Allocating mental health resources based on racial assumptions

Black women have a five day greater delay between diagnosis and their first treatment day- with no explanation other than racism. Doctors are far less familiar in the uk at recognising symptoms on Black skin, so do a worse job in diagnosing etc….

Being unfamiliar with something because you see it less often (because black women are literally a minority) is not ‘racism’. There are clearly also differing clinical circumstances (younger to contract the disease etc) that affect outcomes which are not ‘racism’, it is just our creaking, unwieldy NHS possibly combined with a lack of education in the target group (are black women advised to start checking their breasts at a young enough age?).

I think that the OP is massively oversimplifying the part that concerns about racism played in Calcon's treatment. There are no 'quotas' , just attempts to be mindful about possible bias.

It is clear that his race played a part in the decision making. Let’s just remember that decision making led to the totally avoidable deaths of 3 innocent people.

We hear of numerous examples where race and non English speaking work in favour of criminals wrt to sentencing and mental health patients who are an extreme danger to the public.

When are people going to accept that we need to find a better balance between the institutional paranoia around racism vs the safety of all of us?

I think it would be perfectly legitimate, in deciding whether to section, to have regard to over-representation - as a way for the decision makers to check their own thinking.

Yes, I don’t that sort of ‘check your thinking’ requirement is helpful. It has a starting point that the thinker might be racist - whether inadvertently or not, and that they may not be capable of making a decision on the objective clinical facts in front of them.

It sets up a level of self doubt that is entirely divisive as it requires a different thought process for a PoC than for a white person. Would a black doctor be required to ‘check their thinking’ in the same way?

Clinical decisions should be made on the facts and we should trust clinicians to do that and not require them to second guess themselves and worry about race ‘quotas’ (aka over-representation).

OP, i understand your concerns and points. However a few thoughts to add:

1. having disability quotas etc is intended to counteract the discrimination that people otherwise face. If the workplace are hiring fairly, and its big enough to make aggregation of individual choices relevant, then if they are not discriminating in their hiring, they should have proportionate representation of subgroups anyway. If they don’t, then quotas act as a countermeasure to discrimination. So it is not so much that you get hired because you have a disability, but that you have a chance to get hired, despite the prejudice you are likely to encounter in the selection process. People always talk about the absence of quotas as if that is an even playing field- a meritocracy. It isn’t.
2. in physical health issues, race is very relevant. Eg in breast cancer, Black women are much more likely to die from their cancer than white women (38% more likely in the US… in the UK, we don’t collect such reliable statistics, but the gap is acknowledged by all experts). They tend to contract the disease earlier (too young for nhs mammogram programme) and in severer forms. Standard mammogram scanning is also less effective due to tendency towards denser breast tissue. There is understandably less trust in medical services due to institutional racism in care delivery, meaning medical intervention is often slower and less effective. Black women have a five day greater delay between diagnosis and their first treatment day- with no explanation other than racism. Doctors are far less familiar in the uk at recognising symptoms on Black skin, so do a worse job in diagnosing etc…. All of this adds up to needing specific, better care for specific ethnic groups. Yes, the idea would be to hyper individualise care. And insights from AI-powered research is enabling this. But the database of outcomes the AI is educated on does not have proportionate ethnic representation, meaning AI- powered diagnostics and treatment paths are more effectively individualised for white bodies. (As are traditional drugs too, by the way, due to lower representation of non-white bodies in clinical trials). So to cut a long story short, we ARE part of groups, and while yes, everybody has their own individual stories, grouping people is not just about stereotypes or tick boxes. In medicine it is a vital framing to ensure we are diagnosing correctly and promptly, finding the most effective treatments and intervening in the ways, that on aggregate address the most important gaps in care for the most disadvantaged groups.

In parts of life where there is no discrimination, or no real link between different groups and outcomes, then I agree there is no value in gathering data on the ‘groups’ people belong to. But there aren’t many areas of life like this. In most areas, something can be done with this data or with group-specific interventions that can counteract inequality of opportunity - whether it is for a job or for decent medical care and outcomes.

