Breaking down barriers and fighting mental health inequalities

Throughout my career in mental health services, I have seen first-hand the devastating effects of different ‘inequalities’ on different groups. As a consultant psychiatrist working with homeless people, almost all the people I work with face inequalities, often simply in terms of access to food and shelter. Sometimes inequalities are felt in terms of prejudice and stigma on the street, or in financial terms, especially for asylum seekers and others who have no recourse to public funds. A stark fact embodying these different inequalities is that people who live on the street for significant periods die at an average age of just 43 years.

More generally in mental health, different groups have different rates of mental ill-health, sometimes depending on the inequalities they experience as a group. People from Black and Black British groups are both more likely to suffer with mental health problems, including serious mental ill-health such as psychosis and have worse experiences in mental health services when they use them. For example, this group are four to five times more likely to be detained under the Mental Health Act than their white counterparts and have higher rates of being restrained in inpatient units.

NHS England launched its Core20PLUS5 approach in 2021 to reduce inequalities at national and system levels, focussing on five key manifestations of inequalities. For mental health, one of the key focuses in Core20PLUS5 is on the current average age of death for people with schizophrenia, which is between 60 and 65 years (about 15-20 years prematurely). This is partly due to physical health factors such as smoking, diet, housing, exercise and so on; but is also because the medication they take for their mental illness can lead to obesity and even diabetes in some people.

So the NHS has some work to do to change this. It is also critical that we work together with partners to ensure that our approach translates into concrete improvements for the most vulnerable. This requires supporting the work of local organisations, charities and groups who make a real difference in the lives of their communities.

I recently visited charity groups in Sheffield working in partnership with the NHS to see how they are supporting different communities with their mental health and helping fight the inequalities they experience. One of them, Maan Somali Mental Health Sheffield, is a charity working with the local Somali community to address mental health needs. I attended a workshop where staff provided help and advice on mental health, but also on welfare rights and housing services. Speaking to those in attendance, it was easy to see how Maan’s workshops offered an invaluable space for people from the community to gain the support they need.

Often, there are cultural barriers to accessing mental health services as well. One woman at the workshop told me: “It took us a really long time to get to the point where we can say, actually, I have got a mental health issue, because it’s always been a very taboo subject.” Services like Maan are helping to break down these barriers and give people a safe space to talk about their mental health.

I was also lucky to visit Sheffield Flourish, a mental health charity that organises groups and activities for people in the community, allowing those with mental health issues to bond and flourish. I attended a women’s football class, where I spoke to a young black woman who told me how much the group had helped her both physically and mentally. Because this group is run by the community, for the community, it recognises the needs of the local population and tailors its services accordingly.

Visiting these services really reinforced my ambition to keep advancing equalities in mental health, which is a key commitment of the NHS Long Term Plan. In recognition of the social determinants of health and the need for a consistent approach reducing mental health inequalities, NHS England established the Advancing Mental Health Equalities Taskforce in February 2020, publishing the Advancing mental health equalities strategy shortly after.

As part of this strategy, the taskforce is establishing a Patient and carers’ race equality framework (PCREF), a mandatory anti-racism approach which has been co-designed to support trusts to improve ethnic minority community experiences of care in mental health services. I look forward to supporting the publication and roll out of the PCREF to all NHS mental health trusts across the country in the coming months.

In Sheffield, my birthplace and hometown, I felt proud to see some outstanding examples of communities responding to their own local needs and working with grass root organisations, and local public services, to make a real change. It is impossible to separate mental health from inequality, and there is still a long way to go to achieve equity for people from all communities and backgrounds. However, I am hopeful from the work I saw and the individuals I spoke to that progress has been made. We are on the right track, and we need to keep working hard together to break down barriers and fight mental health inequalities.

Inequalities in mental health

The Somali Mental Health Association in Sheffield meets with NHS Clinical Director for Mental Health Tim Kendall to discuss the impact of inequalities and stigma on people’s mental health.

The Sheffield Flourish charity offers support groups and activities for local people struggling with their mental health – this example of a women’s football group shows how being active together can help both mental and physical health..

Professor Tim Kendall

Professor Tim Kendall is NHS England’s National Clinical Director for Mental Health. He has been Director of the National Collaborating Centre for Mental Health at the Royal College of Psychiatrists for 15 years and Visiting Professor at University College London for the last eight years.

Tim has also been Medical Director for 13 years and continues as Consultant Psychiatrist for the homeless at Sheffield Health and Social Care NHS Foundation Trust.

As Medical Director, Tim has set up a service user experience monitoring unit, led the reconfiguration of acute care and rehabilitation leading to the elimination of out of area treatments, the modernisation of the acute and crisis care pathways and initiated the development of NICE recommended personality disorder services within the community.

He chaired the first NICE guideline, launched in December 2002, on the management of schizophrenia and the first National Quality Standard (Dementia) for NICE.

Tim has published numerous articles and papers and often represents the NCCMH, NICE or the Royal College of Psychiatrists in the media. In 2004, he was awarded “Lancet Paper of the Year” for showing the impact of selective publishing by the drug industry about antidepressants in the treatment of childhood depression; and with others was awarded the Paper of the Year Award for the Health Economic Journal ‘Value in Health’ in 2012 for work on schizophrenia.