Allocating mental health resources based on racial assumptions

[Sassiskt]

We had a thread last week where the charity Young Minds declined an application for services due to the applicant not being ‘culturally diverse’ enough. Many posters were pompously told that many from culturally diverse backgrounds struggled to access services and that’s why this white middle class posters child was declined.

Many others pointed out that it would be fairer for every applicant to be treated as an individual with individual needs, and not as a stereotype of any aspect of their identity. I did therefore find it interesting to read that Valdo Colcane was not sectioned despite showing text book symptoms of extreme psychosis due to the fact that we apparently section too many black people and they didn’t want to seem racist.

When are we going to get to a stage where we are assessed for who we are and they symptoms we are displaying without someone with a quota deciding that we are too white / black / middle class / straight / gay / Irish etc etc to have X wrong with us? Since when did the public sector develop such tunnel vision and see us as just statistic probabilities rather than people? It’s so demeaning. And in this case if had tragic results. I hope all involved are reassessing their farcical, dangerous actions.

https://www.theguardian.com/uk-news/2026/feb/23/nottingham-killer-valdo-calocane-race-mental-health-inquiry

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.

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.

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.

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.

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

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.

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.

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.

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.

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).

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?

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?).