The guardian story makes it clear that it relates to Calcone's first presentation with psychosis. The trajectory of his mental health care after that point was the result of the same sort of chaos and underfunding that affects so many seriously mentally ill people.

Naturally we need to monitor the part that race-related concerns (both anti-racist considerations and racism itself) play in the allocation of treatment, but it is perfectly reasonable for mental health professionals to take into account the research that shows that black men with mental illness are more likely to be viewed as a risk than white men presenting with the same symptoms.

I think that the OP is massively oversimplifying the part that concerns about racism played in Calcon's treatment. There are no 'quotas' , just attempts to be mindful about possible bias.

If it is still the case that black people get a poorer deal from mental health services than white people, clearly mental health professionals have to be mindful of potentials for bias. If they aren't the likelihood is that care will be allocated less fairly, not more fairly.

As well as oversimplifying the part that concerns about racism played in Calcone's treatment, the OP is also massively overplaying the alleged implications for all of us of mental health services being mindful of issues around racism and other forms of bias. Mental health services are broken, and the many, many patients (and their relatives and the occasional victims of psychosis-induced violence) who suffer from its failures are victims of severe underfunding and stigma, not of political correctness.

Hmm I think in the VC case there may be some race-baiting shit stirring going on here by the media (though obviously the appalling decision made in his case has to be considered in detail).

Notice that in the Guardian article the headline refers to him not being sectioned ‘because of’ his race - whereas what was actually said at the hearing (quoted in the article) was that the decision not to section was made ‘after’ consideration of over-representation etc. These are two very different things.

I think it would be perfectly legitimate, in deciding whether to section, to have regard to over-representation - as a way for the decision makers to check their own thinking. Kind of ‘Am I actually making this decision on the basis of the facts before me? Or is something colouring it?’. That kind of ‘having regard to’ is - or should be!- an aid to careful consideration of individual cases on the basis of the relevant facts, and very different from deciding not to section ‘because of’ race or over-representation.

Obviously in the VC case, following that consideration, the decision made should have been to section this clearly highly dangerous individual, because that is what the facts before the decision makers should have indicated very clearly. It is absolutely unforgivable that decision was not made, and we need to know why - but I don’t think that fact means that having regard to over-representation (of any sort) as part of the background ‘thinking check’ in making a decision on the facts is necessarily a bad thing in itself.

Of course, I appreciate some decision makers may be incapable of understanding how these kind of ‘have regard to’ checks are meant to operate. Maybe that is what happened here? If so this needs to be brought out and there an issue about the education & capability of decision makers.

Oh yes, I agree with that - targeted outreach programmes where a particular need has been identified etc. I’m not suggesting that’s wrong.

I was just making the point that obviously we can’t unlawfully discriminate on grounds of race to exclude someone from say NHS mental health services and it’s also not ok to look at someone clearly a danger to the public like Calocane and not apply standard public safety guidelines on grounds of his race.

Why would applying for funding that supports mental health be against their charitable aims?

If your charitable aims are to support ALL under 25s, then taking funding that restricts you to only supporting an arbitrarily defined subset and you don’t raise adequate funds to support the rest of the under 25s and have to exclude them from support altogether then you are not fulfilling your charitable aims of supporting ALL.

I’d say it’s arbitrary and discriminatory to restrict your mental health support to particular people on grounds of race as it is not an overriding factor that would supersede need. Ethnicity may be a factor in level of need but in mental health support, clinical need not racial quotas should be the main assessment.

Pp mentioned a group of Bangladeshi grannies who only wanted to help Bangladeshi kids with mental health problems and not others, why not black kids? If I set up a charity that only helped only Caucasian kids there would be riots.

