By Zara Alansari, Theo Bennett, Alexandra Birch, Eleanor Bootman, Yang Chen, Isobel Dye, Natalia Galindo Freire, Amelia Hope, Leah Kinzer, Guendalina Magnoni Stella, Brock Reeder

You can watch Health Secretary Matt Hancock's speech 'We must bring the Mental Health Act into the 21st century (0.00 - 9.00 minutes) or read the transcript HERE.

Introduction: Medicalisation and Responsibility

Medicalization and Autonomy: A New Concept?

Brock, Amelia & Theo

The conflict between individual rights vs societal responsibility relating to the care of individuals receiving compulsory mental health care is one of the central ideas underpinning Matt Hancock’s speech “We Must Bring the Mental Health Act Into the 21st Century.” Mr. Hancock views compulsion with regards to mental health care as an outdated concept, claiming “That the act goes too far in removing people’s autonomy and does not give people enough control over their care.” and that “The Mental Health Act was created so people who have severe mental illnesses and present a risk to themselves, or others, can be detained and treated. For their protection and the protection of those around them. But so much has changed since the act was put in place…” Given his claim that our understanding of mental health treatment has advanced to the point of understanding the need for the medicalization of mental health in order to support the autonomy of the individual and their loved ones, it is worthwhile to explore how mental health was medicalized in the past, what role the individual and their loved ones played in influencing their care, and whether the proposed changes are an advancement beyond that.

Asclepeia were temples and therefore, public buildings, and so were funded either by poleis, or by individual sponsors such as kings or, in the case of Athens, wealthy individuals fulfilling the societal obligation of a liturgy. Healing was not limited to Asclepeia, however, and healers such as the famous Hippocrates were known to have acted as traveling physicians (although, Hippocrates is referred to by Plato as “the Asklepiad” in Protagoras, implying that he was a descendent of Asclepius. The famed Asclepeion of Kos was built in his honor, and he was one of the first medical scientists to view mental illness as having a physical etiology, rather than a divine one). These traveling physicians probably learned their trade as apprentices to their physician fathers.

Although Asclepeia were often publicly funded (as were some independent practitioners) and had pre-structured courses of treatment, individuals brought themselves to supplicate healing in them, and those who were incapable of making medical decisions for themselves would have been brought by family or friends, as healthcare was a private concern. Care for others was governed by the concept of φιλανθρωπία (philanthropia), which carried an expectation of reciprocity. The cult of Asclepius was merely a tool in assisting individuals and their loved ones in their responsibility for care, and the funding of its temples and operations was a way for wealthy individuals or governments to engage in philanthropia on a macro scale. Thus, they were primarily used to treat illnesses too severe to be handled by loved ones. However, if an individual was too ill to seek out care, didn’t have a family to help, and/or the treatments didn’t work, they would usually end up on the street (a “nightmare situation”).

Given these examples, it is clear that neither is the medicalization of mental health a new concept nor is the importance of the role of the individual and their loved ones in making decisions about care. The advancement that has been made is one of understanding the importance of the state as a safety net for mental health treatment. What Mr. Hancock is proposing is therefore a slight regression in some respects. However, with the lessons we have learned firmly in mind, this is almost certainly a positive change, as long as a proper balance is struck.

Medicalization

To discuss our proposed question in relation to the speech and the topic of mental health, it is important to establish a working definition of what ‘medicalization’ means. The term literally means having a human condition treated within a medical perspective with medical language and intervention. Understanding this is crucial as Peter Conrad states in his journal article Medicalization and social control, “The key to medicalization is definition. That, is a problem, defined in medical terms, described using medical language, understood through the adoption of a medical framework or “treated” with a medical intervention.” Pre-enlightenment thinking associated mental illnesses with supernatural forces that required spiritual healing. However, as medical knowledge expanded in the 17th century, a more scientific approach was applied to mental health, “Medicalisation … provided explanations for the development of mental illness and also indicated ways of treatment. It completely altered the conceptualisation of mental illness, including social attitude and terminology.” The fact that science-based knowledge was being applied to mental health seemed encouraging. However, treatments and detainment were and are damaging, suggesting that the medicalized understanding of mental health did not and does not correspond to how we should morally treat people. Throughout history, there has been a gap between rhetoric and reality that must change.

