Delivering Race Equality in Mental Health Care: a review

2009

programme report

by Melba Wilson, National Programme Lead, Delivering Race Equality (DRE) in mental health care

New HorizonsA shared vision

for mental health

01

Foreword by Louis Appleby 02

Foreword by Victor Adebowale 03

Section 1: About DRE 04

Background 04Accountability and Governance 04The DRE action plan 05Partners 05

Section 2: Key Challenges 06

The complex nature of BME communities 06Using statistics to measure improvements 07High expectations 07External changes 07

Section 3: Key Successes 08

Building Block 1: Appropriate and responsive services 08Building Block 2: Engaged communities 14Building Block 3: Better information 19

Section 4: The 12 DRE Characteristics 22

Section 5: Working in Partnership 24

Section 6: Looking Forward to New Horizons 25

Section 7: References and Resources 26

contents

02

Good mental health is not just important for individuals’ health and happiness but it is fundamental to the well being and prosperity of our society. So it’s vital that everyone can access the services they need to promote their mental health.

ItisalmostfiveyearssincetheDeliveringRaceEquality(DRE)inmentalhealthcareprogrammebeganitsworktotackleinequalitiesandimprovementalhealthservicesforpeoplefromBlackandminorityethnic(BME)communities.Thiswasnosmalltask–DRE’sremitwasbothchallengingandcomplex.ItinvolvedworkingwithorganisationsandservicesacrossEnglandaswellasmanydifferentgroupsfromserviceusersandfrontlinestafftocommissionersandpolicymakers.

Today,thankstoDRE’swork,wehaveamuchbetterunderstandingoftheissuesaroundrace,ethnicityandmentalhealth.Throughinnovativeprojects,research,datagathering,communityengagementandasignificantnewworkforceofcommunitydevelopmentworkers,wehaveastrongbasefromwhichwecancontinuetoimproveservicesforpeoplefromBMEcommunities.

DRE’sworkhasinformedNewHorizons:towardsasharedvisionformentalhealth,ournewvisionformentalhealthinEngland,whichbuildsonthe1999NationalServiceFrameworkforMentalHealth(NSF).NewHorizonsanditsassociatedequalityimpactassessmentdescribedtheevidenceforthe–oftenveryserious–inequalitiesinmentalhealthamongsomeethnicgroups.Therootsoftheseinequalitieslieinsocial,notbiological,factorssotheresponsibilityforremedialactionextendstoalltheagenciesthatinfluencepublicmentalhealthandwellbeing.Therearetwoongoingchallengesfortacklinginequalities:

• Forcommissioners–thedutytounderstand,respectandmeettheneedsoftheirBMEpopulation.Primarilythismeansrecognisingandaddressinginequalitiesinmentalhealth,butthatrequiresdedicatedworkwithcommunitiesandthethirdsectortomakesurethatservicesarepersonalisedaroundtheirlinguisticandculturalcharacteristics

• Forpublicmentalhealthinitiatives–tocompenstateforinequalitybyensuringasaprioritythatactivitysupportinggoodmentalhealthandwellbeingistargetedat,orisatleastequallyeffectivefor,ethnicallydiversepopulations.

DRE’sexperience,expertiseandresearchwillhelpcommissionersandotherstomeetthesechallenges.UnderNewHorizons,wewillbuildonDRE’ssuccessesandworktogethertowardsourvisionofahealthier,fairerandequalsociety.

by Louis Appleby CBE, National Director for Mental Health in England

Today,thankstoDRE’swork,wehaveamuch

betterunderstandingoftheissuesaround

race,ethnicityandmentalhealth.

““

foreword

03

The setting up of the DRE programme represented a significant investment by the government in attempting to improve the position of people from black and minority ethnic communities, who have mental health problems.

Theprogrammemarkedaseachangeinthatitservednoticethatmaintainingthestatusquowasnolongeraviableoption.Thismessagewasthatchangewasnecessaryinhowmentalhealthservicesarecommissionedandprovidediftheneedsofpeoplefromdiversecommunitiesweretobeadequatelymet.

Ihavehadcloseandintegralinvolvementwiththeprogrammefromthebeginning,andIremaincommittedtothevaluesandethosofwhatithasaimedtoaccomplish.DREwasanambitiousundertaking,anditledanumberofgroundbreakingandinnovativewaysofworking.Forexample,theideaoffocusedimplementationsiteswasagoodone–astheyprovidedanopportunitytotestouttheideasandimperativesoftheprogrammeinaco-ordinatedandcomprehensiveway.

Likewise,theDREprogramme’semphasisonmeaningfullyinvolvingpeoplewhouseservices,aswellastheircarersandfamilies;andofreachingouttoblackcommunitiestominetheresourcesandtheresiliencieswithinthemhelpedtogroundtheworkoftheprogrammeasitsoughttoreachthepotentialsetoutforit.

Givenmyinvolvementandbeliefintheroleofthethirdsector,IhavealsowelcomedtheDREprogramme’spartnershipworkingwithvoluntaryandcommunityorganisations.Theimportanceofsuchpartnershipscanbeseenintheworkwhichiscomingthroughthe79nationalcommunityengagementprojects.

Overtheyears,therehasmuchtovalueasaresultoftheexistenceoftheDREprogramme.Thejobisnotyetcomplete,however,andmoreneedstobedonetoensurethatcommissionersandproviderslearnthelessonsandtakecontinuingactiontoimplementthelearningthatisemergingfromtheworkofDRE.

Thiswillmeanongoingworktobetterassesspeople’sneeds;toensurethatpeoplearemoreincontroloftheirlivesandoutcomesinrelationtotheirmentalhealthneeds,e.g.,throughembracingthepersonalisationagendaandpromotingcitizeninvolvement;andthatwecontinuetoseekwaystobringaboutnotonlybetterservices,butalsoabettersociety.

IwelcomethefactthattheworkofDREwillbeactivelyinfluencinghowtheNewHorizonsmentalhealthstrategywilldevelop.ItisimportantthatthelegacyandtheaimofwhatDREsetouttodocontinuestobeprogressedthroughclearandvisiblelinkagewithnewpolicyandguidance.Thereisstillalongwaytogo,andwecannotbecomplacentabouttherealneedforgoodmentalhealthcarewhichstillexists.

by Lord Victor Adebowale, Chief Executive, Turning point

Theimportanceofsuchpartnershipscanbeseen

intheworkwhichiscomingthroughthe79

nationalcommunityengagementprojects.

““

foreword

04

1BackgroundTheDREprogrammewaslaunchedin2005.ItwasafiveyearprogrammethataimedtosupportthedevelopmentofbettermentalhealthserviceswhichmettheneedsofEngland’sincreasinglydiversepopulation.

DREwasneededbecauseitwasfeltthatpatientsfromBMEbackgroundswerenotgettingthementalhealthservicestowhichtheywereentitled.TherewasandcontinuestobeevidencetosuggestthatpatientsfromsomeBMEcommunitiesaremorelikelytobedetainedcompulsorily,admittedtohospital,secludedandadmittedthroughthecriminaljusticesystemthanWhiteBritishpatients.Inanextremecase,theseinequalitieswerefelttohavecontributedtothedeathofDavidBennett,a38yearoldAfricanCaribbeanpatientwhodiedin1998inamediumsecurepsychiatricunitafterhewasrestrainedbystaff.

TheDREactionplanwaspublishedalongsidetheGovernment’sresponsetotheindependentinquiryintoDavidBennett’sdeath.TherecommendationsinthisresponseandtheDREactionplantogethermadeupanextensiveprogrammeofworkforachievingequalityofaccess,experienceandoutcomesforBMEmentalhealthserviceusers.Theprogrammeaimedtochangeattitudesandbehavioursaswellasthewaythatmentalhealthserviceswereorganisedandprovided.ThiswasnotaboutsettingupseparatementalhealthservicesforBMEpatientsbutaboutchangingmainstreamservicessothattheneedsofanincreasinglydiversepopulationcouldbemet.

Accountability and governance DREwasaDepartmentofHealth(DH)programmeanditsactionplanwaspartofDH’swiderequalityandhumanrightsstrategy.Initially,theprogrammewasdeliveredbytheNationalInstituteforMentalHealthinEngland(NIMHE)andthenbytheNationalMentalHealthDevelopmentUnit(NMHDU),whichreplacedNIMHEinApril2009.

TheactionsidentifiedintheDREplanweretobeimplementedbyallNHSandsocialcareorganisationsincollaborationwiththethirdsectorandusersandcarers.Regionaldevelopmentcentres(RDCs)wereestablishedandwerebasedinitiallywithinNIMHEandtheirregionsandlaterwithintheCareServicesImprovementPartnership(CSIP).RDCs’remitwastointegrateDREprogrammeworkintotheotherNIMHEworkforwhichtheywereresponsible.Todeliverthis,eightregionalRaceEqualityLeads(RELs)wereappointedwithintheNIMHEdevelopmentcentres,toleadonawiderangeoflocal,regionalandnationalprojects.TheirrolewastohelpensurethatworkatalocalandregionallevelmetthespiritandintentoftheDREactionplan.

dre programme delivery structure

* NMHDU replaced NIMHE and CSIP in April 2009

section

This review looks back at DRE’s work as its five year plan comes to an end. DRE has carried out an extensive programme of work and this review describes some of our key challenges, successes and learning. It also outlines how DRE’s work will be taken forward under New Horizons.

about dre

dH

Care Quality

Commission

RDCs (x8) Each led by a REL

Regional & Local Projects

Other Central

Organisations

nmHdu*

section

2

05

DRE’sprogrammeofworkwasfar-reachingandinvolvedworkingwithawiderangeof

partnersandstakeholders.

““

The DRE action planTheDREactionplanwasacomprehensiveframeworkofactionthatwasbuiltaroundthreebuildingblocksforchange:• Moreappropriateandresponsiveservices• Communityengagement• Betterinformation.

Thekeyworkthatwascarriedoutundereachofthesebuildingblocksisdescribedonpages8-21.

