Supplementary Written Submission from Equalities and Planning Directorate, Nhs Health Scotland

SUPPLEMENTARY WRITTEN SUBMISSION FROM EQUALITIES AND PLANNING DIRECTORATE, NHS HEALTH SCOTLAND

1. NHS Health Scotland is a special Health Board responsible for delivering Scotland’s public health improvement agenda. Our purpose is “Providing leadership and working with partners to take action to improve health and reduce health inequalities in Scotland”. Within Health Scotland the Equalities & Planning Directorate was established in 2008 to incorporate the previous equality strand specific NHS ‘Fair for All’ programmes, including the National Resource Centre for Ethnic Minority Health. Within this Directorate there is a programme of work focusing specifically on race equality and mental health.

1. The Mental Health and Race Equality Programme has been funded by Scottish Government’s Mental Health Division since 2006. The programme works strategically with relevant partners to promote race equality across mental health improvement and service delivery in Scotland. We work closely with a range of Black and minority ethnic (BME) mental health organizations which affords us specific knowledge about some of the issues. As such our contribution to the committee round table discussion is in respect of the race and ethnicity strand of equalities groups.

Comments

1. We welcome this timely and critical committee focus in respect of the implementation of the equalities principles of the 2003 Act. We are currently engaged in work to support the race and ethnicity strand of this work and also very keen to engage in the round table discussion and contribute to any actions or recommendations arising from it.

How the Mental Welfare Commission, which was established to monitor the Act, has monitored the implementation of the principles of equality and non-discrimination and how it intends to do so in the future?

1. We have worked with the Mental Welfare Commission (the Commission) closely in recent years specifically around ethnic monitoring and the provision of accessible information about the Act. Despite an improvement in the use of ethnic monitoring since the implementation of the Act in 2005, only 70% data was recorded in 2008-09. This makes meaningful interpretation impossible and it is therefore simply not possible for the Commission to analyse whether BME individuals are being treated equitably according to the principles (i.e. analysing whether, for example, there are higher or lower proportions of people from BME backgrounds becoming subject to compulsory measures). Ethnic monitoring is not currently a mandatory activity in the use of the Act. We are aware that the Commission is in favour of making ethnic monitoring a mandatory activity and would fully agree and support the Commission in the respect.

1. We are involved with the Commission in a small research project linking Mental Health Act detention data from 2005-2009 with census data through CHI number. It is hoped that this project will improve ethnic monitoring information to 94% and provide some more meaningful analysis. This will only provide retrospective data, however, and, as far as we are aware, is a one off research study.

How the ‘limited review’ of the 2003 Act took account of equalities issues?

1. The review was not asked specifically to look at any equalities issues but certain recommendations pertain to BME groups. We are aware that the review consulted widely and met with BME service users at the Royal Edinburgh Hospital in Edinburgh to seek views. The review subsequently made a recommendation in relation to always offering professional interpreting services. We made representation to the review team in relation to race and ethnicity, recommending that mandatory ethnic monitoring would improve the ability to monitor race equality in the use of the Act. We are aware that other organizations made similar recommendations. The review report (March 2009), however, makes no recommendations in this respect.

How any changes that will be made following the review relate to equalities issues?

1. The Scottish Government has not yet made final proposals based on the ‘limited review’ or the subsequent consultation on the review findings.

What impact the Act has had for the care and treatment of the different equalities groups, in particular:

• How advocacy services have developed specifically for ‘equalities’ groups following the provision of rights to advocacy under the 2003 Act?

1. We understand that there are very few, if any, BME mental health advocacy services in Scotland. Indeed, one such service recently folded due to the end of funding. BME service users requiring mental health advocacy services have access to ‘mainstream’ mental health advocacy and, where necessary, work with an interpreter to facilitate their advocacy provision. We are aware recently, however, that in one area a service user specifically requested a bi-lingual mental health advocacy worker and this need was unmet. This is in the context of very few specialized BME mental health services across Scotland.

What the constraints are to fully realizing the equalities principles of the legislation?

1. We believe that effective equality and diversity monitoring is a necessary activity underpinning any comprehensive analysis of legislation in terms of meeting equalities principles. Ethnic monitoring was made a legal requirement for public bodies under the Race Relations (Amendment) Act 2000 and yet it is patchy across mental health services in Scotland even to the extent that we do not have comprehensive data for people subject to compulsory care and treatment.

1. Where specialist BME mental health services are provided we are able to collect data evidencing the need and uptake of mental health services by BME individuals and groups. For example:

• Men in Mind (a service for BME men) have had active contact with 67 men (from their database of over 300) in the last 11 months. The majority of these service users self-identified as being of African origin, although the diversity literally encompassed everything from Algerian to Zimbabwean. In decreasing size, the largest self-identification by country was Chinese, Pakistani, and Zimbabwean.

• Saheliya (a service for BME women) provided services for 529 users in 2008-09. They report that according to police statistics, the BME population of Edinburgh is 5.4% and point to unmet need evidenced by waiting lists for some of their services.
• The Minority Ethnic Mental Health Project within the Royal Edinburgh Hospital promotes and supports ethnic monitoring within the hospital. In 2007-08 the total number of in-patients was 2742. 143 (5.2%) were identified as being of BME background through various sources such as language, religion, ethnicity recording and names. Of those 143, 55 were formal admissions and 88 were informal. 19 languages other than English were recorded.

1. We appreciate that there are some sensitivities about when and how to best collect equalities information in the context of mental health care and treatment. We know that with effective awareness raising and guidance, staff across organizations become comfortable and used to undertaking equalities monitoring. We are involved with other NHS Health Scotland and Information Services Division staff in a variety of initiatives to support effective monitoring and the situation is improving with comprehensive guidance now available and being implemented.

Dale Meller

Programme Manager – Mental Health & Race Equality

NHS Health Scotland

March 2010