Today (30 October), NHS England publishes its first ever anti-racism framework, the Patient and carer race equality framework (PCREF), to support mental health trusts and providers to improve experiences of care for racialised and ethnically and culturally diverse communities.
The development of this framework has been necessary because of what the data tell us. People from Black and Black British groups are four to five times more likely to be detained under the Mental Health Act than their White counterparts, have higher rates of being restrained in inpatient units, and are far more likely to encounter mental health services through the criminal justice system. People from other racialised groups also have poorer access to mental health care, including increased use of crisis pathways leading to more negative experiences and outcomes compared to White majority counterparts.
We have been working with vulnerable and racialised communities for many years and have seen the significant impact that systemic racism and injustice has had on so many people’s lives. The PCREF caters for all racialised communities through naming racism, identifying how it operates in services and working with communities to organise and create meaningful actions from these insights.
The PCREF programme has been working with four pilot NHS trusts and six early adopter sites across the country, who have been embedding the framework in different and innovative ways. Over the past three years they have been reflecting the needs of their local communities and are subsequently making significant progress towards becoming actively anti-racist organisations.
One of the key ways these providers have done this is by elevating the voices of service users, carers, and communities to inform service improvements. This is a vital part of implementing the PCREF. Every NHS trust’s journey will look different because no area’s population demographic is the same as another. These pilot trusts have shown us what is possible when we listen to local communities and work with them to deliver care that is culturally appropriate, trustworthy and meets their needs.
Indeed, the NHS Race and Health Observatory’s systematic review into ethnic health inequalities recommends that NHS trusts work with partners across public service, the voluntary sector and community organisations to demonstrate commitment to tackling racial inequality in mental health services. Establishing relationships between ethnic minority communities and NHS provider services is critical for the provision of high-quality services for ethnic minority patients. The PCREF is an intervention and enabler in this regard and serves as a powerful example of embedding genuine anti-racist practice into the day to day working of the NHS. It is work that ought to be replicated elsewhere in the system.
“I am driven to fight for a fairer system where people from racialised communities no longer have significantly worse experiences and outcomes. I have lost two brothers, who throughout their lifetime grappled with long term mental health challenges, and sadly died young, Barry at age 53 and Carlton at 41. In 2023, I also lost my aunt, who died whilst in the care of mental health services. It has been extremely difficult for me to see how my loved ones were failed by mental health services where they endured racialised experiences. I live every day with the excruciating thought that if culturally appropriate care had been available for them, they may have been alive today.”
Dr Jacqui Dyer
Passion around ethnic health inequalities has rarely been as high as it is now. The challenge is to capitalise on that passion in a meaningful way before it is too late. The PCREF must not only be seen as an essential tool to enable the tackling of mental health disparities, but also as an invitation to engage with our diverse communities, to work with one another, to share successes and failures, and to combine collective expertise for the benefit of all patients and service users.