12 characteristicsTheactionplanalsodefined12characteristicsthatwehopedwoulddescribementalhealthservicesby2010.Thesecharacteristicsandtheextenttowhichtheyhavebeenachievedarediscussedonpage22ofthisdocument.

78 actionsInordertodeliverDRE’svision,theactionplandefined78actionsthatwouldbringaboutchange.TheseweretobecarriedoutbyanumberofdifferentorganisationsfromNIMHEtoPCTs.Theyrangedfromstrategicactions–forexample,allNHSorganisationsweretoputaraceequalityschemeandculturalcapabilityframeworkinplace–tooperationalactions,forexample,NHSDirectwastoprovideanationalinterpretationservice.Implementingtheactionsprovedchallengingandmanyorganisationswereunabletoprovideinformationthatwasofsufficientlyhighqualitytomeasureperformance.Toaddressthis,wedevelopedtheDREDashboard,whichenablesstrategichealthauthorities(SHAs)tomonitortheirprogressonraceequalityinmentalhealthusingdataandinformationthatismorereadilyavailable–seepage20formoreinformation.

PartnersDRE’sprogrammeofworkwasfar-reachingandinvolvedworkingwithawiderangeofpartnersandstakeholders.Theseincludedgovernmentdepartments,localauthorities,SHAs,mentalhealthtrusts,theNHSUniversity,NHSDirectandPrimaryCareTrusts(PCTs).Wealsoworkedwithfrontlinestaff,serviceusersandpeoplefromBMEbackgrounds.

section

1about dre continued

section

06

2key cHallenges

Ourworkhasdevelopedanevidencebase,whichhashelpedustobetterunderstand

thedemographyofBMEcommunities.

““

Oneofoursuccesseshasbeentoexposeandachieveabetterunderstandingofsomeoftheseissues,whichwillbeusedtoinformfutureworktoreduceinequalities.Wealsohadtofaceotherchallenges,suchaschangeswithinthehealthandsocialcareenvironment,whichwerebeyondourcontrol.Inthissection,welookatthemainchallengesthatwefacedandwhatwehavelearntfromthem.

The complex nature of BME communitiesTheDREactionplanaimedtoimprovementalhealthservicesforallpeopleofminorityethnicstatusinEngland.ThisincludedpeopleofIrishandMediterraneanoriginandEastEuropeanmigrants.Italsocoveredspecificpopulations,forexamplerefugeesandasylumseekers,olderpeopleandchildrenandyoungpeople.Thedefinitionincludedawiderangeofgroupswithverydiverseneeds,andunderstanding;andmeetingtheneedsofallofthesegroupswasalwaysgoingtobeachallenge.

Ourworkhasdevelopedanevidencebase,whichhashelpedustobetterunderstandthedemographyofBMEcommunities.Wenowhaveaclearerunderstandingoftheirneeds,howtheyaccessservices,howtheywanttoaccessservicesandwhatcommissionersandproviderscandotoimproveservices.

Whatworksforonecommunitywillnotnecessarilyworkforanother–theneedsofanAfricanCaribbeanmanwhoisafraidtoengagewithservicesaredifferentfromtheneedsofanAsianwomanwhomaythinkthathavingamentalhealthproblemisshameful.Ourresearchhasshownthatdifferentethnicgroupshavevariedperceptionsaboutmentalhealthservicesandwanttoaccessandusethemindifferentways.

However,differencesdonotarisejustbecauseofethnicity.Thedemographyofethnicgroupscanvaryindifferentways.Forexample,ifoneethnicgrouphasahigherproportionofolderpeoplethananother,theirexperienceandperceptionsofmentalhealthservicesmayvarybecauseofageratherthanethnicity.

Equally,wecannotclaimthatallpeoplewithinacommunityhavethesameneeds.Thereisvariationbetweenandwithincommunities.Thisisperhapsnotsurprising,aspeopledonotexperiencementalill-healthinsilosofraceorageorgender.

PeoplefromBMEcommunitieshaveemphasisedhowimportantitistoseetheperson,notthestereotype,thepersonnotthediagnosis.Whentalkingaboutmentalhealth,weneedtotalkaboutthecomplexitiesofunderstandingindividualsintermsofrace,culture,ethnicity,geography,sexualityandfaith.

Transforming the way that we provide mental health services to people from BME communities was never going to be straightforward or easy. DRE’s ambitious programme had to tackle some complex issues if it was to be successful.

07

section

2

Totackleinequalitiesinmentalhealth,wemustlookattherootcauses

ofmentalillness.““

Using statistics to measure improvementsDRE’sactionplanaimedtoreducetheproportionofmentalhealthinpatientsfromBMEcommunitiescomparedtoWhiteBritishinpatientsandthedisproportionaterateofcompulsorydetentionforBMEinpatients.

Ourworkhashelpedtoidentifythecomplexandvariedreasonsforthedifferencesbetweenethnicgroupsandtheevidencewehavegatheredhasquestionedwhetherthosestatisticsalonecanmeasureanimprovementinservices.

Totackleinequalitiesinmentalhealth,wemustlookattherootcausesofmentalillness.IndependentresearchsuggeststhatahigherproportionofpeoplefromBMEcommunitiesintheUKexperiencementalhealthproblemscomparedtoWhiteBritishpeople.Thereasonsforthisarecomplex.Themostsalientcausalfactors,andthoseamenabletoimpact,aresocialratherthanbilogicalorgenetic.FactorsthatcausementalhealthproblemsaremorepresentinthelivesofBMEcommunitiesthatforWhiteBritishcommunities.

Basedonindependentresearchthatindicateshigherratesofmentalhealthproblems,wemightexpecttoseehighernumbersofthesegroupsusingservices.Giventhisevidence,itisnowclearthatadmissionanddetentionratesarenotagoodindicatorofqualityinmentalhealthservices,althoughtheyareanimportantreflectionoftheexperienceofBMEserviceusers1.Ifwewanttoreducethesefiguresinameaningfulway,wemustaddressthesocialissuesthatcausementalhealthproblems,suchaspovertyandsocialdeprivation.Improvingmentalhealthservicesisstillvital,butitisonlypartofthesolution.Futurework,underNewHorizons,willtakeapublichealthapproachtoimprovingmentalhealthforall.

High expectationsThescopeofDRE’schallengewashugeandexpectationswereveryhigh–perhapswecouldneverhaveliveduptoallofthem.

Therewasalsodiversityofopinionabouttheworkoftheprogramme.Differentstakeholdersincludingusers,carersandprofessionals,haddifferentinterpretationsaboutwhatDREshouldbedoingandhowweshouldbedoingit.

TherewillinevitablybesomestakeholderswhofeelthatwehavenotachievedenoughandthatpeoplefromBMEcommunitiesarestillnotgettingtheservicesthattheyareentitledto.WehopethatthisreviewcandemonstratewhatDREhasachievedandshowhowourworkwillbecontinuedunderNewHorizons,throughajoinedupapproachthattacklesallinequalities.

External changesTherewereanumberofchangestothehealthandsocialcarelandscapeandthesehadanimpactonourwork.Theseincluded:

• OrganisationalchangestoNIMHEandtheCareServicesImprovementPartnership(CSIP),whichwerereplacedbyNMHDU

• Thegeneralshifttodevolveddecision-makingtoSHAs,whichaffectedtheaccountabilityandgovernanceofDRE

• StructuralchangeswithintheNHSthroughthereconfigurationofSHAsandPCTs

• TheendoftheNSFandlaunchofNewHorizons.Thishasbroadenedthefocusfromimprovingmentalhealthcareservicestoembraceapublichealthapproachtomentalhealth.

key cHallenges continued

08

section key successes

3Focused Implementation Sites (FISs) AllNHSandsocialcareorganisationswereaskedtoimplementtheDREactionplanbutDREalsoestablished17focusedimplementationsites(FISs)toleadthesereformsandchanges.TheFISsbroughttogetherSHAs,PCTsandotherpublicsectorprovidersofmentalhealthservices;theyalsoestablishedlinkswithvoluntaryandcommunityorganisationsandusersandcarers.Theirsizeandstructurevaried–someworkedaspartofaSHA,othersworkedacrossSHAboundaries.

Thesesitesoperatedforthreeyearstotacklediscriminationandinequalityacrossmentalhealthservicesintheirarea.Awiderangeofprojectswerecarriedouttoidentifytheneedsoflocalcommunitiesandtotestnewandinnovativewaysofcommissioninganddeliveringservices.Aspioneersofchange,theFISshelpedtoidentifyandsharebestpracticewithotherNHSorganisations.

FIS evaluationTheoriginal17FISswerereviewedbetweenOctoberandDecember20062.Morethan32reviewpanelmembersandaround450stakeholdersacrossthethenCSIPregionswereinvolved.Evidencefromprojectmanagers,serviceusers,statutoryandnon-statutorysectorstaff,RELsandseniormanagerswastakenintoaccount.

Thereviewhighlightedareasofgoodpractice,identifiedchallengesandmadesuggestionsforimprovementsatlocal,regionalandnationallevels.Someofthebestpracticethatwashighlightedissummarisedinthefollowing:

• TheBradfordFISwasoneofanumberofsitesthatwereimprovingtheirunderstandingoffaithandinvolvingfaithleaderstoimprovetherecoveryofpatients.TheirJinnprojectdeliveredamoreholisticapproachtothecareofmaleMuslimpatientsbyincludingspiritualtherapy

• MortonHallPrisonintheEastMidlandswasoneofanumberofprojectsshowinggoodpracticeintheareaofcriminaljustice.BMEresearcherswererecruitedfromtheprisoncommunity.Theaimwastofocusresearchonculturallyappropriateassessment,communicationandtranslationneeds.Theprojectaimedtocreatelessfearofmentalhealthservices,provideamorebalancedrangeofservicesandsupportcompliancewiththeprisonsRaceRelations(Amendment)Act2000

• TheManchesterFISworkedtohelpensurethatpractice-basedcommissioningwouldtakeintoaccountspecificarrangementsforBMEcommunities.Theywerealsoinvolvedwithcontractingandprocurementprocessestomakesurethatequalityanddiversitywereaddressed

• TheLondonDevelopmentCentrecommissionedtheLondonHealthObservatorytoanalysecensusdata,clarifydatatrends,comparedatatonationalcensusandmakerecommendationsforaddressingtheissuesarisingfromdata.

