containment, unless it is absolutely necessary.
Code of Practice consultation: African Caribbean experience
Our consultation on the Code of Practice has also supported this.
The revised Code will detail the best way in which professionals can support people detained under the Mental Health Act, no matter what their background. I hope this will be evident when we lay the revised Code in Parliament, which we plan to do before the end of the year.
My Department has found the consultation incredibly helpful – it has informed us about the areas that we need to spend more time looking at. One of which, of course, is race.
Some of the responses to our consultation have been sobering.
People have responded saying:
• clinicians don't understand mental health as it relates to people from the UK's African Caribbean communities;
• people from BME communities are more likely to be restrained; and
• black patients, in particular, are over-medicated, more likely to be detained than white people, and more likely to experience much longer periods of indefinite detention.
Frankly, this is appalling. The fact that these perceptions even exist means that something is going wrong – we have a duty to act.
In April we issued new guidance on reducing the use of restrictive interventions, Positive and proactive care, as part of a two-year programme called Positive and safe.
End use of face down restraint and other restraints
I was clear that I want to end the deliberate use by health and care professionals of face-down restraint and other restraint that restricts the airway, breathing and circulation or involves the use of pain, and the practice of inappropriately secluding a person from others.
In part my view was informed by discussions with Black Mental Health UK, Olaseni Lewis' parents and many other discussions. No one deserves to be treated in this way.
The consultation process for the Code has been an important one – it's vital that such significant conversations don't exist in a vacuum.
That's why I was keen to ensure that my officials worked hard to talk to the relevant people about how we can shape services to be inclusive.
Legislation is there to protect people
It's important to remember that mental health legislation is there to protect people – to provide support to some of the most vulnerable people in our society – not as an excuse to detain them.
The consultation has also shown that we need to have a focus on inclusion.
Everyone experiencing mental health problems, regardless of colour of skin, deserves the same level of treatment.
This is why I'm very pleased to announce today that the Department of Health is endorsing new guidance for commissioners of mental health services for people from black and minority ethnic communities, produced by the Joint Commissioning Panel for Mental Health.
Crucially, the guidance has been developed collaboratively by a group of mental health professionals, people with mental health problems, and carers with expertise and experience in the mental health of people from BME communities.
The importance of inclusion was also spelled out in our recently-announced five year plan on mental health services – to introduce "culturally competent services seeking to eliminate discrimination and advance equality of opportunity".
And the principle of waiting time standards for mental health services, which we are introducing from April next year, is based on the very premise of fairer access for all.
We should never lose sight of the fact that all of this work – the Concordat, the restraint guidance, the five year plan, the Code of Practice which underpins the Mental Health Act, the BME guidance for commissioners – is there to serve and support these people.
I want to thank you all for coming here today.
The more that we discuss the problems in these areas, the closer we are to solving them.
By improving mental health care and improving collaboration between health and police staff, we are building a fairer society.
But we need to ensure that within that society, there is equality – that people from all backgrounds get the same treatment and support.