Detention

One of the critical reasons for reviewing the 1983 Mental Health act was the alarming increase in detention cases. According to Sir Simon Wessely,

the number of people being detained has increased by 47% in the last decade, alongside the fact that people from ethnic minorities were subject to a higher risk of detention. Within the 1983 MHA, a patient’s nearest relative was given right over the patient’s care which, in some cases, is detrimental to a patient if they do not have a healthy relationship with their nearest relative. Therefore, it is encouraging that the 2021 mental health act is including a review of patients voices regarding their care, giving patients the right to choose their nominated person. However, despite the repeated use of the word “detain” and acknowledging how it has alarmingly increased, there is a lack of discussion on how this process will actually change. Within the Oxford English Dictionary, “restrain” and “stress” are two synonyms for the word “detain,” highlighting the negative associations the word possesses. The 1983 MHA meant that over half of the patients being detained were not voluntary; instead, they were enforced without consent rendering many people vulnerable and stressed. Given the highly negative association with the word itself and the process, the reality of detainment must correspond with the changing rhetoric surrounding the word and its process, making it less sinister and more about treatments and care.

Responsibility

Because of the lack of understanding and certain historical and literary rhetoric surrounding mental conditions, there is a perpetuated fear and dismissal of acknowledging it. Understanding a certain medical condition has been placed upon the individual rather than asking society to help reduce the problem. Social constructs and stigmas perpetuate conditions associated with mental conditions, such as depression and anxiety. However, the emphasized onus for this is placed upon the individual rather than a society. Antonio Maturo notes in his research 'Medicalization: Current Concept and Future Directions in a Bionic Society', “considering illness as an external risk, the responsibility to avoid it is shifted from social policy to the individual… Nowadays, health is increasingly considered an individual responsibility…Therefore, prevention is socially constructed as an individual duty”. In order to create positive and progressive change, the stigma and rhetoric surrounding mental disability and conditions have to be broken down, and we, as a society, need to take active responsibility in encouraging this. The 2021 speech does acknowledge this, “I believe that everyone in our society has a contribution to make, and I believe everyone should be respected for the value they bring”. The fact that this is being said is encouraging. However, there needs to be greater awareness of what we can actively do to create change instead of just saying it. For example, discussions in schools, conscious thinking about the language we use, making it an open and safe space to talk, this way, the way we approach mental health will become less stigmatised. To bring mental health into the 21st century then, we need to recognise that mental health is a collective responsibly that needs to be an active process instead of passive discussions. Instead of just stating what needs to change start saying how it will change.

Mental Health Ontologies

Any conversation about attitudes towards mental health is likely to fall short of providing an honest, complete picture of the topic in hand if it fails to confront the thorny question of what we actually mean when we talk about “mental health” or “mental illness”. It is not a particularly straightforward question to answer, which is what makes its entire avoidance appear so appealing. But to do so would be to give implicit support to an alarmingly dangerous presupposition: that the essence or substance mental health is immutable and definable, and fully comprehended and known.

Janna Hastings, an ontologist and self-styled “knowledge scientist”, published her work Mental Health Ontologies in 2020, a book which discusses why so much disagreement continues on the definition of the nature or essence of mental illness, and why problems will continue to arise as long as no definitive, final conclusion is reached. She identifies three principal ways that mental illnesses are conceptualised, and how attitudes and behaviours in this domain vary depending on the terms that are favoured. I will attempt to outline the factors motivating each of the primary conceptualisations of mental illness. It must be noted that each is supposed to reflect in non-absolute terms an observed, broadly systematic but general approach to mental illness, rather than present a precise definition. An individual may have an understanding of mental illness that draws upon two or more of these frameworks – and, in fact, a perspective that combines all three to some degree may really be the most helpful.