ThereviewalsomadeanumberofrecommendationsforhowtheworkoftheFISscouldbesupportedandimproved.Thisresultedinworkthatrangedfromimprovedcommunicationandbusinessplanningtobetterpartnershipworkingandtheinvolvementofserviceusersandcarers.

The DRE action plan organised its programme of work through three building blocks for change. Here, we look at the main activities that were carried out and what we learnt from them.

building block 1APPROPRIATE AND RESPONSIVE SERVICES

Thesesitesoperatedforthreeyearsto

tacklediscriminationandinequalityacross

mentalhealthservicesintheirarea.

““The first building block for change was improving services so that they were appropriate, responsive and met the diverse needs of BME patients.

09

Partnerships in Care PartnershipsinCare(PiC)isaprivatesectorproviderofsecurementalhealthfacilitieswithover20years’experienceofcaringformenandwomenwithcomplexmentalhealthneeds.In2007,PiCaskedDREiftheycouldbecomeaFIStoreinforcetheirorganisation’scommitmenttoequalityofopportunityforbothitspatientsandstaff.Amongotherwork,PiC:revieweditsHRpolicies;involvedpatientsinstaffinductiontraining,councils,auditsandclinicalgovernance;andgatheredbetterdatabyincludinganalysisofethnicityandgenderforsomeoftheirreporting.

PiC’saffiliationalsobenefittedtheDREprogrammeby:• Promotingaccesstoprivatesectorforums• HelpingDREtoshareinformationandlearning

acrossthepublicandprivatesectors• Promotingtheprogramme’sabilityto

makechanges.

StevenWoolgar,DirectorofPolicyandRegulationforPiCsays,‘PiChasalwaysfocusedonprovidingindividualisedcareandinvolvementintheDREProgrammehashelpedmoveforwardthatworkinamorestructuredandfocusedway.ThePiCapproachhasbeentointegrateanyDREinfluencedchangesintothewaythatweworkandnotasadditions.’

Workforce developmentThementalhealthworkforceneedsgoodculturalcompetencyskillsiftheyaretoprovideappropriateandresponsiveservicesthatmeettheneedsofmentalhealthpatients.Race,faith,ethnicityandcultureallaffecthowmentalillnessandhealthareexperiencedandthesefactorsneedtobetakenintoaccountwhentreatingpatients.DREresearchfoundthattherewaslittleevidenceofdirectdiscriminationbypractitionersbutsomereportsindicatedifferencesinhowpeoplefromBMEandWhiteBritishgroupsexperiencestaff.Thisshowsthecomplexityofexperiencesthatpractitionersneedtounderstandwhentheymakeassessments.Mentalhealthorganisationsacrossthecountrysaidtheyneededahighqualitytrainingpackage.Inresponsewe

developedtheRaceEqualityCulturalAwarenessProgramme(RECAP).

OneDREreportfound,‘littleornoevidenceofdirectdiscriminationonthegroundsofraceorculturethatsubstantiallyinterferedwithrelationshipswithservices.Serviceusersandcarersweretolerantofethnicdifferencesaslongaseffortsweremadetoensureeffectivecommunicationandahighstandardofcare.Thereweremanyinstancesofmentalhealthprofessionalsworkingverysuccessfully(intheopinionoftheserviceusersthemselves)withserviceusersfromaverydifferentethnicbackgroundtotheirown3.’

Race Equality and Cultural Capability TheRaceEqualityandCulturalCapability(RECC)trainingmaterialsformentalhealthstaffandNHSorganisations,weredevelopedbyatrainingconsultancy,FernsAssociates.Afteraninitialpilotinfourareas,thepackageincludedasetofpre-coursereadingmaterials,aseriesofworktasktemplatesandmaterialstosupporttheteachingof12RECCsessions.

Race Equality Cultural Awareness Programme BuildingontheRECCworkandmaterials,DREdevelopedtheRECAP,atwo-dayprogrammetohelpmentalhealthprofessionalstodeveloptheirknowledgeandunderstandingofracismandculturaldifferences,promoteraceequality,workpositivelywithculturaldifferencesanddealwiththeimpactofdiscrimination.Wealsodevelopedafive-daytrainthetrainercourse,whichwasdeliveredin2009/10byanationaltrainingteamof18trainers.

AnindependentevaluationofRECAPshowedthatfeedbackbyparticipantswasverypositive.AngelaKandola,ExecutiveDirectorofAWAAZ(AsianMutualHealthResourceUnit),EastMidlandssaid:

‘Thecoursebrokedownbarriersbetweenmentalhealthserviceusers.Itwasaccessible,jargon-freeandempowering–forinstance,Isawoneserviceuserliterallyturnherlifearoundaftergainingconfidenceandself-esteemfromthecourse.

Race,faith,ethnicityandcultureallaffect

howmentalillnessandhealthareexperienced.

““

key successescontinued

section

3

10

section

3Participants’commentsrangedfrom‘vibrant,warmandsupportive’to‘themostinteresting,comprehensiveandenjoyabletraining.’

TheevaluationofRECAPrecommendedsomeimprovementstothetrainingprogramme,inparticulartomakethecontentofthecoursemoreoperationalandfocusedonimprovingprofessionalpractice.ThisresearchwillbeusedtoinformthefuturedevelopmentofRECAP.

Clinical TrailblazersDREfunded20organisationstorunarangeofprojectsthatlookedathowtheycouldchangeandimprovetheclinicalservicestheyprovidedtopatientsfromBMEbackgrounds.TheprojectsrangedfromanauditandinterventionswithinaHomeTreatmentteamtothedevelopmentofaWellnessRecoveryActionPlan(WRAP)forBMEcommunities.Projectmembersmetregularlytosupporteachotherandsevenoftheorganisationsreceivedadditionalfundingtodeveloptheirprojectsfurther.

key successescontinued

CASE STUDy

Developing culturally sensitive cognitive behavioural therapy for psychosis

AspartoftheClinicalTrailblazers’programme,HampshirePartnershipNHSFoundationTrustcarriedoutastudy:Developingculturallysensitivecognitivebehaviourtherapyforpsychosisforethnicminoritypatientsbyexplorationandincorporationofserviceusers’andhealthprofessionals’viewsandopinions.

Thestudyaimedtoproduceaculturallysensitiveadaptationofanexistingcognitivebehaviourtherapy(CBT)manualthatwaswellsuitedtotheneedsofpatientswithpsychosisfromBlackBritish,BlackCaribbeanandBlackAfrican,BangladeshiandPakistaniminorityethniccommunities.ThiswouldbeaccompaniedbyguidanceforhealthprofessionalstoenablethemtodeliverCBTthatisculturallysensitiveandresponsiveforpatientswithpsychosisfromthesecommunities.

Interviewswereconductedwith114participants,includingserviceusers,laymembers,mentalhealthpractitionersandCBTtherapistsinHampshireandWestLondon.ThestudyresultscapturedwhatthespecificBlackandMinorityEthniccommunities(BlackBritish,BlackCaribbeanandBlackAfrican,BangladeshiandPakistani)thinkaboutattributionstopsychosis,helpseekingbehavioursandpathwayswhichinfluencetheirchoicesonwhethertoengagewithmainstreamservicesorreverttotraditionalapproaches.Thekeyfindingsofthestudyare:

• CBTwouldbeanacceptabletreatmentifculturallyadapted

• Thewaythattherapyisdeliveredneedstobeadaptedsothatthereismorepre-engagementandanunderstandingofaperspectivewherefamilyandreligionareatthecentreofaperson’sthinking

• Someofthepeopleinterviewedsawthetherapistasthe‘expert’andexpectedthemtohavealltheanswers.ThishasimplicationsinthetherapeuticrelationshipbetweentheCBTtherapistandpatient

• Therewerecomplexlanguageissues.EventhoughthestudyfocusedonpatientswhospeakEnglishorcancommunicatewiththeuseofinterpreters,somewouldreverttotheirownlanguagetobeabletoexpressaparticularthoughtorfeeling

• Understandingone’sculturalbackgroundwashighlightedasanimportantfactorgiventhatindividual’sculturalbeliefs,normsandvaluesinfluencetheirattitudes,behavioursandresponsetopsychologicalproblems.Asaresultofthisstudy,theCBTmanualwithguidanceisbeingdeveloped.

AfeasibilitystudyofculturallyadaptedCognitiveBehaviourTherapyforpsychosisforethnicgroupsisunderwayinHampshire,WestLondonandManchester.

Asaresultofthisstudy,theCBTmanual

withguidanceisbeingdeveloped.

““

11

section

3key successescontinued

TheSheffieldEPICproject,runbytheNHSFoundationTrustinpartnershipwiththreecommunitypartners,aimedtoformalisethepartnershipsbetweenstatutoryandNGOservicesthroughajointassessmentandsharedcareplan.

AnNHSemployedCommunityDevelopmentWorker(CDW),workedonedayaweekataPakistanivoluntarysectororganisation.Thislinkworkeridentified16Pakistaniin-patients.Eightaccessedthelinkworkerforadvocacy;fouraccessedthePakistaniMuslimCentre;twoaccessedhometreatmentviaearlydischarge.

OutcomesLengthofstayfellby12.5%amongPakistaniin-patients,ascommunitytreatmentoptionswereextended.Thepatientsreportedincreasedsatisfactionwithservicesandthenumbersbeingreferredfortreatmentroseasknowledgeofmentalhealthconditionsincreased.PeoplefromthePakistanicommunitywhosufferedrelapsesafterleavinghospitalarenowcomingforwardfortreatmentsooner.

ThesuccessofthisprojectledtothepermanentemploymentofaworkerfromthePakistanicommunitybytheNHSFoundationTrust.TheprojectalsowonaleadershipawardwiththeHealthFoundationandgroupcoachingwasofferedtodevelopleadershiponBMEhealthcare.A‘HowtodoanEPIC’manualisbeingdevelopedandwillbelaunchedinFebruary2010.

