Making mental health care fairer for all

I have seen first-hand the devastating impact health inequalities can have on people’s lives.

I have lost two brothers who throughout their lives had struggled with long-term mental health challenges – the second one just this year, one week after George Floyd’s death and in the midst of COVID-19 sharply unfolding.

It has been a tough year for many of us. I now live with the very painful thought that if culturally appropriate services like advocacy and peer support had been available for my brothers they would still be here. Instead they passed age 53 and 41.

I channel my distress into the mission for equality in mental health services as this is one of the most urgent challenges of our lifetime. We have a chance to prove ourselves as a different kind of society than we have experienced thus far.

Today, as the chair of the Advancing Mental Health Equalities Taskforce, I work closely with NHS services to make sure we are progressing towards equitable and accessible mental health care for all. This work must yield tangible outcomes for those who have been discriminated for too long – we can no longer work in a system that assumes the same approach fits all. The cost of this dissonance can be fatal.

The events of 2020 have shone a light on the inequality that persists in our society. The COVID-19 pandemic, which has disproportionately impacted specific groups, including Black, Asian and minority ethnic (BAME) communities, older people, and the LGBT+ community, also highlighted the inequalities in mental health care.

I am proud to announce that NHS England and NHS Improvement has published its first Advancing Mental Health Equalities Strategy, laying out plans for addressing inequalities in access, experience and outcomes in mental health care. This strategy aims at making care fairer for all. Its sets out three avenues we will take to achieve this: supporting local health systems; collecting and using data and information to inform decision-making; and creating a diverse and representative workforce which is equipped with the capabilities to achieve change. Whilst we promote access to mental health care, we are rethinking what that care contains. We are urging systems to cooperate more closely with the populations they serve to determine what they need, especially for groups experiencing disadvantages, discriminations and crises that impact detrimentally upon their health and wellbeing.

Studies show that black men are far more likely than others to be diagnosed with severe mental health problems, but uptake of services from this community is still very low. Working closely with patients and carers to understand their experiences is the only way we will tackle inequalities for this group. I am delighted that the strategy includes our commitment to develop the Patient and Carer Race Equality Framework (PCREF) which will allow us to work directly with ethnically diverse groups, and make sure their experience and feedback drives the changes we aim to implement within our services. Learning from people with lived experience, and coproduction, are critical elements of the framework.

Services across the country have already taken huge strides forward to bridge the gap for communities fairing worse than others in mental health services. We have some provider pilot sites (South London & Maudsley, East London, Greater Manchester and Birmingham and Solihull) that are helping us develop the framework. Based on insight into local populations, demographics and trends, they have created bespoke projects to tackle inequalities in mental health. Examples include the iCope service in Camden and Islington, offering culturally specific treatment for different BAME communities, and a Greater Manchester Mental Health Foundation Trust, which created a programme for young people from the LGBT+ community who experience mental health problems disproportionately as a result of their sexuality or gender identity.

This work at the local level has been extremely impactful, and we know there is so much more that can be done across the country. Every single person working in mental health has a role to play in making our services and systems fairer and challenging racism in all its forms. I am optimistic that the Mental Health Equalities Strategy will be the start of a process in which we will drive forward change and ensure all those accessing mental health services have the same positive experience and outcome of our care.

I am hopeful that with concerted national effort and strong partnerships with social care and the voluntary sector we can deliver real change and prevent another sibling, son or friend dying too young. We can do this.

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).