Thomas Szasz:

"Unlike true diseases of the brain and body, mental illness is a destructive social construct that medicalizes living and deprives people of their dignity

…

True freedom means taking control of and responsibility for our choices and their consequences. Neither psychotherapy, drugs, nor the power of our techniques will restore a client’s personal sense of agency."

Sociological

The Hungarian-American academic Thomas Szasz is one of the figures most associated with scepticism with regards to the concepts and language of mental health. His book The Myth of Mental Illness sent ripples through the world of psychiatry and psychology upon its publication in 1961, igniting a debate that would rage for decades to come. Szasz argued that there was no inherent reason why conditions of the mind should be characterised “medically” in terms of symptoms and conditions, as they are not constituted of the same matter as illnesses of the body.

Among Szasz’s core postulations was the claim that medicalisation in the domain of the mental constitutes an attack on the agency and freedom of an individual. It enables them to shirk responsibility for their actions whilst also making them more vulnerable to coercion by those wielding clinical power. Similar themes crop up in the work of French philosopher Michel Foucault.

Because mental illness is so hard to define in exact terms, Szasz argues, there is theoretically no limit to the reach of the areas of consciousness that may be subject to diagnosis, ultimately handing over control of all aspects of lived reality to those to which power is bestowed under the guise of medical expertise.

Szasz’s provocative ideas failed to take hold and current clinical practice moves ever further in the opposite direction to Szasz’s proposals. Understandably, many might find themselves averse to an attitude that might come across as more than a little paranoid. Crucially, a major gripe with Szasz’s sociological approach could be that it appears to deny the existence of mental illness. Indeed, this is the fatal flaw in a purely sociological approach that deems mental illness to be purely and exclusively socially constructed, brought into existence solely by our belief in it and ideas about it. To expunge entirely the established terminology of mental health from our vocabulary – as Szasz advocated – would be to throw away the most important tools we have at our disposal to develop our understanding of this area of consciousness and facilitate the creation of environments that allow for happier living.

But it may be that this can be true while it is simultaneously acknowledged that the words and the concepts to which they are tethered have an effect on how our experience of mental health is shaped which cannot be ignored. If we take the view, as I do, that the relationship between ideas and experience is one of endless feedback in both directions, as experience informs ideas which likewise overlay and partially constitute experience, there is surely something significant about how this process manifests itself in the discourse surrounding mental illness, a phenomenon inextricable from the lived experience of reality itself.

Mark Fisher:

"I want to argue that it is necessary to reframe the growing problem of stress (and distress) in capitalist societies. Instead of treating it as incumbent on individuals to resolve their own psychological distress, instead, that is, of accepting the vast privatization of stress that has taken place over the last thirty years, we need to ask: how has it become acceptable that so many people, and especially so many young people, are ill?"

Psychological

The approach to the understanding of mental health that is most evidently the product of the theoretical and analytical tradition pioneered by Sigmund Freud and the psychoanalysts of the early 20th century is that which we may dub the “psychological” definition. It emphasises the subjectivity of mental health. It has as a general principle the idea that mental illnesses are interpretable, and that their causes can be found by analysing the history and personal circumstances of the individual in question. This approach often rejects the idea of mental “illness”, based on the grounds that an individual’s psychological state must not be defined relative to a perceived “norm”.

This perspective on mental illness may be best equipped to contribute towards the de-stigmatisation of mental illness, rejecting the existence of objectively good or bad or right or wrong mental states.