Asaresult,twofurtherEPICprojectshavebeendeveloped:• TheSheffieldHealthandSocialCareNHS

FoundationTrustworkedwithSheffieldAfricanCaribbeanMentalHealthAssociation(SACMHA)tomeasureandtryandreducethelengthofstayforAfricanandCaribbeanserviceusersandimproveaccesstothefullrangeofservices,includingvoluntaryprovisionandcrisisintervention.Theyalsoworkedwithwardsandclinicianstounderstandbetterreferralstrategiesandpatientexperience.

• ThethirdSheffieldEPICprojectaimedtohelpmembersoftheSomalicommunitytoaccessservicesandtomakesurethattheseservicesmettheirneeds.

Bringing statutory and NGO services together in Sheffield

Thesuccessofthisprojectledtothepermanent

employmentofaworkerfromthePakistani

communitybytheNHSFoundationTrust.

““Enhanced pathways into care TheEnhancedpathwaysintocare(EPIC)projectaimedtoimprovethepathwaystomentalhealthcareforBMEgroups.TheprojectwasdevelopedbecausepeoplefromBMEbackgroundscanhavedifferent,sometimesmorecoercive,pathwaysintomentalhealthcarecomparedtotheirWhiteBritishpeers.Therewasalackofevidenceaboutwhythishappensandhowitcanitcanbeimproved.EPICsetouttoidentifytheknowledge,skillsandchangeprocessesthatareneededtoimplementimprovedpathways.

Initially,therewerefourEPICsiteswithinNHStrustsinSheffield,Durham,BirminghamandManchester:• InSheffield,theEPICprojectaimedtoformalise

partnershipsbetweenstatutoryandNGOservices–seethecasestudybelow

• InDurham,theEPICprojectaimedtoimproveaccessforpeopleofChineseorigin

• InBirmingham,anassertiveoutreachteamworkedtomovepatientsofBlackAfricanorBlackCaribbeanoriginfromcontainmenttodischarge

• TheManchesterEPICprojectworkedacrosstruststobringaboutawholesystemsapproachtochange.

CASE STUDy

12

section

3Refugee and asylum seeker communitiesThereasonswhypeopleseekasylum–includingwar,genocide,tortureandrape–andtheactualprocessofseekingasylumandexperiencingovertracismhasanegativeeffectiveonasylumseekers’mentalhealth.DREhasengagedwithrefugeesandasylumseekersthroughthecommunityengagementprojectsthataredescribedinmoredetailonpage16.ThefindingsofthisengagementshowedthatmanyasylumseekerswereunsatisfiedwiththeirGPandthisledmanytodisengagewithmentalhealthservices.Oftenprimarycarestaffareunsureabouttherightsofasylumseekerstotreatmentandinsomecasestherewasalackofsensitivitytotheirsituation.Forexample,oneasylumseekerreportedthat,

‘MyGPgavemeadiagnosisof‘AsylumSeeker’onasickcertificate.Beinganasylumseekerisnotanillness.Ifeltverydepressedandangry4.’

DREhassupportedthedevelopmentofDHguidelinesforprimarycare,whichaimtopromotemoreeffectiveworkingwithrefugeesandasylumseekers.However,thisisanareawherefurtherworkisneededsothatrefugeesandasylumseekersgetthesupportandservicestheyneed.

Older peopleTherearecurrentlyaboutthreemillionolderpeoplewithamentalhealthproblemintheUKandthisisexpectedtorisebyaboutathirdoverthenext15years.DREhascalledforgreatercollaborationbetweenPCTs,mentalhealthandotheragenciesandorganisationsthatspecificallyfocusontheneedsofolderpeople.

TheNIMHEolderpeople’smentalhealthprogramme(nowMentalHealthinLaterLifeprogramme)developedaNationalConsensusstatement,whichwassignedbyanumberofvoluntarysectoragencies.Thiscalledforarangeofactions,includingmoreperson-centredcare,betterclinicalpathways,improvedaccesstoservices,amoresociallyinclusiveapproachtodevelopingservices,supportforcarersandimprovedskillstrainingforstaff.TheMentalHealthandLaterLifeprogrammehasalsodevelopedguidanceforcommissioningmentalhealthservicesforolderBMEpeople.

InApril2008,theMentalHealthandLaterLife,DREandGenderEqualityProgrammeswerebroughttogetherintotheNIMHEEqualitiesprogramme.Thiswasakeydevelopmentandworkisunderwaytostrengthenlinksandintegratedworkingbetweentheseprogrammes.

Children and young peopleTheDREactionplancalledforimprovedservicesforchildrenandyoungpeoplethroughmorecollaborativeworkingbetweenchildandadolescentmentalhealthservices(CAMHS),NIMHEandothers.WewantedCDWstobridgethegapbetweenlocalCAMHSandBMEcommunities–seethecasestudyonpage13foranexampleofhowthiswasachievedintheNorthWest.

DREhassupportedthedevelopmentofDH

guidelinesforprimarycare,whichaimto

promotemoreeffectiveworkingwithrefugees

andasylumseekers.

““

key successescontinued

13

section

3

CAMHSCulturalCompetencytrainthe

trainertraininghasbeendeliveredtoCAMHS

staffandCDWsacrosstheNorthWest

““

CASE STUDy

DRE in CAMHS in the North West

Key learnings about appropriate and responsive servicesTherehasbeendefiniteprogresstowardsdevelopingappropriateandresponsiveservicesforpatientsfromBMEbackgrounds.AnumberoforganisationsandpartnershipshaveengagedwithlocalcommunitiesanddevelopedinnovativeservicesacrossEngland.Inaddition,DREhasraisedawarenessabouttheneedsofBMEcommunitiesandtheneedtotackleinequalitiesisnowbeingconsideredatacommissioninglevelmorethaneverbefore.However,thereisstillmuchmoretodo.Herearesomeofourkeylearnings:• Oneofthekeyareasforimprovementishow

PCTsaddresstheparticularanddifferingneedsofBMEcommunitiesinthewaytheycommissionservices

• ThesuccessofprojectssuchastheSheffieldEPICproject(seepage11)haveshownthatservicescanmeetcommunities’needsbuttheyneedtotakethetimetoengagewiththeminameaningfulway.Thisengagementneedstoinformatalllevels–fromcommissioningthroughtothedeliveryandpromotionofservices

• Mentalhealthproblemscanhaveacomplexrangeofcausesandawiderangeoffactorsneedtobetakenintoaccountwhentreatingpeople.Servicesneedtobeflexibleenoughtoaddressmanyissuesandstaffneedtohaveappropriateculturalcompetencyskills

• Aswithmostpublichealthtransformations,changetakestime.However,thepre-requisitestoimprovedoutcomesarenowbeginningtotakeroot.

SupportedbyaregionalBMEChildandAdolescentMentalHealthServices(CAMHS)consultant,providedbyNHSNorthWest,CDWsacrosstheNorthWestofEnglandhavehelpedCAMHSpartnershipstoimplementraceequalityactionplansanddeliveranumberofsuccessfulprojectsandinitiatives:• InLancashire,culturalcompetencytraininghas

beenorganisedandwillshortlyberolled-out.Theaimistohelpstaffidentifyhowtoimprovementalhealthservicesforchildrenandyoungpeople.AswellasinformingLancashire’scommissioningcycle,theresultswillbesharedacrosstheregion

• InManchester,amentalhealthandwellbeingtoolkittohelpyoungpeoplesupporteachotherwillberolledout.Staffandparentswillalsoreceivetrainingaroundthetoolkitanditishopedthatthereferralprocessandcarepathwaywillbeenhanced

• InWigan,acommunityartsprojectinschoolshastargetedyoungasylumseekersandrefugees,BMEchildrenandthemainstream

populationofchildrentoexpresshowtheyfeel.Acreativewritingprojecthasalsoenabledyoungpeopletoexplorementalhealthandwellbeing

• InLiverpool,theCDWhelpedtoestablishanagreementthatCAMHSCulturalCompetencyTrainingwillbeincorporatedinallcontractsforstaffandservicedeliveryroll-outwilltakeplaceshortly.TheBridgesProject,adropinserviceforyoungBMEchildren,adolescentsandparentshasdevelopedaswellasservicestomeettheneedsofyoungBMEadolescentsfacingforcedmarriage

• IntheWirral,Merseyside,clinicalstaffaresupportingthedevelopmentofalocalyoungpeople’sforumthataddressesmentalhealthissuesexperiencedbychildrenandyoungpeoplefromBMEcommunities

• CAMHSCulturalCompetencytrainthetrainertraininghasbeendeliveredtoCAMHSstaffandCDWsacrosstheNorthWest.Thisisnowbeingdeliveredtootherstaff–forexamplemedicalstaffinLancashire.

key successescontinued

14

section

3Community Development Workers CDWshadandcontinuetohaveakeyroleinengagingandworkingwithlocalcommunities.TherolewasdevelopedtohelpbridgethegapbetweenBMEcommunitiesandhealthandsocialcareservices.CDWsworkedstrategicallyacrossNHSdirectoratesandservicesbutalsodirectlywithBMEcommunities.

TheimportanceoftheCDWrolemustbeparticularlynoted.TheyhavebeenthefocusandleadforexemplaryworkinmanyaspectsoftheDREprogramme.CDWshave:• Overcomebarriersandtakenupopportunities

tobuildbridges• Workedwithcommunitiestoidentifyneeds• Workedtohelpreducestigmaandpromote

betterunderstandingofmentalhealth• Actedasanecessaryconduitforhelpingto

bringaboutbetteraccessandoutcomes.

ThroughtheDREprogramme,450CDWshadbeenrecruitedatthelastcount.DREresearchhasbeencommissioned,whichwebelieveshowsthepositiveimpactCDWshavehad.

