Advancing mental health equalities: looking back, taking stock and looking forward

More than a year has now passed since the first national lockdown in response to COVID-19. This has been a year that has tested all of us, both personally and professionally, and with the Five year forward view for mental health also ending in March 2021, I find myself reflecting on what we have achieved and where we are going next.

I can still recall the sense of achievement and relief I felt when the Five year forward view for mental health was first published. As the Vice Chair of the Mental Health Taskforce developing the recommendations contained within it, I spoke of the stark reality decades of underinvestment in mental health was having on communities most in need. I also emphasised the urgency to thread throughout the recommendations our focus on addressing inequalities. The promise of an increase of £1 billion for mental health by 2020/21 was such an important step for all of us, as was the promise to implement a number of specific recommendations to reduce mental health inequalities for people with severe mental illnesses and ethnic minorities (especially Black African and Caribbean communities and Asian communities) in secure care.

While there is much more to do, there are some achievements which assure me we’re moving in the right direction. These include:

  • The steady progress in improving recovery rates for ethnic minority communities in talking therapies.
  • Improvements in the collection and flow of data on health outcomes for groups with protected characteristics.
  • New approaches to secure care which are more healing and culturally informed.

The NHS Long Term Plan seeks to go beyond this, by creating a ringfenced local investment fund worth at least £2.3 billion a year in real terms by 2023/24 which will ensure that the NHS provides high-quality, evidence-based mental health services to an additional two million people. In  the past year alone, I have been proud to have fully mobilised the Advancing Mental Health Equalities Taskforce (AMHE), with the first ever strategy for advancing equalities in mental health care being published in October 2020.

Development of the Patients and carers race equality framework (PCREF) has also proceeded at pace over the past year, with the goal of supporting trusts to improve Black, Asian and minority ethnic experiences of care. The PCREF Steering Group led a series of online engagements with Black, Asian and minority ethnic patients, carers, staff and community members to unpack what contributes to good experiences of care for racialised groups, and groups with diverse cultural backgrounds. These engagements were strengthened by additional conversations with Black, Asian and minority ethnic LGBT patients, carers, voluntary and community sector organisations to account for intersectional needs, and engagements with senior health system leaders across England to ensure what we produce delivers on its promise to support mental health services to provide more culturally appropriate care.

The four PCREF pilot sites; South London and Maudsley, East London, Birmingham and Manchester, are in the midst of rolling-out grass roots community engagement programmes, in partnership with Black, Asian and ethnic minority-led community organisations. Each site is exploring what the barriers and enablers to good, culturally appropriate care are – and how services can operate differently to improve racialised experiences. Key to this is understanding how Black, Asian and minority ethnic community feedback can be acted on within mental health services. The engagement will last at least three months and the PCREF Steering Group and I are excited to learn how the PCREF can best facilitate the change we need to see, and how we can support services to act on feedback.

Another important milestone was the first 10 fast track NHS-led provider collaboratives (PCs) going live in October 2020, followed by a further nine in April 2021. NHS-led provider collaboratives seek to improve care for people who use specialised mental health services, through providing more mental health care in the community to prevent people being in hospital if they don’t need to be, and to support people to leave hospital when they are ready. Provider collaboratives will also be supported to tackle inequality and will demonstrate they are aware of local inequalities and of people who disproportionally receive poorer care as a result of protected (or other) characteristics, and this will result in strategic plans to address these inequalities.

Finally, improvements in the quality and flow of mental health data to national datasets continue to unlock new opportunities to analyse, feedback and act on findings. Public Health England’s Fingertips Profile continues to expand, allowing health systems and the communities they serve to look at differential experience and outcomes in their communities. This tool will continue to develop as data quality improves, becoming a rich source of information to inform population health planning and local priorities in advancing mental health equalities.

We have been steadfast in our determination to improve access, experience and outcomes for all populations across the country. Via the AMHE Taskforce and the PCREF, we have further sharpened our focus to deal with the inequalities within mental health services. That means that we are addressing the disparities and variations in access, outcomes and experience faced by people who hold Equality Act protected characteristics, with a special focus on racialised communities. We are certain that with our collective effort we will significantly improve these experiences and in so doing transform the narrative to one which demonstrates safe and trustworthy mental health services for all. Although this evolution has been too late for two of my younger brothers with severe mental illness, both of whom have passed, their contribution to propel us to do better is a legacy they would be proud of.

Find out more about the Advancing Mental Health Equalities programme (insert link)

Jacqui Dyer

Jacqui Dyer is an independent health and social care consultant with a background in adult mental health commissioning as well as community and family social work.

Jacqui has worked with a wide range of vulnerable care groups and has a strong passion in grass roots community empowerment. As an experienced counsellor, trainer, personal and professional development coach and group facilitator, Jacqui brings many dimensions to her insights.

As a mental service user and carer for the past few decades Jacqui’s experiential knowledge of mental health services is extensive and her commitment to this agenda is personal, political and professional. Currently she is a senior management board lived experience advisor for the ‘Time To Change’ anti-stigma and discrimination campaign. Additionally Jacqui was an appointed member of the Ministerial Advisory Group for Mental Health chaired by the Minister for Care and Support, which oversaw the implementation of the national mental health strategy and a member of the Ministerial Advisory Group for Mental Health.

Jacqui was vice chair of England’s mental health Taskforce, which collaboratively developed the 5 Year Forward View for Mental Health. Jacqui is currently the Mental Health Equalities advisor for NHS England and co-chairs the Mayoral ‘Thrive London’ programme.

Jacqui is also an elected Lambeth Labour Councillor where she is cabinet member for health and adult social care and is the chair of Lambeth’s Black Thrive; a partnership for improving black mental health and wellbeing.

Jacqui is also an advisory panel member of the Mental Health Act Review and co-chair of its African & Caribbean Working Group (MHARAC).