Some commentators have observed a connection between the growth in acceptance of the core tenets of the psychological approach and the ongoing process of increased individualism most starkly noticeable from the start of the latter half of the twentieth century onwards. Theorist Mark Fisher critiqued the framing of mental illness according to the individualised psychological approach within his works making broader comments on the problems inherent in the capitalist logic by which modern Western societies operate. He argued that the framing of mental illness as something belonging to and coming from within the individual allows for the evasion of the acknowledgement of the systematic ways in which living conditions in the present are making us more and more stressed, anxious, and depressed.

Biological

Mental illnesses can be defined as physically existing entities that can, at least in theory, be scientifically observed and measured. Alzheimer’s disease is an example of a condition generally considered to belong to the category of mental illness but is primarily defined in biological terms. The biological aspect of mental illness might be preferred by some who find by showing that mental illness is provably physically real, it is therefore more legitimate. It is an approach that can tends to assume an exact equivocation between mental illness and other types of illness.

Responses to the 2021 Mental Health Speech

Conclusion to the responses

Considering these responses to the 2021 Mental Health Act and the subsequent White Paper, it is evident that there is a balance of encouraging signs and lack of clarity. Whilst the proposed changes on patients rights and funding are welcomed, there now needs to be an updated definition of detention which can only be achieved through physical practice, not just rhetoric. There is a lack of consideration for the actual conditions that the patients have to endure. While the proposals of the speech seem inviting, however, its reality is ambiguous and vague. Furthermore, whilst the speech repeatedly emphasises that we have a responsibility as a nation, it does not state how, as a society, we can help implement these changes into our daily lives to make our daily living experiences accessible for everyone. The reality of these practices need to match the encouraging rhetoric.

Responses to the treatment of and discussion around Autistic people in Matt Hancocks Mental Health Act Reform Speech

Eleanor, Isobel & Guendalina

The screenshot of Steven Kapp's work above gives a brief introduction to the Neurodiversity movement. It could be argued that the by demedicalising the treatment for autism, the new mental health act reforms are contributing positively to the movement. However, Matt Hancock's speech as well as the full white paper, does not directly refer to neurodiversity. This implies that there is still a lacking of motivation by those dictating policy to listen and respond to the needs of the neurodiversity movement.

Practical implications of ‘detention’ and autism

Stringent emphasis on community led services is what Matt Hancock should have championed. During the pioneering stages of this project, we asked ourselves both what is said and what is left out of the speech and the white paper. It is ironic that Matt Hancock chooses to ignore the British governments role in the marginalisation and distrust between black and minority ethnic groups and health services. As the ‘experience of abuse, violence and other forms of negative treatment’ are part of the experience of treatment in the UK. This is not an example of one bad egg, or a bad apple, or a form of inter personal racism but a systemic issue that needs to be reformed. To ignore the British governments role within the maintenance of white supremacy within all of its institutions is to mislead the marginalised groups you claim this act is for. What is a cultural advocate when black women in the UK are four more times as likely to die during childbirth? What is an advocate when their pain, mental or otherwise is not believed? When they are perceived as ‘aggressive’ and a ‘threat to life’ rather than as someone who is suffering. Detention will not solve the issue of racism in the UK, but it will prolong it, and I implore the audience to draw on the works regarding the new Jim Crow— as the disproportionate misuse of section three is one and the same with mass incarceration within America

Within the white paper, use of detention is continuously called ‘inappropriate’ but nothing is done to acknowledge previous wrongdoings nor the hundreds of people previously determined. He insists that ‘the detention environment can fail to meet the specific needs of this group’ and goes on to claim that autism or mental illness alone is not enough to detain someone under section three. This is misleading, and arguably a lie from Hancock. Later within the speech it states that one can be detained for being a ‘danger’ or a ‘threat to life’ and then detained for up to 28 days to see if they then ‘develop’ or have a mental health condition as well. Despite stating that the detention environment will worsen autistic people’s conditions, Hancock also does not see any other way to treat people. He acknowledges that detention will result in a ‘deterioration of their condition’ but does not offer any alternatives. Autism is not something that can be cured, and nor should it be, and detaining them within environments that will worsen their condition which will result in a longer detention is a cruel misuse of the NHS. By the end of the white paper, he claims ‘we want to limit the scope to detain people.’ This is not a promise nor a policy, this is a hypothetical. They ‘want to limit it’ but have not introduced any practical examples of them doing so, as learning disabilities are still grounds for detention.