The roleTheroleofCDWsvariedfromregiontoregion,dependingonlocalneed.FlexibilitywithintherolewaskeytoitssuccessbutthefourmaintasksforeachCDWwere:• Tobringaboutchangestothewaythatservices

werecommissioned,deliveredandperceived.Thisincludedidentifyinggapsinservices,improvingmentalhealthneedsassessmentsandimprovingcommunicationbetweenBMEcommunityservicesandstatutoryservices

• Toidentifyandremovebarrierstoaccessingservices• Toimproveservicesanddevelopjointworking

betweenstatutoryandcommunityservices• ToworkwithBMEcommunitiestohelp

developgrassrootssolutionsandcommunity

resourcesformentalhealth.Theyalsohelpedtobuildrelationshipswithlocalgroupsandnetworkssothattheycouldhaveamoreeffectiverolewithinlocalpartnerships.

CDWswererecruited,ortherolecommissioned,locallybyPCTsbutDREdevelopedanationalsupportprogrammetohelpthemdeveloptheskillstheyneededtoreachandcommunicatewithBMEgroups.Thisincluded:• Awebsitewithbestpracticecasestudies

andupdatesonnationalprogrammeactivity• Regulare-newsletters• Toolkitsthatcoveredarangeoftopicsfrom

howtoengagestakeholderpartnerstorunningeventsandworkingwiththemedia.

TrainingaroundcommunicationsplanninganddeliveryandmediarelationswererunacrosstheCSIPregions.NationalandregionalnetworkswerealsosetuptohelpCDWstosupporteachotherandtobuildcompetencies.

ResearchAreportonhowtheCDWrolewasbeingimplemented4identifiedthefollowingaskeytosustainingtherole:• PartnershipinfrastructuresthatenableCDWs

toworkacrossagencyboundariessothattheyareinabetterpositiontoinfluencestatutoryservices

• Organisationalframeworkstoenableorganisationstoimplementtherolefullyandbuildcapacity

• EducationandtrainingforCDWs• Anevidencebasethatdocuments,

disseminatesandraisesawarenessaboutthewiderangeofworkofCDWs.

AfurtherreportwascommissionedtoidentifyapproachesaimedatsupportingthedevelopmentoforganisationalframeworksforCDWs5.

TheroleofCDWsvariedfromregiontoregion,

dependingonlocalneed.Flexibilitywithintherole

waskeytoitssuccess.

““building block 2

ENGAGED COMMUNITIES

key successescontinued

DRE engaged with people from BME backgrounds so that we could understand their needs and fears as well as the barriers that might prevent them from getting help. We wanted people from BME backgrounds to influence mental health policy and the way that services were provided. Engaging communities was also about changing the perceptions of mental health problems among BME communities to reduce stigma and promote treatment and recovery.

15

section

3CASE STUDy

“AsaBMECDWit’scrucialtounderstandyourtargetaudience.Withthisknowledge,youcanensurethatpeoplewithmentalhealthdifficultiesfromBMEcommunitiesaresignpostedtoculturallyappropriateservicesandcomplexneedsaremet,”saysCurtisHenry,whoisaCDWbasedatDoncasterPCT.

CurtiswasappointedasaBMECDWinMarch2007,afterextensiveexperienceworkingwithBMEgroupsasayouthworkerandlaterasaco-ordinatorforaCaribbeancommunitycentre.“Myworkhasalwaysinvolvedworkingwithdisadvantagedgroupsandengaginghard-to-reachcommunities.It’sanextremelychallengingbutveryrewardingrole”,saysCurtis.

Fromtheoutset,Curtishasbeeninvolvedinavarietyofcommunityengagementprojects,includingsettingupamulti-culturalsportsinitiativeforwomenfromBMEcommunitiesinDoncaster.AfterinitialresearchfoundthatmanyMuslimwomenintheareadidn’tfeelcomfortableexercisinginpublicgyms,andthataccesstomentalhealthinformationforthisgroupwaslimited,Curtisdevelopedagroupwherethesewomencouldexerciseinasafe,privatesetting,aswellasreceiveculturallyappropriatementalhealthinformation.Feedbackfromuserswaspositive.

Onastrategiclevel,CurtisisleadingonaDoncasterPCTprojecttoevaluatetheequalityframeworkforcommissioners.TheframeworkisachecklisttoensureBMEmentalhealthneedsarebeingmetbyservicesthatarecommissionedbythePCT.

Additionally,CurtisisworkingwiththeImprovingAccesstoPsychologicalTherapies(IAPT)programmewhichseekstoprovideimprovedaccesstopsychologicaltherapiesforpeoplewhorequirethehelpofmentalhealthservices.Italsorespondstoserviceusers’requestsformorepersonalisedservicesbasedaroundtheirindividualsneeds.DoncasterPCTwasapilotforthisprogramme,andCurtisnowsitsonthe

steeringgroupinanadvisoryroletoraiseawarenessabouthowIAPTrelatestoBMEservicesandhowtoeffectivelyengageBMEcommunitiesaboutmentalhealthissues.

CurtisalsoworkswithTierThreeprofessionalsinCAMHSinDoncastertoraiseawarenessofadolescentmentalhealthissuesandtodevelopcommunity-basedpathwaysofcareforchildrenandfamiliesfromBMEcommunitiesinthearea.AfterayearofengagingandbuildingcredibilitywithCAMHS,Curtisnowworksalongsidetheteam,liaisingcloselywithhealthpractitionersandfamilytherapiststoestablish,identifyandwidenaccesstoBMEspecificmentalhealthservices.

Curtissays,“ToooftentheBMEperspectiveisabolt-onservice,whenitshouldbeanintegralpartofprovidinganysystem.MyworkwithIAPTandtheCAMHSteamisawayofpassingonmyknowledgeaboutthesecommunitiestofullyinformserviceprovision.”

AlthoughCurtishasbeeninvolvedwithmanyBMEcommunitymentalhealthprojects,headmitsthatengagingyoungerpeoplehasn’tbeeneasy.Heexplains,“MakingyoungpeopleawareofBMEmentalhealthissuesandserviceshasbeenchallenging,particularlyintermsofaccess,sowearekeentotargetschoolswithyoungpeopleengagementwork.Ideally,wewouldliketogainaccesstoschoolsandtalktoteachersabouttargetingBMEchildrenaroundmentalhealthissues.Ithinkit’sincrediblyimportanttoreachchildrenatanearlyagetodemystifymentalhealthandcreateawarenessaroundservicesavailabletoBMEgroups.”OverseveralmonthsCurtishassetupaseriesofmeetingswithyoungBMEpeopletoconsultwiththemaboutmentalhealthissues.Hesays,“Toengageyoungpeopleyouneedtogetoutintothecommunitiesandfindoutfirst-handwhattheyneed.FromhereIhopetodevelopabetterideaabouthowwecanestablishserviceswhichmeettheneedsofavarietyofBMEcommunities.”

Curtis Henry, CDW

key successescontinued

16

section

3Community engagement projectsBetween2005-08,79communityengagementprojectswerecarriedoutbynon-statutorycommunityorganisationsacrossEngland.TheprojectsengagedpeoplefromBMEbackgroundstofindouttheirviewsandopinions.Theaimwastobuildcapacity,throughdevelopingskillsandcompetenciesofpeopleandgroupsinthenon-statutorysector,todeveloppartnershipsbetweenthenon-statutoryandstatutorysectorsandtohelpprovidersoffernewandinnovativeservicestomeetneeds.

AcommunityengagementapproachwasdevelopedbytheUniversityofCentralLancashire(UCLan).ItinvolvedtrainingandsupportingBMEorganisationstocarryoutresearchamongtheircommunitiesandsupportingthemtoconnectwithlocalservicesbysettingupsteeringgroups.Thesegroupstypicallyincludedlocalmentalhealthserviceplanners,commissionersandproviders.Thisengagementensuredthatthestudieswerecompatiblewithlocalprioritiesandstrategies,providedamechanismforimplementingtherecommendations,andmadeitmorelikelythatthecommunityorganisations’workwouldbesustainedinthelongterm.

547communityresearcherswererecruitedtocarryouttheresearch,48ofwhomwerepreviousorcurrentmentalhealthserviceusers.Theycollecteddatafromalmost6,000peoplefromBMEbackgrounds.935ofthesepeoplewerepreviousorcurrentmentalhealthserviceusers.

Eachprojectfocusedononeormoreofthe12DREcharacteristicsfor2010(seesection4forthefulllistofcharacteristics).ThefindingsforsixofthecharacteristicshavebeensummarisedinUCLan’sreportontheprocess,findingsandoutcomesofthecommunityengagementproject6.

Outcomes UCLan’sreportdescribedtheoutcomesforthefollowinggroups:

Community researchersCommunityresearchersacquirednewskillsandknowledgeaboutmentalhealthandmentalhealthservicesduringUCLan’strainingworkshopsandtheirworkontheproject.Somewentontoobtainemploymentinthementalhealthfield(includingatleast20asCDWs).321ofthemwereawardeduniversitycertificates.

Community organisationsThecommunityorganisations’profileswereraisedamonglocalandregionalmentalhealthservicesandamongthelocalBMEpopulations.Linksandpartnershipsbetweencommunityorganisationsandprimarycaretrustswerestrengthenedandtherewasanincreaseincommunityorganisations’knowledgeof,andengagementwith,localBMEpopulations.SomecommunityorganisationsobtainedfundingtoconductfurtherworkrelatedtothementalhealthserviceneedsofBMEpopulations.

BME communitiesAsurveyontheoutcomesofthecommunityengagementprojectwascarriedoutwith140CDWsinAugust2009.Of72CDWswhowereawareoftheproject(including42whohadbeendirectlyinvolved),40%hadobservedimprovementsinmentalhealthservicesforBMEcommunitiesthathadoccurredasaresultoftheproject,21%wereunsureifimprovementswereconnectedtotheproject,and39%hadnotobservedanyimprovementsconnectedtotheproject.ThemostfrequentlyreportedimprovementswerethattheprojecthadhighlightedBMEcommunities’mentalhealthserviceneeds,andraisedtheprofileofmentalhealthinthecommunities.TherewasalsoanincreasedawarenessofmentalhealthandmentalhealthservicesamongBMEcommunities.

key successescontinued

Therewasalsoanincreasedawareness

ofmentalhealthandmentalhealth

servicesamongBMEcommunities.

