The statistics for racial disparity in mental health services are familiar and still shocking. Despite numerous cross-government efforts over the past 10 years, Black Caribbean and African people remain consistently overrepresented in mental health detention and are far more likely to come in contact with mental health services through the criminal justice system. Similarly, though there have been gradual improvements, the IAPT recovery rate for Black and Minority Ethnic (BME) service users is below that of their white-British counterparts (49.9% recovery compared to a 53.9% recovery for white-British IAPT service users in March 2019, an increase of 1.7% BME recovery from the previous year).
There are multiple intersecting factors which contribute to these and other inequalities, such as stigma, discrimination and environmental factors. What is clear is the need for mental health services to provide care which is accessible, safe and culturally responsive if we are to truly advance equalities in care.
As part of NHS England and NHS Improvement’s concerted efforts to address these disparities, we commissioned resources to support commissioners and providers to focus on co-creating more equitable services; namely Advancing Equalities and Coproduction Toolkits. Additionally, I led a mental health secure transformation pilot delivering culturally appropriate training of advocacy, personal development and peer support programmes to Caribbean and African people with a range of lived experiences.
The Mental Health Act Review recommended the NHS develop an organisational competence framework, the ‘Patient and Carers Race Equality Framework’ (PCREF), a practical tool which enables organisations to understand what steps it needs to take to achieve practical improvements for individuals of diverse ethnic background. This recommendation was derived and further developed from The Crisp commission’s Old Problems, New Solutions report (2016). This was endorsed as part of the 2016 Five Year Forward View for Mental Health (FYFVMH), particularly in light of persistent inequalities in early intervention and crisis care, rates of detention and lengths of stay in secure services following the end of the five-year Delivering Race Equality (DRE) programme in 2010. My involvement in the Commission, Taskforce and Review has been persistent with the drive and intention to elevate the voice of service users, carers and communities as critical feedback to inform service quality improvements to address, in particular, the staggering disparities experienced by Caribbean and African communities within mental health and associated services.
The NHS will commence development and testing of the PCREF as part of our commitment to advance mental health equalities outlined in the Long Term Plan. It is vital we ensure the expertise of patients, carers and health system leaders is embedded in its development so the PCREF achieves the improved outcomes we should rightly expect. At its core, the PCREF will guide organisations to engage with BME communities and identify their core organisational competencies, then take measured and practical steps to develop these competencies in the spirit of continuous improvement. A core competency could, for example, be ‘leadership’ – we know that support from senior leadership is vital to make effective change within organisations, so how might senior leaders champion advancing BME mental health equalities within their organisation?
The government has welcomed our approach as contained in Theresa May’s recent Mental Health Act Review announcements:
the first ever Race Equality Framework will ensure NHS mental healthcare providers work with their local communities to improve the ways in which patients access and experience treatment, and ensure data on equality of access is monitored at board level and acted on
The Race Equality Framework will include a choice of approaches trusts can employ to support them to engage, reflect on, challenge themselves, and improve these competencies, in line with their local priorities, and in partnership with BME communities. Regular and robust monitoring of change at board level is also expected to be a key feature of the PCREF, to support an ongoing dialogue and action.
At the heart of developing and testing the PCREF is the commitment to improve the BME experience – thereby co-creating positive outcomes – drawing on the expertise of BME service users, carers and communities whom deeply care. This, and the suite of other efforts to bring advancing mental health equalities to the forefront, is a promising step forward.
I thoroughly embrace my leadership role in this matter as NHS England and Improvement’s Mental Health Equalities Adviser, England’s Mental Health Equalities Champion, Co-Leader of Thrive LDN and as the Chair of Black Thrive. Quality mental health outcomes are derived from collaboratively delivering the Advancing Equalities agenda. I have become more hopeful as I have been working with many like-minded people in many parts of the public, statutory, private and voluntary sectors – we have come thus far – there is much further to go – but the current momentum encourages me that the legacy for my brother, and so many other brothers, sisters, husbands, wives, friends, family and networks experiencing racialised mental health disparities, in the pathways into and during mental health care, will change for the better.