• The surface level reform shown within his speech is arguably more harmful to those within the autistic community. Emphasising ‘appropriate advocates’ without dismantling the impact of white supremacy within the medical field shows that Hancock cares more about what looks good rather than what will help the most— having detention as the only available resort because of underfunding proves this. If he genuinely cared about racial equality he would invest more into community led resources within these underfunded areas.

The ignorance of the patriarchy under medical science research.

Zara & Yang

According to Merriam-Webster dictionary, the word 'people', refers to “human beings making up a group or assembly or linked by a common interest”. 'People' is a collective noun, which is used when referring to a collective group or indeterminate number. In Matt Hancock’s speech, he indicated the collective group for which the Mental Health Act applies by using this word. Considering the diversity of the society, the different situations of mental health problems exist within different groups of people in terms of their gender identity or race, etc. It is not representative enough to summarize all of the individuals in the society and the over-generalized use covered up the latent factors of medicalization in many aspects. The diction seems to be irresponsible for ignoring the diversity of the society.

In general, as introduced in previous sections, medicalisation is the term to define the process “by which non-medical (or social) problems become defined and treated as medical problems, usually as illnesses or disorders.” The concept was first brought up in the 1960s. Since then, it was widely discussed and its realm stretched out to many different human behaviors. Some actions that were once regarded as immoral or sinful are now described as sickness, some common life processes such as reproduction and death have also undergone with the process of medicalization.

Women’s life experiences have been more medicalized than men’s according to the differences of their physical structures. The experiences which are unique for women such as infertility, menopause, reproduction, premenstrual problems, etc., are nowadays been treated as medical problems. Some biochemical and cosmetic surgeries are welcomed by women, for example, breast augmentation, liposuction, rhinoplasty (nose reshaping), blepharoplasty (eyelid surgery). There are also many medical surveillance and interventions for women body such as mammography, pap smears, prenatal care and testing and so on. Studies show that in the 21st century, there is a tendency that men gradually fall into the gaze of medical surveillance. Men also turned to cosmetic surgery such as pectoral/calf implants, steroids, and treatments for baldness to enhance their appearance.

Apart from the physical differences, we are going to delve into the gender differences of mental health between men and women, indicating that mental disorders can also affect men and women differently, to prove that the diversity is so significant that it should have been mentioned in the speech.

The medicalization of PMS and its related diagnoses is controversial. Some people have advocated for the medicalization of PMS, so as to legitimate distress related to PMS. However, the medicalization is also regarding natural female body and its biological features as in need of normalize and treatment.

As for the psychological problems both men and women suffer from, significant differences exist in terms of gender differences. Overall, the Adult Psychiatric Morbidity Survey suggested that women (19%) are more likely than men (12%) to experience a mental health condition. An estimated one in 20 women (1.2 million women) in England have experienced extensive patterns of physical, mental, and emotional abuse throughout their life, including being physically and sexually abused as children, raped as adults, and subjected to severe violence in adult relationships. A majority (54%) suffer from a mental illness, while a third attempt suicide).

There are clear links between domestic abuse and mental health, in both directions: exposure to domestic abuse can cause mental health problems such as depression and PTSD, and people with mental health disorders are especially susceptible to domestic abuse and sexual abuse. Women are nearly five times more likely than men to have experienced sexual assault. Around three times as many young women and girls aged 10-19 self-harm as men, and the reason for it is by far unknown.