““

17

section

3

DRE ambassadorsTheDREAmbassadorsprogrammewasestablishedthreeyearsagotoinvolveusersandcarersstrategicallyintheDREprogramme.Thereare33ambassadorsacrossthenineEnglishregions,includingcarers,formermentalhealthserviceusersandex-offenderswhohavehadmentalhealthproblems.

TheambassadorsprogrammewasfoundedbyLeadDREAmbassadorJulieJayeCharlesandisajointinitiativewiththeEqualitiesNationalCouncil.ItfollowstheInvolvementChoiceAdvocacyNational(ICAN)programme,whichenablesambassadorstonegotiateintheirregions.

TheirrolehelpstoshapetheimplementationoftheDREActionPlan,bothregionallyandlocally.AmbassadorsworkwithRELs,CDWsaswellas

health,socialcareandotherprofessionals.Overthelast18months,theyhavereceivedtrainingtohelpthemtounderstandpolicyatbothlocalandcentralgovernmentlevels.Now,ambassadorsarerecruitingandtrainingpeoplefromlocalBMEvoluntaryorganisationstoactasadvocatesforBMEmentalhealthissues.

Juliesays,‘Theambassadorsprogrammesupportsindividualsbackintoemploymentandeducationbut,moreimportantly,itgivesthemastrategicvoicethatreallyinfluenceslocaldecisions.’Shesaysthatambassadorscanhelptomakesurethatregionalpartnershipsaddressthecross-cuttingissuesthatpeoplewithmentalhealthproblemsface.Juliesays,‘It’snotjustabouttheinterfaceofmentalhealthservicesandsupportingpeopletoaccessthoseservices.Peopledon’thavementalhealthproblemsinisolation,we

CASE STUDy

DerbyshireGypsyLiaisonGroupprovidesassistanceandinformationtotheGypsycommunityinandaroundDerbyshire.

Their2007communityengagementstudyexploredtheemotionalandwell-beingneedsofRomanyGypsiesandIrishTravellers.Ateamoffive,includingtwoCDWs,interviewed50IrishTravellersand100RomanyGypsies.Thestudy’srecommendationshavebeenprogressedasfollows:• AfurtherstudywascommissionedbyWest

MidlandsCSIPtoexploretheemotionalwell-beingandmentalhealthneedsofolderpeople.ItsfinalreportwasShoonteoPuriFolki(ListentotheElders).

• Throughoutreachworkandimprovedinter-agencyworking,therehavebeenimprovementstoprimaryhealthcareforpeoplefromGypsyandTravellercommunities.

• AswipecardsystemisbeinginvestigatedtohelpTravellersprovideinformationabouttheirhealthatGPsurgeries.Thecardswouldholdtheirpatientrecordsinaprotectedformat.

• DGLGareworkingwithaLeeds-basedorganisationtoprovideaDVDpackageofinformationfollowingthestudy’srecommendationtoprovideinformationnotjustinwrittenformats.Informationisalsoprovidedthroughtwoleafletsaspartoftheolderpeople’sproject.

• DGLGsendoutreportstoagenciesandoffertrainingseminarsonculturalaspectsoflifeofRomanyGypsiesandIrishTravellers.ThesehavebeenpickeduponbyagenciesoutsideDerbyshire,includingthoseinDevon,Sussex,KentandtheNorthEast.

Derbyshire Gypsy Liaison Group (DGLG)

key successescontinued

Ambassadorshavearoleinshapingthe

implementationoftheDREActionPlan,bothregionallyandlocally

““

18

section

3

TheworkofCDWshasinformedpolicyatregionalandnational

levelsandhelpedtoimproveservices.

““Key learnings about community engagement TherehasbeenthesuccessfulengagementofBMEcommunitiesthroughthecommunityengagementprojectsandthedaytodayworkofCDWs.Thisworkhasinformedpolicyatregionalandnationallevelsandhelpedtoimproveservices.Herearesomeofourkeylearnings:• Themajorityofthecommunityengagement

projectsrecommendedvastlyincreasedBMEcommunitymembers’andserviceusers’involvementintheplanning,commissioninganddeliveryofmentalhealthservices.

• Communityorganisationsrecommendedanumberofwaysofreducingfearofmentalhealthservicesincluding:

–educationaboutmentalhealthdisorders

–addressingthenegativeconnotationsofsometerminology–forexample,theword‘mental’

–communitybasedservicesratherthanmainstreamservices

–culturallysensitivesupportgroups

–partnershipswithotherorganisations.

• Oneofthekeychallengesforcommunityengagementisthefluidityoftheterm‘communities’.Theyarenotstaticorfixedandpeoplemayidentifywithanumberofcommunities.Workatalocallevelisimportant.Forexample,itwouldaddressthediversityof‘theSouthAsiancommunities’,withinwhichtherearedifferencesbetweengenders,generations(especiallybetweenthosewhowereborninandoutsidetheUK),faithsandreligions,andlanguagesanddialects,aswellasbetweenthoseofBangladeshi,Indian,PakistaniandSriLankanheritage.‘Whatworks’foranyoneofthese–orforanyotherBMEpopulation–maybeinappropriateforanother.

• CDWsneedtobesupportedtoworkacrossdisciplines,directoratesandservicessotheyarebetterplacedtoinfluencestatutoryservices.OrganisationsneedabetterunderstandingoftheroleandshoulddevelopframeworksthatallowCDWstoworkstrategically.

key successescontinued

needtolookatfactorslikehousing,employmentandeducation.’Theprogrammewasinitiallyconcernedwithsupportingpeoplewithmentalhealthproblemsbutnowincludespeoplewithmentalhealthaswellasothermultipleimpairments.

AmbassadorswillcontinuetheirworkaftertheDREprogrammeends,creatingactionplansoutoftherecommendationsfromtheequalityimpactassessmentsthateverypublicsectororganisation

mustcarryout.Tohelpdeliverthese,theEqualitiesNationalCouncilhasdevelopedanEqualitiesImpactAssessmenttoolkitforambassadorstouse.TheprogrammeisalsolinkingwiththeDepartmentofWorkandPensionsandDHonotherserviceuseractivity.

19

section

3DRE Research programmeTheDREprogrammehasbothcommissionedresearchdirectlyandbeenacatalystforthedevelopmentofotherresearchandevaluationinrelationtoBMEcommunitiesandmentalhealth.Ourresearchhashelpedustoimproveethnicmonitoring,identifygoodpracticeandprovidebetterinformationtopatients.Therewerethreemaintypes:• Originalresearchthatinsomewayaddressed

oneormoreofthe12DREcharacteristics.Thesubjectscoveredincludeprescribing,adaptingcognitivebehaviouraltherapytoBMEcommunitiesandculturalconsultationinforensicsettings

• EvaluationofDREwork,includingreviewsofFISs,CDWsandthecommunityengagementprojects

• ResearchthatwasspecifictoDREprogrammes,forexamplethe79CEprojectreportsandresearchintotheDREdashboard.

Count Me In CensusTheCountMeIncensuswasanewapproachtogatheringdataaboutmentalhealthpatients.CommissionedbyDHaspartoftheDREprogramme,itwasajointinitiativebetweenNIMHE(nowtheNMHDU),theHealthcareCommission(nowtheCareQualityCommission(CQC))andtheMentalHealthActCommission(nowpartoftheCQC).

Thecensusisaheadcountofallmentalhealthinpatientsthatiscarriedouteachyear.Itrecordsethnicityandinformationaboutinpatientspathwayspriortoadmission.Byrecordingnumbersandencouragingserviceproviderstokeeprecords,thecensushelpsserviceproviderstakepracticalstepstoreduceinequalities.238healthcareorganisationstakepart,helpingtogiveacomprehensiveoverviewofmentalhealthinpatientsinEngland.Itwasalsousedtogather

datatomeasuretwooftheDRE’sactionplanaims–toreducetherateofmentalhealthinpatientsfromBMEcommunitiesandtherateofcompulsorydetentionforBMEpatients.Seesection4ofthecensusforadiscussionofthisaim.

PatientswereaskedaboutmixedsexaccommodationtocompareBMEpatients’experiencesandtogetthemostoutofthecensusasageneralmonitoringtool.Indefining‘mixedsex’,DHguidelineswereused,forexampleanyonewithoutaccesstosinglesexdayareasiscountedasnotinasinglesexward.DHguidanceisthatsinglesexaccommodation–separatesleeping,toiletandbathingfacilities–ismandatory,butsinglesexwards–separatedayareasaswell–arenot.In2008,theCensusaskedformorespecifics:whetherpatientshadsinglesexsleepingaccommodation,toiletandbathingfacilities,anddayareas.Thishelpedtogetafullerpictureofpatients’experiences.

ThefindingsofCountMeInbothconfirmedandchallengedassumptionsaboutBMEcommunitiesandmentalhealthservices.Forexample,thefirstcensusin2005showedthatpeoplefromBlackAfricanorCaribbeancommunitieswerethreetimesmorelikelytobeadmittedtohospitalthanthepopulationasawhole.Theywerealsoabouttwiceaslikelytobereferredtohospitalthroughthepoliceorthecourts.HoweverperceptionsthatBlackinpatientsaremorelikelytobesubjecttomeasureslikephysicalrestraintorsecludedwerenotconfirmed.Thegroupmostlikelytoberestrainedorsecludedchangedfromyeartoyear.TheexceptionistheOtherBlackgroup,whohaveshownhighratesofseclusioninallfourreports.

Ourresearchhashelpedustoimprove

ethnicmonitoring,identifygoodpractice

andprovidebetterinformationtopatients.

““building block 3

BETTER INFORMATION

High quality information that can be used intelligently is vital if services are to better understand BME communities, provide services that meet their needs and measure progress. Over the last five years, as a result of the DRE programme, a wealth of information and learning has been produced. This has greatly improved the evidence base around mental health and BME communities.

key successescontinued

20

section

3

Theindicatorshighlightthebasicdataneeded

tomeasureprogressonraceequality.

