Proposed reforms look unlikely to stamp out racism in mental health. And there are fears, reports Matt Weaver, that they could even make things worse

A deaf Ghanaian boy was separated from his parents at the Notting Hill carnival. The police picked him up and, because they thought he was acting strangely, he ended up being sectioned. The boy is still recovering from the experience.

The episode is seen as a typical example of discrimination in the mental health system. The National Schizophrenia Fellowship interviewed more than 450 people with mental health problems for a report published earlier this year. It found that 88 per cent of black respondents had been detained under a section of the Mental Health Act compared to 43 per cent of white respondents. And while only 14 per cent of white respondents disagreed with the diagnosis they had been given, the figure for black respondents was 42 per cent.

In another survey, this time of carers, mental health professionals and service users, Mind found that 87 per cent thought there was institutional racism in mental health services.

In this context, the government's reform of the 1983 Mental Health Act was seen as an opportunity to right some of these imbalances. But the reforms outlined in last November's green paper have been a big disappointment to campaigners.

Peter Scott Blackman is co-director of the Afiya trust, a charity which promotes health awareness among black and ethnic minority groups.

He claims that the emphasis in the green paper on public safety is likely to compound existing discrimination. Mr Scott Blackman adds that the green paper is itself a 'direct product of institutional racism'.

Dr Suman Fernando, honorary senior lecturer in mental health at Kent University, agrees. 'A chance has been missed and in some ways it's going backwards. Extending compulsory treatment without addressing racism in the existing system would compound the problem. Widening the definition of mental disorder is also very worrying. Legislation could slip into being very oppressive and it would fall on groups that are already institutionally excluded from society, like black and gay people.'

He adds: 'People don't think mental health is a purely medical problem any more, and that's not reflected in the reforms.'

Gary Hogman, NSF head of policy and campaigns, sums up: 'The whole mental health lobby has been telling the government the same thing, but they don't appear to be listening.

They have completely misjudged it.

They felt the political need to make strong statements about public safety, but they have aggravated the mental health lobby.'

It is not quite true to say the proposals have annoyed everyone in mental health. Dr Matt Muijen, director of the Sainsbury Centre for Mental Health, supports the desire to stamp out discrimination in the system. But he claims that legislation is the wrong place to do it. He says:

'The problems come when you get poor services. You can't legislate for good practice.'

He says the government should have made the national service framework on mental health more explicit on race and he calls for a strong code of practice within the new act. But he argues that a 'gesture' in the legislation itself could 'do more harm than good, by stigmatising black people as dangerous'.

But these views appear out of step with those members of the expert committee asked by the government to suggest reforms of the act. The committee proposed that the principles of respect for diversity and equality should be enshrined in new legislation. It also advised that people should only be subject to compulsory assessment if there were objective grounds for mental disorder.

Committee chair Professor Genevra Richardson explains:

'What we were driving at is that there should be some- thing in the criteria at an early stage that demands objective evidence of mental disorder with a view to guarding against culturally determined perceptions of behaviour.'

But Dr Muijen asks: 'What does objective assessment mean? Every psychiatrist tries to be objective, but it is very difficult to enshrine it in law.'

So far, the government appears to agree with Dr Muijen. It argues that the principles of equality and respect for diversity were already covered in existing legislation.

But Professor Richardson stands by the principles. 'We know that black and minority ethnic communities are affected by compulsion to a far greater degree than the rest of us, therefore I think it is important that the government takes account of that.'

She is more forgiving of the omission of an objective criterion for mental disorder - attributing this to the haste in which the paper was drawn up.

Professor Richardson says she is not worried yet, but she will be if at a later date more detailed legislative proposals continue to ignore the committee's suggestions.

The National Schizophrenia Fellowship recommends:

The government should investigate why so many African-Caribbean people are within the secure hospital or psychiatric system.

The NHS needs to improve the image of mental health services for black and ethnic minority communities to encourage people to get help quickly.

Health professionals should be trained in the way the new Mental Health Act affects ethnic minorities.

Black and ethnic minority patients should have better access to a second opinion on diagnosis and medicines.