Piloting a route to race equity in mental health

Real change to end systemic injustice requires action by the system itself – but in partnership with the people who have everyday experiences of the injustice.

Their insights – and the genuine commitment of leaders who have the power to drive change – can deliver progress on the ground and improve people’s lives and experiences.

That is particularly true in the mental health sector where lack of cultural awareness and an imbalance of power has led to something we have been talking about for decades – excessive use of restraint and a disproportionate use of the Mental Health Act detention powers with Black people.

Within the South London and Maudsley NHS Foundation Trust, our baseline data indicates that Black service users are up to three times more likely to be detained under the Mental Health Act and twice as likely to be restrained. Black people are up to four times more likely to receive a diagnosis of psychosis. We must recognise, however, that these stark variations in access, experience and outcomes for Black service users exist within – and as a consequence of – wider systems of oppression.

We’ve brought service users and carers, staff and communities together to work in a new way for the Trust; developing a model that acknowledges the power imbalance that normally prevails between these groups and is designed to improve it. The involvement of the Trust’s senior leadership shows we are committed to implementing real change.

To make sure we hear from as many Black residents as possible we’re working with our host organisations: Croydon BME Forum, an umbrella organisation for Black and minority ethnic voluntary and community organisations, and Black Thrive Lambeth whose focus is on communities of African and Caribbean descent; addressing the systemic inequalities that negatively affect the mental health and wellbeing of Black people in Lambeth. These organisations, together with the Trust, comprise the PCREF Partnership. They are our PCREF host organisations with a crucial role in helping us engage with Black citizens in all four of the London boroughs we serve: Croydon, Lambeth, Lewisham and Southwark.

“We are very proud to be working in partnership with South London and Maudsley and Black Thrive as one of four pilot sites in the UK to deliver PCREF. PCREF is a genuine meaningful attempt to gain the trust of our local Black communities and build a social movement that will lead to real, needed change.”Andrew Brown, CEO – Croydon BME Forum

Black community members and Black service users and their carers worked with the Trust to design and deliver separate engagement events for each of our three groups: communities, service users and their families and our staff.

We used these events to recognise and agree what mental health access, experience and outcomes actually looks like right now from a racialised perspective – and what needs to change. We looked at what the data was telling us about the experiences of Black people in south London.

Although there was a lot of positive feedback about the delivery of these events, we also listened to those who talked about the need to genuinely involve more people in planning the agenda. We listened when people said we need to be more aware of issues such as the digital divide and the potential for other forms of engagement (including allowing more time at meetings for general conversation!).

We responded by deciding to slow down the process to make sure that in phase two of the pilot we get genuine inclusive engagement and codesign. That’s why we’ve added six months to our schedule, [with phase two due to end January 2022].

NHS England has asked us and the other pilots to address ten coproduced organisational competencies (key objectives) which every organisation needs to be good at if they are going to eliminate racial disparity in all their services. These include having a workforce that reflects its local community and ‘having a clear plan within the service to improve outcomes and experiences for Black, Asian and minority ethnic communities’.

Responding to what we heard at the engagement events, we’ve added two local organisational competencies which we will work on as a partnership with our three groups to undertake. The first is to develop a plan that will set out a shared vision for tangible improvements, that when delivered, will help build trust and confidence in the Trust and its services. The second is developing a definition of an anti-racist organisation with a shared understanding of anti-racism and the impact of colonisation on mental health services.

In phase two, the Trust leadership and PCREF team are working with our community partners and the three groups on making those 12 organisational competencies a reality.

 “We are encouraged that South London and Maudsley are showing a commitment to improve the mental wellbeing outcomes of Black communities. The Patient and Carer Race Equality Framework provides a genuine opportunity to do things differently, the matter is urgent and there is no time for empty gestures. Things feel different and I am more confident that we can transform services for Black communities now and into the future. This work can’t be achieved without the Black community being involved. The mental health system needs to create space for us to have our voices heard, to be involved in both identifying and delivering solutions. To give this work the best chance of success it is important for our community to get behind this work and become a PCREF Activist. I would urge everyone to get involved, because even offering 15 minutes of your time each week could make a huge difference in the lives of people in our community” – Natalie Creary, Programme Delivery Director – Black Thrive Lambeth

If you’re one of the many people who are passionate about banishing discriminatory practices and improving outcomes in mental health, you should join us and be part of a social movement inside and outside of the Trust as we are determined to achieve this change. Each constituency is tailoring their Activists and Allies Programme to suit the interests and opportunities that are available – so please get in touch to check out what’s involved.

Opportunities to find out more and get involved


Zoë is Director of Organisation and Community and Freedom to Speak Up Guardian at South London and Maudsley NHS Foundation Trust.