The notion of ‘hysteria’ is understood as an assumption in which women are more overwhelmed by their emotions than men are. The symptoms associated with ‘hysteria’ includes shortness of breath anxiety fainting sexual forwardness and agitation which initially came from the Greek term ‘hystera’ which actually means ‘uterus’ — this already directly enforces this ‘mental illness’ this onto people that have a womb. So those in power can elude those with wombs into thinking they were the dominant sex. It stopped being a diagnosable condition from the 1980s and instead of identifying it as a female disease as Freud explained, now we would understand hysteria as included in dissociation disorders, for what we know as anxiety alongside the typical ‘hysteria’ symptom of nervousness and irritability.

A lot of these symptoms focus on the physical, such as weakness or pain causing distress and difficulties with normal functioning, however, the way in which men and women function physically are different as in men are generally stronger and taller than women, leading to the assumption women are too fragile and sensitive for any ‘real work’ so instead push women into staying inferior to men, for example, being encouraged to ‘provide for their husbands’ and look after children.

For instance, if you look at this in the 20th and 21st centuries we now understand that hysteria is not a real psychological disorder it's not a female disease it is a form of control and this has been proven through medical research through a greater understanding of what mental health actually is, which in many ways, the ‘symptoms’ affect men too so obviously it couldn’t have been accurate in the first place as a ‘woman disease’. However, this categorises women as inherently being in need of medical and mental help, at the submission of being 'helpless' to men.

Hysteria has not only effected women, in fact, it is arguably the reason why suicide rates for men are higher than women’s, and why men may not discuss their mental health traumas. This is because of toxic masculinity and the idea that men must remain completely levelheaded and without fear of looking 'hysterical', like a woman.

But the lasting effects of this notion of the fragility and overall stereotyping of women into post-modern day — for instance, viewing women as fragile and overwhelmed by their emotions, alongside the concept that men are the most strong and omnipotent beings, is enough to subside women into a position where they are expected to fail as an expectation of their ‘fragile’ and ‘incapable’ sex — leading to things such as, the glass ceiling, which might not even be male dominated, but because of this influence of gender biases and stereotypes women arguably have to ‘prove’ themselves as not being hysterical and essentially as ‘dominant as a man’ while remaining feminine, as well as showing full capabilities of raising a family, all while staying level headed and really not being viewed as anything more by men and the media as this “inherently delicate sex”, women can't win in a world built for men.

This is contradictory as although women are deemed mentally and physically lesser than men, meaning men must be mentally and physically stronger than women, men’s health has always taken priority even though they claim they aren't 'weak' physically or mentally as women have been labelled to be. Although we have seen improvement in the equality between men and women in health care, this concludes an incredible lack of respect towards women as through mental health and medical care history. This is precisely what Matt Hancock fails to acknowledge in his speech, as he talks about people as a whole, "Our mental health services are now helping more people than ever before", however, Hancock does not explain exactly who he is talking about as 'people' is far too generalised, and some would argue, brushes over the history of women and the fights of feminism within health care. Demonstrating Hancock as stuck in an intransigent position of ignorance towards the history of women's health.

Women manipulated by gender and racial ideologies

It is becoming increasingly popular for Asian women to undergo cosmetic surgery in recent years. When considering all types of cosmetic surgery, rhinoplasty (nose reshaping), blepharoplasty (eyelid surgery) were the most popular‌ ‌choices. In Eugenia Kaw’s research on the medicalization of racial features (1933), Kaw examined what motivated Asian American women to undergo cosmetic surgery to change their facial features. These procedures are intended to correct the defining features of Asian faces, the "slanted" eyes and the "flat"‌ ‌nose. And it is also an attempt to escape from the racial prejudice and rooted stereotypes of the correlation between the physical features and negative characteristics. Those with pathologized Asian features crave cosmetic surgery to enhance their appearance, which causes them to feel anxious about appearances. The‌ ‌ideal outcome would be closer to the characteristics of western genetic physical features.

