Call for mandatory reporting of ethnicity for all patients using mental health and learning disability services

Black people more likely to be admitted to mental health and learning disability services

People from some black and minority ethnic groups were three times more likely than average to be admitted to mental health hospitals, results of a national census have shown.

It is the second year that the national 'Count Me In' census has shown significantly higher rates of admission and detention among some black and minority ethnic groups. The census has prompted calls for the introduction of mandatory reporting of ethnicity for all patients using mental health and learning disability services, not just those admitted to hospital.

The Count Me In Census 2006 was a joint initiative by the Healthcare Commission, the Mental Health Act Commission and the National Institute for Mental Health in England. The census aimed to provide accurate figures on the numbers of inpatients in mental health and learning disability services in England and Wales on one day and to encourage service providers to collect and monitor data on the ethnic groups of patients.

The census is one of the three key building blocks of the government's five-year action plan, "Delivering Race Equality in Mental Health Care".

The census was conducted in England and Wales on March 31st 2006 and gathered information on more than 32,000 inpatients in mental health services and more than 4,600 inpatients in learning disability services.

The first census in 2005 involved mental health services only; in 2006 the census also included the learning disability sector. Results showed that rates of admission for people with learning disabilities in some of the black and minority ethnic groups were also much higher than the average for all patients.

Key findings in the mental health sector show that:

admission rates were lower than average among the White British, Indian and Chinese groups, and three or more times higher than average in Black and White/Black Mixed groups. In the Other Black group, patients were overall 14 times more likely average to be admitted (amongst men this was almost 18 times - the same as in 2005).

black and White/Black Mixed groups were significantly more likely than average to be admitted to hospital via the criminal justice system (under section.37/41 of the Mental Health Act), and less likely to be admitted via community mental health services.

there were lower rates of self-harm and accidents in Black and some other BME groups, and higher rates of self-harm and accidents among White British patients.

men from the White Irish and White/Black Caribbean Mixed groups had seclusion rates of almost double the average. There was improvement in the rate of seclusion in Black Caribbean and Black African groups as well as the Indian and Other Mixed group, compared with the 2005 census.

thirty per cent of patients had been in hospital for one year or more. This means that almost one third of patients surveyed in 2006 were also surveyed in 2005. In the Black Caribbean group, 40% of patients had been in hospital for over a year.

fifty-five per cent of inpatients in mental hospitals were in mixed sex accommodation. A direct comparison to the 2005 results is not possible due to a change in the definition.

Key findings in the learning disability sector show that:

eleven per cent of inpatients with a learning disability were of black and minority ethnic origin - lower than the 20% for mental health inpatients.

rates of admission were lower than average among the South Asian, Other Asian, Other White and Chinese groups, and two to three times higher than average in the Black Caribbean, White/Black Caribbean Mixed and Other Black groups.

unlike mental health inpatients, no ethnic differences were observed for those detained on admission under the Mental Health Act 1983.

rates of referral by carers were double the average among the White Irish, Other White and Black Caribbean groups.

thirty-five per cent of inpatients were detained under the Mental Health Act on admission. Unlike the mental health inpatients,

no ethnic differences were observed for detention rates among inpatients with learning disabilities.

fifty-seven per cent of people with learning disabilities who participated in the census were in mixed sex accommodation. It should be noted that the census included people with a learning disability in a variety of accommodation models, including campus accommodation.

Professor Sir Ian Kennedy, Chair of the Healthcare Commission, said: "The census gives us an important snapshot of inpatients in mental health and learning disability services on one particular day. But we still need to know more. That is why we are calling on Department of Health and the Health and Social Care Information Centre to extend the mandatory recording of ethnicity that currently applies to inpatients, to all users of mental health and learning disability services, not just those admitted to hospital, and indeed for all users of health care services. Without this additional information we cannot effectively monitor the quality of care of black and minority ethnic patients on an ongoing basis.

"There are a multitude of factors that affect both the levels of mental illness and the subsequent pathways to care for certain black and minority ethnic groups. It is clear that the solution does not rest with any one organisation or agency. What is required is cooperation across government and beyond to address the factors, including the socio-economic factors, leading to these acute outcomes."

In addition to calling for mandatory reporting, the Commission is developing performance indicators to help drive improvement in services for black and minority ethnic groups.

Professor Lord Patel of Bradford, MHAC Chairman said, "I support Sir Ian Kennedy's call for mandatory recording of ethnicity for all people using mental health and learning disability services whether they be patients in hospital, or accessing services in the community. This information is vital if we are to undertake a detailed examination to understand why some black and minority ethnic communities have such high admission and detention rates. Why, for example, are men in the 'other black' category 18 times more likely to be admitted and detained as mental health inpatients? We must get to the bottom of it.

"The census has also been a valuable tool in collecting information relating to a range of issues. For example, in 2006 for the first time, we collected information relating to sexual orientation. Through this greater understanding of the patients themselves, we seek to drive improvements so that mental health services are really meeting the needs of all patients regardless of factors such as race, religion, or sexuality."

Steve Shrubb of NIMHE joined the call for mandatory reporting of ethnicity: "The Count Me In Census provides invaluable information to support the development of mental health care pathways which can better meet the needs of people from black and minority ethnic groups. The mandatory reporting of ethnicity would support the ongoing development of these pathways over time."

The third count me in census is due to take place on the 30 March 2007 across all mental health and learning disabilities in-patient services in England and Wales. The 2005 and 2006 have been very successful in providing ethnicity data that can be used to improve the quality of services and this year we once again welcome the efforts of staff to build on this information.