CQC releases results of Count Me In census

On the 6th April, the Care Quality Commission (CQC) published the results of the final Count me in census that looked at the ethnicity of mental health inpatients. The results call for organisations beyond the healthcare sector to play their part in improving the mental health and well-being of black and minority ethnic (BME) groups.

The following press release on this census was published on the CQC's website:

"Greater understanding is needed about the factors that lead to the variations that exist between the proportions of some ethnic groups on mental health wards, says CQC. Early intervention is vital to reduce the need for admitting people to hospital.

Mental health services have a key role, but collaborative working is needed between statutory agencies and other organisations in the healthcare sector and also outside the sector, such as education authorities, police authorities, the criminal justice system, primary care services, voluntary organisations and BME community groups.

CQC also says the proposed NHS Commissioning Board and general practitioner (GP) consortia, under the Government’s health reforms, will have a crucial part to play. They will have a statutory obligation to promote equality and reduce inequalities in healthcare, something that is also enshrined in the Equality Act 2010.

As the lead commissioners of healthcare services, it will be up to GP consortia to assess with councils’ social services the needs of their local populations and to commission the right services to meet those obligations, says CQC. The strengthened public health role of councils offers significant potential for addressing the socio-economic and other disadvantages faced by BME communities, which impact adversely on mental health.

Since 2005 the annual Count me in census has been important in providing information on the ethnicity of inpatients in mental health and learning disability services.

It was designed to support the Department of Health’s five-year action plan for improving mental health services for BME communities in England, Delivering Race Equality in Mental Health Care, which ended in 2010.

Overall, the findings of the sixth Count me in census show little change from previous years. They continue to show differences in mental health admission and detention rates between black and minority ethnic groups and white groups, and also differences within minority ethnic groups. Although the total numbers of mental health inpatients have fallen since 2005, ethnic differences in rates of admission, detention under the Mental Health Act and seclusion have not altered materially.

• Admission rates remain higher than average among some minority ethnic groups, especially Black and White/Black Mixed groups. In contrast, admission rates remain average or lower than average among the south Asian (Indian, Pakistani and Bangladeshi) and Chinese groups.
• Rates of detention under the Mental Health Act are higher than average among the Black, White/Black Caribbean Mixed and Other White groups (but not in other ethnic groups). The rates for detained patients who were placed on a community treatment order (CTO) are higher among the south Asian and Black groups.
• Although there have been fluctuations in seclusion rates, they have generally been higher than average for the Black, White/Black Mixed and Other White groups. (Seclusion is the supervised confinement of a patient in a room, which may be locked to protect others from significant harm.)

Dame Jo Williams, CQC’s chair, said: “NHS trusts and independent providers need to look carefully at the census information. These findings, however, do not in themselves show that mental health services are failing to meet the needs of people from black and minority ethnic groups. The findings need to be interpreted in the light of evidence about levels of mental illness and pathways to care among different groups.

“There is a need to move on from counting patients to understanding more about the factors that lead to hospital admission, such as ethnic differences in the rates of mental illness, the socio-economic and other disadvantages faced by some BME communities, and the ways in which patients enter the care environment – for instance, patients from some ethnic groups are much more likely to be referred from the criminal justice system than other groups.

“In this report, as in previous years, we are again highlighting the need for all involved to try to prevent mental ill-health by addressing these contributory factors and intervening early. This must be done by organisations not only in healthcare but also in other sectors, working collaboratively and with people from the BME communities themselves.

“This message, about prevention and early intervention, is at the heart of the Department of Health’s new strategy for the future of mental health care in England, No health without mental health, which aims to tackle the economic, social and environmental determinants and consequences of mental health problems, and to improve outcomes and reduce inequalities.”

In publishing the results of the final Count me in census, CQC says that a one-day snapshot tells only part of the story. It is essential that good-quality data is available on all mental health and learning disability patients, not just those in hospital on a given day.

CQC urges all providers of specialist mental health services – both NHS and independent – to improve the quality of the data they submit to the Mental Health Minimum Data Set (MHMDS), which is collated by the NHS Information Centre.

The MHMDS covers both hospital and community-based services in England and provides a rich source of information on levels of need and patterns of care."

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