““CASE STUDy

WestLondonMentalHealthTrusthasusedCountMeIndatafortheyears2005and2007toanalyseandcomparetheproportionofBMEandWhitepopulationswithinitscatchmentareasandadmissionsrateswithinspecificservices.TheworkwasundertakenthroughitsClinicalandResearchGovernanceCommittee.TheworkcoversEalingadultservices,Hammersmith&Fulham,BroadmoorDirectorates,WestLondonForensicandOlderPeoplesServices.

ThefindingsindicatedadisproportionaterateofadmissionsoftheBMEpatientgroupwhencomparedtotheWhitepatientgroup.ThefindingsalsosuggestedthatBlackpatientgroups“arealsodisproportionatelyadmitted

totheservicewhenexaminedinrelationtothelocalpopulationcensus.”Inaddition,insomeservicestherateofseclusionandincidenceofrestraintwashigherintheBMEpatientgroup.ThereportidentifiedthreeDREservicecharacteristicsaskeyperformanceindicatorsfromwhichthetrustcanbenchmarkimprovementsyearonyear:• AreductionintherateofadmissionofBME

communitiestopsychiatricinpatientunits• Reductionintheuseofseclusionin

BMEgroups• Amorebalancedrangeofeffectivetherapies

suchaspsycho-therapeuticandcounsellingtreatments.

The DRE DashboardTheDREDashboardisatooltohelpSHAs,PCTsandmentalhealthtruststomeasuretheirprogressonraceequalityinmentalhealthatlocalandregionallevels.LaunchedinSeptember2008,ithelpsorganisationstoidentifysuccessesaswellasgapsandrisks.

Thereareatotalof26indicators,coveringarangeofareastoaidunderstandingaboutaccessandoutcomes.Thesearecross-referencedagainstthe12DREcharacteristics.TheDREDashboardalsosetouttotracksixheadlineindicatorsaspartofanationaldatacollectionexercise:• Accesstoearlyintervention• Accesstocrisisresolution/hometreatment• Useofassertiveoutreachservices• Accesstopsychologicaltherapies• ImplementationofSupervisedCommunity

Treatment(SCT)(undertheMentalHealthAct2007)

• RecruitmentandimpactofCommunityDevelopmentWorkers(CDWs).

Theresultingreport,dueforpublicationinDecember2009,hasfocusedonthefirstfourcommunityaccessindicators.Thefindingsprovidearichsourceofinformationandanalysisonregionaldatacapture.InformationontheuseofSCTisavailablefromtheNHSInformationcentrethroughtheKP90returnspublishedinOctober2009(www.ic.nhs.uk/pubs/inpatientdetmh@0809)andtheMentalHealthBulletinpublishedinNovember2009.

InformationonCDWshasbeendescribedelsewhereinthisreview.

Theindicatorshighlightthebasicdataneededtomeasureprogressonraceequality.ResearchsofarhasbeenpositiveandtheoutcomeswillbeusedtoinformNewHorizons.

ThebenefitsoftheDREDashboardarethatitsupports:• EarlylocalengagementbySHAs,PCTsand

mentalhealthtrusts• Earlyawarenessofanyobviousmajorlocal

issues/problems• PCTsinassessingneedsandtargetingresources• Thecollectionoftimelyinformationona

regularbasis.

West London Mental Health Trust: Using Count Me In data to benchmark change

key successescontinued

21

section

3

AkeysuccessofDREhasbeenimprovingthe

informationwehaveinrelationtoraceand

mentalhealth.

““

Key learnings about information, research and evaluationAkeysuccessofDREhasbeenimprovingtheinformationwehaveinrelationtoethnicityandmentalhealth.Thishasenabledevidence-baseddiscussionsaboutcomplexissues,whichultimatelyhelpsservicestoimprove.Futureworkmustbuildonthisandcontinuetoaddresshowtodevelopmetricswhichbetterquantifyandmeasureprogress,forexampleinrelationtomeetingthecompetencyrequirementsofWorldClassCommissioning.Keyareasincludegoodethnicmonitoring;developingarangeofwaysofimprovingdemographicinformation;ensuringgoodlinksbetweeninformationtechnologyservicesandequalityanddiversityleadswithintrustsinordertoeffectivelyusetheinformationtoinformservicedevelopment;andmonitoringandreviewatboard,management,wardandcommunitylevels.

key successescontinued

22

section

4tHe 12 dre cHaracteristics

1. Less fear of mental health care and services among BME communities and BME service usersResultsfromtheHealthcareCommission’spatientsurveysindicatethatratesofsatisfactionwithservicesarethesameforBMEandWhiteBritishcommunitytreatmentserviceusers.However,someoftheevidencefromthecommunityengagementreportsshowsthatpatientsfromsomeBMEcommunitiesdofearservices–particularlythosewithexperienceofmentalhealthservices.

2. Increased satisfaction with servicesTheHealthcareCommission’spatientsurveysshowthatsatisfactionlevelsbetweenBMEandWhiteBritishcommunitytreatmentserviceusersaresimilar.However,someofourresearchshowedthatdifferentcommunitieshavedifferentsatisfactionrates.

3. A reduction in the disproportionate rate of admission of people from BME communities to psychiatric inpatient unitsTheCountMeInCensusshowsthattherehasbeenlittlechangeinthenumbersofBMEpatientsoninpatientwards.Thefourthannualcensus,publishedinNovember2008,showedthatadmissionratesforBMEcommunitiesarenotfallingandthatsomeBMEgroupsarethreeormoretimesmorelikelythanaveragetobeadmitted.Asdiscussedonpage7,higherratesofmentalillnessinsomeBMEgroupsmeansthatcompulsorydetentionratesalonearenotagoodindicatorofqualityinmentalhealthservices,thoughtheyareanimportantreflectionoftheexperienceofBMEserviceusers.

4. A reduction in the disproportionate rates of compulsory detention of BME users in inpatient unitsThefourthannualCountMeInCensus(November2008)showedthatdetentionratesforBMEcommunitiesarenotfalling.Asdiscussedonpage7,higherratesofmentalillnessinsomeBMEgroupsmeansthatcompulsorydetentionratesalonearenotagoodindicatorofqualityinmentalhealthservices,thoughtheyareanimportantreflectionoftheexperienceofBMEserviceusers.

5. Fewer violent incidents that are secondary to inadequate treatment of mental illnessTheCountMeInCensusshowsthereisnodisparitybetweenBMEandWhiteBritishinpatientsintheincidenceofphysicalassault,accidentsandself-harm.DHfundedastudy(2008)byQueenMaryUniversityofover700psychiatricinpatientsingeneraladultpsychiatricunitsacrosseightmentalhealthtrustsinEngland.Theyhadbeenadmittedonsections2,3or4oftheMentalHealthAct1983orbecameinvoluntarypatientswithinthefirstsevendaysfromadmission.Thestudyfoundnoassociationbetweenethnicityandtheuseofcoercionreportedbyinpatientsinpsychiatricunits.

6. A reduction in the use of seclusion in BME groupsTheCountMeInCensusshowsnoconsistentdisparityintheuseofseclusionbetweenBMEandWhiteBritishinpatients.Theexceptioniswiththe‘otherblack’group.

7. The prevention of deaths in mental health services following physical interventionDeathsfollowingphysicalinterventionareverylow.Dataupto2006(thelatestyearforwhichinformationisavailable)showanaverageof2-3casesperyear.Theirnumbersaretoosmalltodemonstratetrendswithanyethnicgroup.

8. An increase in the proportion of BME service users who feel they have recovered from their illnessResearchshowsthereisnodisparitybetweenBMEandWhiteBritishgroupsintheproportionofserviceuserswhofeeltheyhaverecoveredfromtheirillness.The2008QueenMarystudyindicatedthatthosefromethnicminoritieshavebetteroutcomesonsymptomimprovementscalesandscalesrating‘satisfactionwithlifeingeneralanddifferentlifedomains’oneyearafteradmission.HealthcareCommissioncommunitypatientsurveysalsoshownodisparitybetweenBMEandWhiteBritishserviceuserswhenaskedabouttheirfeelingsabouttheirownmentalhealth.

In 2005, the DRE action plan identified 12 characteristics which we hoped would describe mental health services in 2010. Below is an assessment of how we have progressed towards achieving the 12 characteristics.

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4

PatientsfromBMEgroupswhoweretreatedintheservicealsoachievedatleastasgoodoutcomes

asnon-BMEpatients.

““

9. A reduction in the proportion of prisoners from BME communitiesHomeOfficeandMinistryofJusticefiguresshowtherewasaslightdecreaseintheproportionofprisonersfromwhitebackgroundsbetween2005and2007(from82%to81%oftotalBritishnationalprisonersandfrom75%to73%ofthetotalprisonpopulation).TheBlackorBlackBritishproportionoftheBritishnationalprisonpopulationincreasedfrom10%to11%inthesameperiod,whiletheproportioninthetotalprisonpopulationstayedthesameat15%.TheAsianorAsianBritishproportionoftheBritishnationalprisonpopulationincreasedfrom4%to5%inthesameperiod,whiletheproportioninthetotalprisonpopulationalsoincreased,from6%to7%.

10. A more balanced range of effective therapies such as peer support services, psychotherapeutic and counselling treatments, as well as pharmacological interventions that are culturally appropriate and effectiveTheHealthcareCommissioncommunitypatientsurveysindicatethatBMEpatientsarelesslikelytogettalkingtherapies,butalsolesslikelytowantthem.However,BMEpatientswhodowantthemarelesslikelytogetthem.TheDREclinicaltrailblazerreport(2009)carriedoutbyUniversityofSouthamptonandHampshirePartnershipTrust(2009)indicatedthatfactorsaffectingaccesstotherapyinclude:• Mistrustofservices/practitioners• Worriesaboutconfidentiality• Pooravailabilityofinformation• Languageissues.