Moreover, following the trend of consumer-oriented society, this idea can grow rapidly. At‌ ‌the‌ ‌same‌ ‌time‌ ‌that the medical system advocates women's right to pursue beauty, it also maintains a beauty standard that requires Asian American women to modify their racial features.The‌ ‌pathologisation of Asian features combined with the manipulation of the market led Asian women to become morbidly fascinated with cosmetic surgery.

The speech in regards to race and ethnicity

Problems with 'detainment' from a racial standpoint

Leah, Natalia & Alex

Those who are deatined are held against their will for their own or others’ safety. Detainment must only be done with the intention of assessment or treatment of someone with a mental health problem. Detainment should not be the first choice from a mentally ill person’s healthcare professionals: other options, such as being an ‘Informal Patient’ - someone who can choose to leave a hospital - should be considered first.

The problem in practice is that many people get prematurely detained, especially non-white groups. Superficially, this is what Matt Hancock’s speech intends to resolve this problem by stating that the government now intends to detain less BAME people. However, how would this work in practice?

Negative Racial Connotations: The modern associations with the word also colour its meaning. Google trends data for this word show that it was most researched in 2018 - when the public scandal of Donald Trump’s ICE forces were detaining Mexican immigrants and refugees in cages, including children. They were barbaric prison-like captivity which lacked basic human rights, like storing children in cages and unjust deportations. Since this is the most common meaning associated with detainment, the word choice remains controversial and peculiar given the negative associations in recent years.

Additional Linguistic Issue: The word 'detainment' is rarely used and thus obscure to most English speakers, espcially non-native speakers. The various definitions of the word may lead to confusion of the listener and therefore obscure Matt Hancock’s meaning.

Are these 'real' terms? If so, should this type of medical data be gathered?

It can be argued that these terms lack utility for two primary reasons. Firstly, geneticists concur that race and ethnicity are not real from a biological standpoint, since the terms only describe the physiological. Secondly, ‘race’, ‘ethnicity’ and ‘nationality’ are remnants from the age of nationalism used to classify humans. In the past, these terms were used to serve nationalist goals of independence or unity and support a political goal. In a postcolonial world, ulitising such terms for humans may seem even foolish.

Hence, if these are unscientific terms it may seem peculiar that the U.K. asks for this information on medical documents. The reason is that even if the words’ initial purposes may seem outdated, they serve a purpose now because that is how we perceive ourselves. We continue to view our world in terms of 'race' and 'ethicity'.

This data is collected so that the disparities in treatment between different races and ethnicities are known. If this data is recorded, we can spot trends and identify when a problem is occurring, such as BAME people being more likely to be detained. Data collecting data on these groups allows people to know who faces this discrimination, when and where, and how to stop or decrease it.

U.K. Race Data Collection and GP forms

To understand how different races are affected by the mental health act data must be collected. One of the simplest ways to do this is when patients register at GP practices have the choice to indicate their race, ethnicity and/or nationality. However, there are many problems with standardisation that make it difficult to collect this data.

Specific GP Forms

It is interesting that there are several caucasian/white groups listed on GP forms, such as White Irish and White British, creating a distinction between two nationalities as two different White ethnicities, whereas other racial groups are represented under an umbrella term, such as Asian and Arab, with different forms sometimes recognizing specific countries. This is likely due to location of the GP forms in the UK relating to ethnic populations in the area, and the racialized history between the British and the Irish.

In contrast, another component we noticed is how the Hispanic/Latino/x ethnicity is not listed on any of the U.K. GP forms we found. This observation is interesting because this ethnicity is usually found on U.S. health forms or other legal forms (a source taken from the experience of one of our team members, who is Latinx and lives in the U.S.), which shows how the terms race and ethnicity can vary across the world.

How standardization of GP forms may assist data collection about difference races and ethnicities

A national (or even international) standardization process may help assist data collection. If all medical forms requiring personal information are the same throughout the country (or world) it may lead to better recording of data and thus a better understanding of ethnic disparities and how to address the issues surrounding racial and ethnic identity in the medical world.

