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There is a range of issues relating to inequality in mental health services. The main areas of concern are those which concern race and age. The Equality and Human Rights Commission (EHRC) continues to take a keen interest in mental health policy and services.
There is strong evidence of inequalities between ethnic groups in England in the incidence of severe mental illness. The 2006 ‘AESOP’ study of ethnicity and psychosis in England found rates of psychosis up to nine times higher for African Caribbean communities than for the White British population, six times higher for African communities and increased risks of a smaller degree for other Black and minority ethnic groups. In contrast, rates in the Caribbean and Africa are comparable to the overall rate in England.
The differential rates of severe mental illness are reflected in the ethnicity of service users, in particular the inpatient population. Since 2005, the Healthcare Commission’s annual Count Me In census has consistently found rates of admission for the Black ethnic groups to be around three times higher than average. While these rates are disproportionate to the ethnicity of the population of the country, the evidence indicates that they may not be disproportionate to the numbers of people experiencing severe mental illness. The 2009 census, the first to be carried out by the Care Quality Commission, found that rates of admission and detention had not significantly reduced. There will be one more Count Me In Census in 2010.
Most mental health problems for older people, other than dementia, are similar to those experienced by working age adults. There are exceptions that services reflect – the incidence of psychosis peaks in early adulthood, for example. Older people often have very different care and treatment needs, though, and the fact that the National Service Framework for Mental Health (which ended last year) focused explicitly on working age adults has raised concerns that services for people in later life have not kept pace. A study carried out by the then Healthcare Commission examined age discrimination in mental health services for older people and was published in March 2009.
Work with Special Interest Groups and pilot projects has shown that those from ethnic minorities and older people can benefit as much as the rest of the population from IAPT for mild/moderate depression and anxiety disorder. Where individuals are able to self-refer to appropriately designed services, uptake has been shown to be greater than when via GP referral. GPs have generally been reluctant to refer older people in particular to 'talking therapies' for depression.