Otherwise, any charity can set up and then just ignore its charitable objectives ‘because the funding made me do it’ which I’m not sure would wash with the Charity Commission

I think that thread really didn't shed much light. Mainly because people just kept shouting that of course it was ok to give special support to specific groups, without bothering to get into where that would cross over into unethical actions.

I mean, with your Irish Catholic group. If I started a business that was intended to produce shoes only for Irish Catholic men, I wouldn't be allowed to do that, even if it was a completely privately owned business. I would not be allowed to turn away Presbyterians or Jewish people from my shoe shop.

On the other hand, what if I endowed a charity to provide free shoes only to Irish Catholic men? Could I turn away Presbyterians or Jews who were equally in need of shoes?

People tend to say, well, a private person can give their money where they choose, which is true of me as an individual, but I own a business privately too. But we regulate businesses and how they can serve (or not serve) customers due to protected characteristics like race or sex. If we wanted to, we could equally regulate charities, or government services accepting charitable money, in a way closer to how we treat commercial businesses. We could be more( or less) strict about circumstances where exceptions are ok. We could treat differernt protected characteristics differently.

That's really the substance of the discussion.

I think it's a little more complicated than this. For one thing, differernt protected characteristics have differernt qualities.

So ther emight be services we only offer to people with relevant disabilities, or even something like special parking arrangements, or door to door bus service. Or with sex, we similarly offer sex specific services in terms of things like maternity care, or even separate hospital wards or sexual assault services.

Race or ethnicity (and I don't really like to use them interchangably but I think in this instance it's reasonable,) is much less clearly the same kind of thing - these are really cultural constructs, not like sex or disability where there are objective material differernces that effect people.

However, there are real cultural effects people can feel due to these kinds of protected characteristics. So maybe you come from a definable community where many women are afraid to go to the doctor, so you design an outreach program for that community in particular. Or where I live there was at one point a health outreach initiative for black men like this - it was identified that certain information wasn't getting to this group, so there was a targeted initiative to raise awareness.

The questions raised in many ways are around where we draw lines with these things. It seems clear that some can be legitimate, while others aren't - and we do need to define explicitly how we decide.

The grants are typically provided for groups where there is additional identified need though. The homeless charity I worked in had a funding stream for Irish Catholic men. Technically it wasn't defined as 'only for whites' but I don't think I ever met anyone who had that support who wasn't white. It was part of funding through the church, and dated back to the days when many Irish men came to work as labourers and were widely discriminated against in society at that time.

I hadn't been on the original thread about mind for a while and didn't realise how long it had been, I can see I'm repeating the sort of answers previously shared by posters who I assume work in the charity sector who have explained already how it all works. I'm assuming this thread has been started because the OP didn't like the answers they got first time round, I'm not sure what the point of rephrasing the title and starting a new thread is really.

With healthcare that is signposted as a universal service I can understand that there are still needs that require extra funding to widen participation for groups who are not seeking treatment. But once at screening and triage and not to prioritise the severity of needs has to be verging on unethical. There is a difference of a charity that is focused on particular group than a service offered for a wider population that then within itself creates a hierarchy that is not focused on need.

If thats the case they need to change their charitable objectives, they can't just stop helping a subsect of their core service group because they choose to apply for a specific type of funding that excludes 1 subsect or another.
Think of it this way a MH charity is set up for all young people but takes a grant thats just for white people so they say to all black people we only have funding for whites so we cant help you anymore even though our charitable aims are to support both white and black young people with MH problems, surely you could understand why that would be wrong.
Oh BTW if the non binary person is female then by law a women's charity cant refuse them service as that would be illegal discrimination, it would be legal discrimination to exclude any male non binary people from a woman's charity as they are men

Also I'm not sure if the reference is to MIND as in the national charity or the local branches, but in our area MIND definitely don't receive the majority of their funding from NHS. There's different mental health charities that have the contracts with the NHS, some of who focus on 16-24 year olds, and some who focus on adults with drug and alcohol addictions so I'm guessing you'd want them to be shut down for discrimination too. There's very little 'generic' support in our area (other than the MH support via a GP)