Formoreinformationvisit:www.mentalhealthequalities.org.uk/our-work/delivering-race-equality/clinical-trailblazers/

LearningfromtheDREprogrammeisbeingincorporatedintotherolloutoftheIAPTprogramme.TheNewhamIAPTsitehasbeenabletodevelopaservicethatBMEcommunitiesaccessandthatprovideseffectivetreatmentforthem.Theabilityforpatientstoself-refertotheservicewasakeyaspect.PatientsfromBMEgroupswhoweretreatedintheservicealsoachievedatleastasgoodoutcomesasnon-BMEpatients.

11. A more active role for BME communities and BME service users in the training of professionals, in the development of mental health policy, and in the planning and provision of servicesCDWs,communityengagementprojects,theworkoftheDREAmbassadorsprogrammeandawiderangeofotherinitiativesandprojectshavebeenundertakenaspartofaddressingthischaracteristic.

12. A workforce and organisation capable of delivering appropriate and responsive mental health services to BME communitiesRaceequalitytraining,clinicaltrailblazers,CDWsandthedevelopmentoftheDREDashboardhavehelpedtoimproveandmeasuretheskillsofthementalhealthworkforce.Evaluationandresearch,however,indicatethattheunderstandingandimpactofsomeoftheseinitiativeshasbeenvariable.

tHe 12 dre cHaracteristics continued

Key learningsThe12characteristicswerenotallmeasurableindicatorsandasignificantpartoftheDREprogramme’sworkhasbeentoidentifywaysthattheprogrammecanmeasureitssuccess.Questionshavebeenraisedaboutthecharacteristicsandawidersetofsuccessfactorsmaybeneededgoingforward.Someofthekeylearningaroundthe12characteristicshasbeen:• Weneedtocollectdataforlongerifwe

aretomeasureongoingtrendsratherthanyearonyearfluctuations

• Datashouldbemeasuredonaregionalaswellasanationalbasis

• Therearesomegapsindataandinsomecasesdatafromdifferentorganisationscannotbecompared

• Differencesbetweenethnicgroupscouldbedowntootherfactors–forexampleageorgender.AstraightforwardcomparisonbetweenBMEcommunitiescannotbemade

• DifferentBMEgroupsneedtobeengagedandconsideredseparately.

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5working in partnersHip

TheDREprogrammeisalsoundertakinga

successfulcollaborationwithShiftthrough

theBreakingThroughBarriersproject.

““

• TheDREactionplan’saimtopromotegreateraccesstoamorebalancedrangeoftherapiesforpeoplefromBMEcommunitiesfittedwithIAPT’saimtopromoteaccesstopsychologicaltherapies.DRE’sworkhasinformedandinfluencedtheIAPTprogramme.Wehavebeeninvolvedatastrategiclevel,contributingtoequalityimpactassessmentsandatalocallevelthroughtheworkofCDWs.SeethecasestudybelowforhowIAPTisimprovingaccesstotherapiesinNewham.

• DREworkedwithotherNMHDUprogrammestosupporttheimplementationoftheMentalHealthAct2007,includingtheThreeKeysinitiativeofadoptingashared,values-basedapproachinmentalhealthassessment.ThisinvolvestraininganationalcohortofCDWchampionstodeveloptheThreeKeysapproachtohelpimprovetheskillsofmentalhealthpractitionersinworkingwithdiversecommunities.

• TheRaceforHealthprogrammeisaDHinitiativethatworkswithPCTstoenablethemtodelivermeasurableimprovementsinthehealthoutcomesofpeoplefromBME

communities.In2007,wejointlycollaboratedonaMinisterialmeetingwithPCTandmentalhealthprovidertrustchairsandchiefexecutives.TheRaceforHealthprogrammehasdevelopedperformancemetricstoenablemeasurementofimprovementsinthehealthcareofpeoplefromBMEcommunities.Mentalhealthmetricsareakeycomponentofthis.WehopetotakethisworkforwardthroughthedevelopmentofEqualityDashboardswithinSHAregions.

• ShiftisaDHfundedinitiativetotacklestigmaanddiscriminationsurroundingmentalhealthissuesinEngland.Wehavejointlycommissionedanumberofprojects,includingafilm,OpenSecrets,aphotographicexhibition,aresearchprojectintothecoverageofmentalhealthstoriesintheAfricanandCaribbeanmediaandaBMEmediaresourceslibrary.TheDREprogrammeisalsoundertakingasuccessfulcollaborationwithShiftthroughtheBreakingThroughBarriersproject.ThisinvolvesCDWs,workingregionally,toimprovementalhealthawarenessinBMEcommunities.

The DRE programme’s work has involved working with a range of partners and organisations. This section looks at where we facilitated partnership working to improve outcomes for people from BME backgrounds.

CASE STUDy

BasedattheNewhamPsychologicalTreatmentCentre,theNewhamIAPTprojectislocatedinanareawithalargelocalBMEpopulation.NewhamsuccessfullyincreasedthenumberofBMEpeopleaccessingitsservicestoafigurethatwasclosertotheethnicdistributioninthearea’spopulationasawholefollowingtheintroductionofanumberofreferralpathways.PatientsfromBMEgroupswhoweretreatedintheservicealsoachievedatleastasgoodoutcomes,andhavesimilarsatisfactionrates,asnon-BMEpatients.

TotalnumbersofannualreferralstotheNewhamservicehaveincreasedfrom614(2006)to1860(2008).ThishasbeenaccompaniedbyanincreaseintheproportionofBMEreferrals.In2006,theseaccountedfor58.1%oftotal

referrals,withthisfigurerisingto62.8%in2007and63.9%in2008–thecurrentBMEpopulationestimateforNewhamstandsat66.2%(OfficeforNationalStatistics).

LeadclinicianDrBenWrightstressestheimportanceofprovidingaculturallyappropriateserviceoncepatientshavebeenreferred:“Wetelephoneallpatientstospeaktothemaboutanyconcernsbeforetreatmentbegins–thisisofrealimportanceasBMEpatientsinparticularmaybewaryoftreatmentprocedures.OuraccessmaterialsarealsotranslatedintothemainlanguagesspokenintheareaandweuseinterpretersinPunjabi,Hindi,BengaliandUrdu.Allmembersofourteamhavesignificantexperienceoftransculturalwork.”

Improving Access to Psychological Therapies in Newham

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6looking forward to new Horizons

NewHorizonsalsooutlinestheGovernment’s

commitmenttotacklinginequalitiesinmentalhealthandaccessto

mentalhealthservices.

““

ThiswillbuildonthesuccessofNSFbysupportingthelocaldevelopmentofhigherquality,morepersonalisedservices.NewHorizonswilltakeapublichealthapproachtotreatingmentalhealthproblems.Itwillbuildacross-government,multi-agencyalliancethattacklestherootcausesofpoormentalhealthandgetsupporttopeoplewhereandwhentheymostneedit.

NewHorizonsalsooutlinestheGovernment’scommitmenttotacklinginequalitiesinmentalhealthandaccesstomentalhealthservices.ItwillbuildontheworkoftheDREprogramme,consolidatingthisworkintoawidermentalhealthequalitiescontext.Thisisbecauseithasbecomeincreasinglyevidentthatweneedtoconsiderallstrandsofequalitytogether–ethnicitycannotbedealtwithinisolation.Mostpeoplehavemultipleidentitiesandmultipleexperiencesofdiscrimination.Theequalitiesprogrammeaimstoberesponsivetothecomplexwaysinwhichindividualsidentifythemselveswhilstbeingskilledintacklingtheuniqueimpactsarisingfromdifferentformsofinequalities.NewHorizonsaimstoensurethatwehaveanintegratedapproach.

NewHorizonswillpromoteraceequalitythrough:• Assessmentsoflocalneedsbasedonabetter

understandingoftheethniccompositionofthelocalpopulation

• Continuingconsultationwithlocalcommunitiesonthedevelopmentofappropriateservices

• Measurestoensureequalityofaccessandoutcomes,particularlytoservicessuchasearlyinterventionteamsandpsychologicaltherapies

• Identifyingandaddressinganyinequalitiesinpatientexperiencebetweenethnicgroups

• Ensuringthatstaffreceivetraininginculturalcompetenceandindevelopingorganisationalcompetenciestopromoteequality

• Highlightingtheimportanceofpersonalisedcare,bywhichservicesbuildthecaretheyprovidearoundtheindividualcharacteristicsoftheserviceuser-theirpastexperiences,familysupport,educationandethnicity.

The NSF was the blueprint for changing mental health services in the England over the last ten years. As it approaches the end of its ten year lifespan, it will be succeeded by New Horizons: a shared vision for mental health.

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7references and resources

References1:Fearon,P.,etal.,Incidenceofschizophrenia

andotherpsychosesinethnicminoritygroups:resultsfromMRCAESOPstudy,PsychologicalMedicine;36(11)CambridgeUniversityPress2006,pp.1541-1550

2:FISpeerReview(DRE,2006)

3:Weich,S.,et.al.,Users’,Carers’&MentalHealthProfessionals’experiencesofreceivingandprovidingacutementalhealthcareinadiverseinnercitysetting,inpress)

4:Fountain,J.Hicks,J.Deliveringraceequalityinmentalhealthcare:reportonthefindingsandoutcomesofthecommunityengagementprogramme2005-2008.

5:Walker,R.&Craig,G.,CommunityDevelopmentWorkersforBMEmentalhealth:EmbeddingSustainableChange,DRE/NIMHE,2009

6:Walker,R.&Craig,G.,(2009)OrganizationalframeworksforimplementingthecommunitydevelopmentapproachwithinDeliveringRaceEquality(DRE)inmentalhealthcare

Other key publications• Inside Outside: Improving Mental Health

Services for Black and Minority Ethnic Communities in England (NIMHE 2003)

• The Government’s response to the independent inquiry into the death of David Bennett (DH 2005)

• DRE action plan

• The National Service Framework for Mental Health (1999)

• National Horizons: Towards a shared vision for mental health (2009)

• BME Inpatient Review – Royal College of Psychiatrists (2009)

• DRE dashboard report – Glover, G. & Evison F., ‘Use of new mental health services by ethnic minorities in England’ (North East Public Health Observatory, August 2009)

• Delivering Race Equality in Mental Health Care: a review (August 2009)