Racial inequalities in the mental health system will remain without investment in more psychiatrists, warns RCPsych

Press release
19 October 2021

The government will struggle to deliver the much-needed reforms to the Mental Health Act, which include tackling racial disparities, unless the Chancellor invests in the psychiatric workforce in next week’s Spending Review, warns the Royal College of Psychiatrists.

The Mental Health Act allows people to be detained in a mental health hospital if they are very mentally unwell and are a risk to themselves or others. However, Black people are four times more likely to be detained than their white counterparts, with white people the least likely ethnic group to be detained under the Act.

The Government has proposed welcome changes to the Act to tackle these racial disparities while also improving patient care and increasing safeguards. This landmark reform also seeks to ensure that an individual’s dignity, autonomy, and human rights are protected when subjected to the Act.

Now a new report commissioned by the Royal College of Psychiatrists has found that the proposed changes will result in an increased workload for psychiatrists. To implement these vital reforms an additional 333 psychiatrists are needed by 2023/24, and a further 161 by 2033/34.

The Royal College of Psychiatrists is calling on the Chancellor to use the upcoming Spending Review to commit a cumulative £82million to pay for the 349 psychiatrists that are required over the three-year Spending Review period. Additional funding will be needed after the three years to deliver the extra 145 psychiatrists needed by 2033/34.

Professor Subodh Dave, Dean of the Royal College of Psychiatrists, said:

“The current Act often fails people from ethnic minority backgrounds, particularly Black people.
“The changes to the Act are absolutely necessary and must be delivered if we are to end this discrimination, modernise mental health law, and improve support for people in a mental health crisis.
“But the changes can only be delivered if there are enough psychiatrists. We don’t have a workforce big enough to take on the extra work while continuing to deliver high quality care to our patients.
“The government cannot break its promise to reform the Mental Health Act. The Chancellor must deliver the funding needed to increase the psychiatric workforce in next week’s Spending Review, otherwise discrimination will remain, patient care will be compromised, and the success of the reforms will be jeopardised.”

The reforms will mean significant changes to the workload of psychiatrists. Time intervals between tribunal hearings will be reduced, while the statutory use of care and treatment plans will add to psychiatrists’ workloads. The new and changing roles of Nominated Persons and Mental Health Advocates will also likely generate additional tasks for psychiatrists.

The Royal College of Psychiatrists is also calling for the Health and Care Bill to be amended so the Secretary of State for Health and Social Care has to report independently verified assessments of current and future workforce numbers at least once every two years.

James, 37, from London, who’s been sectioned three times, said:

“I’ve lost my freedom so many times and have lost many years of my life because of being sectioned.
“I had very little say over what was happening to me and couldn’t appeal the decisions that had been taken.
“To know I can have my freedom taken away based on accusation alone means I live in a constant state of fear. It’s also made it very difficult for me to move on from past mistakes and get on in life.”

At the end of the Spending Review period in 2024/25 the Government should also commit to further annual investment in the psychiatric workforce to reach £60m by 2033/34 in current prices, to ensure continued implementation of the reforms is successful.

The psychiatrists needed to deliver the reforms are in addition to those required to deliver the NHS Long Term Plan commitments, meet increased demand for mental health services, fill existing vacancies within services and replace those leaving the profession.

In the year to March 2020, Black people were more than four times as likely as White people to be detained under the Mental Health Act – 321.7 detentions per 100,000 people, compared with 73.4 per 100,000 people.

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