Why would applying for funding that supports mental health be against their charitable aims?
And 'funding' isn't used as an excuse, they are legally bound to honour whatever parameters are set by the provider. If they apply for a grant where the provider has specified the funding is to be used to support female victims of domestic abuse for example, they aren't allowed to use that money to provide support to male victims. If they want to do that, they have to find another funding stream. Charities apply for as much as they can but there's no guarantees.
Charities have to adjust their services all the time, when I worked for homeless charities we rarely got funding for more than two years at a time from a council, or grants that would cover costs of a particular project for more than a year. It was always a balancing act.

Curious why you think its arbitrary and discriminatory if it's providing a service to a particular ethnic group, and not say, if it's a women's charity that isn't providing services to men or non binary people. And if it's because you think that it's because the charity wasn't set up to only support that ethnic group, what if the reason was that a different charity won the grant they'd previously relied on, as that's a common issue? Or perhaps the grant no longer exists, should they close because the only way to be 'fair' is to make sure no one gets any help?

Yes, you’d be amazed at how many people I’ve come across that are unable to comprehend or accept that fact.

Quite. And in the same way that it is generally unlawful discrimination to withhold requested services on grounds of race (even if that race is Caucasian) , it should be unlawful discrimination to not apply the usual standards for public safety and detain dangerous people.

Sadly, due to a decision based on some imagined ‘race quota’, 3 people were murdered by Valdo Calocane.

No charity should be applying for funding that doesn’t match its charitable objects though.

And they certainly shouldn’t be withholding services on arbitrary or discriminatory grounds using ‘funding’ as an excuse.

I don't quite see this as being similar? It's not good, but it's a different kind of problem.

Similar thing with Southport ( I refuse to use his name) His school teachers knew he was dangerous but were forced to strike it from their report because it was deemed to be racist. Of course we know what happened next..
The person responsible for this should be charged with being an accessory 😡

For your first paragraph, one option might be to say that funding can be limited by medical need, but not group characteristics. In particular, when donating the funds to be used by a body like the NHS.

So, I can say, I am raising money for people with sickle cell disease. I can't say, I am raising money for black people with sickle cell disease.

Which would effectively be a limit on what kinds of funds groups like the NHS could accept, and maybe even a limit on private health care providers.

I think we are seeing an interesting problem becoming an issue that we haven't really had to address in the past in the same way.

I don't really agree that the real issue is cuts to government services. That has certainly made the problem come out more clearly but the underlying question is still there. There will always be limits to spending and the need to make choices about funding, so how do we make sure services offerered are fair?

That underlying question is around what is ok or not ok in terms of offering health services according to characteristics that are legally protected. In particular, how direct the relationship needs to be between the service and the medical need.

Everyone recognises that there can be needs like this, we don't need to offer services for the visually impaired to those with normal vision, it would not be more "fair" and it would be a waste of resources. But what about when the relationship is less direct? How do we decide what counts as a "need". Because in the end, services are for individuals who need them, not for abstract groupings.

The big issue in this example is if there is private money being offered to health care services, to what extent is it allowed that the donor can determine who is allowed to benefit from those funds, especially when it involves a characteristic that is is not legal to discriminate on the basis of.

That would be a fair point if they weren't 90% funded by the NHS for all young people and if they could explain what they ment by "culturally diverse" which when asked they couldn't

Gender is not a protected characteristic and should not be asked about on a diversity questionnaire as its a gdpr breach to hold that irrelevant data.
Sex however is a protected characteristic and is allowed to be asked about on diversity monitoring forms, its also the characteristic that you were confusing with gender.
The WI have just had to kick all the men out who claim to have a gender identity because they were being sued by a man without a gender identity who they wouldn't let join and they were about to lose and faced losing their charitable status because they were allowing a subset of men join against their charitable aims as set out in their founding charter, so probably not the best example for you to use