The Evasive Passive: Race and Subconscious/Conscious Language

Another interesting aspect of Matt Hancock's speech is his use of the passive voice:

The article (Eunson, 2014) also uses the Google Ngram Viewer in order to identify the phrase “mistakes were made” versus “I made mistakes”. The phrase “mistakes were made” peaked around the time of US Prohibition and the Great Depression, both times of great political unrest, showing that the employment of the phrase was likely used on purpose in order to avoid accountability and backlash from the public. Therefore, we would have reason to logically conclude that Matt Hancock uses the passive voice intentionally. However, in their book Mistakes were Made (But not by me)” by Carol Tavris and Elliot Aronson, the authors argue that people tend to avoid blame through language often without realizing. For example, we as people will use psychological tools such as cognitive dissonance, cognitive biases, and confirmation bias (Tavris, and Aronson, 2020) to do so. The evidence from this book suggests that Matt Hancock likely shows his racial biases through his speech, either with or without realizing. Therefore, the question is not whether Matt Hancock uses the construction to avoid responsibility, it is whether he realizes he does or does not.

The further influence of language on our perception of race:

Sometimes the language we use surrounding conversations of race is as important as what we are saying. We may often show our racial biases through our language choices subconsciously. We can observe a case of the manifestation of racial biases through language in the following newspaper extract:

The second sentence of the extract is our focus in this example: “The three-page document acknowledged the achievement gap between white students and kids of color” (Staver and Mitchell, 2021). The separate categorization of the white children being ‘students’ while the non-white students being ‘kids’ provides a clear distinction into how the reader then views the academic abilities of both “groups”: the abilities of the white students are superior, thus they are given the title of ‘students’, rather than ‘kids’.

"Culturally Appropriate Advocates"

When discussing racial disparities in accessing mental health resources, Hancock briefly mentions something called “culturally appropriate advocates”:

It is difficult to find many resources independent from the UK government that use the specific term 'culturally appropriate advocate' or 'culturally appropriate advocacy', however we can find context in the Final Report of the Independent Review of the Mental Health Act 1983 published in December 2018. Here, cultural appropriate advocacy is described a comprehensive understanding for cultural differences within the UK, and an acknowledgement that people's different cultural, racial, and ethnic identities may affect the way in which they receive mental healthcare and access to resources (GOV.UK, 2018). The emphasis on cultural appropriate advocacy in this report specifically redresses imbalance of recovery resources for individuals of African or Caribbean heritage, and acknowledges that other social inequalities, which are not explicitly mentioned, have an impact on how these individuals receive care (ibid).

And finally, one interesting takeaway from the phrase “cultural appropriate advocacy” is its phonetic similarity to “cultural appropriation”. While these two concepts are immensely contrasting, upon first read, before discovering context, we were taken aback by this similarity, especially after doing research on the history of the connotation of the words “detention” and “detainment”.

Suggestions for further study

1. Make mental health an active process. Instead of just stating what needs to change, there needs to be an emphasis on how it will change. For example, our language cannot use mental health conditions as adjectives, we should treat mental health the same as physical health and we need to make discussions about it more regular, open and accepting. This way, we can start to bring mental health into the 21st century.

2. Ensure that autism continues to be de-medicalised and the neurodiversity movement is further promoted in government policy. This needs to happen alongside further investment into the community and social care sector, and finding safe alternatives to detention for autistic people.

3. Based on the facts and the severity of the problems, the government should put more efforts providing equal mental health services for male and female based on their needs. Equal funding for both men and women’s health researches can be an initial step. More efforts should be made to confront women’s mental problems and come up with reliable solutions.

4. There needs to be a consideration as to how race and ethnicity can be ambiguous and translate that into how we think/speak about it. It needs to be highlighted how certain people can avoid taking responsibility for racist or discriminatory incidents through the language they use. We need to advocate practical solutions for implementation of policies rather than vagueness.