City and Hackney Integrated Care Partnership

Background

• Why did you sign up to the Synergi National Pledge to Reduce Ethnic Inequalities in Mental Health Systems?

  We are committed to reduce inequality in all health provision, and we want to ensure good mental health for all. We live and work in a very ethnically diverse and deprived area and should serve the needs of our residents.

• At the point of signing the Pledge, what were the specific ethnic inequalities in your mental health system / services that you wanted to redress?
  • We wanted to ensure equality of access to good mental health care, including inclusive mental health promotion, for all people from an ethnic minority background across Hackney and the City and to ensure that outcomes of treatment were equitable.
  • We wanted to address the ongoing issue of the over-representation of black men entering the mental health system via emergency routes or in crisis – for example Section 136- and also to look at the wider determinants of poor mental health in this group and try to address them.
  • We wanted to address the poor physical health of people with severe mental illness and especially those from ethnic minority groups

   

• Who are you working in partnership with to redress these ethnic inequalities in your mental health system in line with the Pledge?

  We are working with London Borough of Hackney, City of London and both Public Health services as well as with our voluntary sector and service users across both boroughs.

  City and Hackney CCG is now part of North East London Integrated Care System.

Pledge commitments

• What steps have you taken to action this Pledge commitment?
  • We have commissioned services specifically for ethnic minority clients (Core Arts, Growing Minds and Open Minds)
  • We have appointed an equality strategy lead.
  • We have asked our mental health service providers to report on access and outcomes by ethnicity and to improve recording of this data.
  • We have commissioned Advocacy Voice as one of our service user representative groups. They attend all our joint mental health steering committee meetings and have a rolling agenda slot for reporting.
  • Outcomes from access data currently show that both within CAMHS services and adult talking therapy services we have a use of service by most ethnic minority groups proportionate to their prevalence in the community. We continue to look at those groups where access is poor. We are developing the data set for outcomes by ethnicity.
  • London Borough of Hackney continues to develop its work around young black men, which has a specific mental health workstream. This priority was chosen by the young black men as one having a profound effect on their lives and ability to flourish. The Improving outcomes for young black men (YBM) programme aims to reduce disproportionality for young black men, ensuring that outcomes and opportunities for black boys and young black men are the same as the wider population. The YBM Programme and partnership works with local people, the voluntary and community sector and the statutory sector to shape and deliver solutions, which young people are at the heart of. The partnership aligns with Hackney Council’s commitment to anti racism and recognises that addressing structural inequality and institutional and systemic racism is fundamental to meaningful sustainable change and improvement.

• What has been the outcome so far?
  • LBH also commissions the Mental Health Network, which is run by MIND and has specific reach into ethnic minority communities offering therapy and activities to improve wellbeing. Both these report into our joint mental health steering group to ensure integration.
  • City of London continues its work to improve the mental health of unaccompanied asylum seekers through targeting provision for this vulnerable group. This work also feeds into the steering group.
  • The City of London and the CCG jointly commission a street outreach mental health team which has successfully reduced S 136s within the City of London.

  The CCG was the most successful CCG in the UK in achieving the highest percentage of NHSE health checks for people with severe and enduring mental illness. People from ethnic minorities are over-represented within this group.

• What challenges have you faced actioning this Pledge commitment?
  • The interaction between ethnicity and deprivation affects outcomes from mental health treatment and Hackney continues to be a very deprived borough. The chance of recovery reduces by 15% for every standard deviation change in the deprivation score (IAPT Big Data)
  • Post Covid- all services are affected and the impact on staff and clients is only just starting to be felt. We need some time for staff recovery before more service innovation can happen.

   

• What steps have you taken to action this Pledge commitment?

  As above- we have some data on mental health outcomes from treatment showing poorer outcomes for some ethnic minority groups. We are looking at this currently and also at improving coding of ethnicity, as the need for accurate data is of paramount importance.

  The City and Hackney Mental Health team (CCG, LBH, City of London) are linking into the wider City & Hackney’s work analysing the impact of pandemic on health inequalities in City and Hackney work. Objectives of this work include:

  Informing the production of an equalities framework, aligning with existing equalities frameworks to guide local decision making and service planning for organisations across City and Hackney.

  • Informing the development of the inequalities dashboard to monitor progress and hold ourselves to account- at a City and Hackney level and a Neighbourhood level.
  • Monitor inequalities impacts of recovery/phase 2 actions, as well as the impact of the initial/crisis response phase.
  • Collating data sources (national and local, quantitative and qualitative) in one place.
  • Use to ensure all relevant data sources are feeding into action planning on an ongoing basis.
  • Identify future priorities for engagement and insight gathering
  • Agree any future data analysis and data sources.
  • Agree broad ‘vulnerability factors’ within the matrix, to allow organisations to assess the impact of their activities/service changes.
  • Identify priority ethnic minority groups for consideration.
  • Identify short term actions needed to mitigate post-Covid impact on priority groups.
  • Use the ‘opportunity’ of Covid-19 to create a shared public narrative around inequalities to support engagement/co-production of a local (C&H) response.

• What has been the outcome so far?

  The City & Hackney Mental Health Coordinating Committee (our system wide mental health group) has agreed to develop a template to understand what data is currently captured by ELFT, Homerton, MIND and the local authority partners’ mental health services. Part of this work will be to analyse the type of data captured, assess the robustness of the data, explore the gaps from across the mental health system and address and resolve any issues. This will link into the wider CH inequality systems work.

• What steps have you taken to action this Pledge commitment?

  We have a strong voluntary sector partnership in City and Hackney.

  • The Hackney Caribbean Elderly Organisation were commissioned to deliver a dementia outreach and awareness raising programme to our local BAME community. This was informing people about the importance of treating hypertension as a risk factor for dementia development. City and Hackney has a disproportionately high number of people from ethic minority backgrounds affected by hypertension and cerebrovascular accidents.
  • In 2020 the CCG commissioned Hackney CVS to develop and deliver Open Minds, a community-led, multi-agency partnership of local African and Caribbean Heritage (ACH) charity led organisations and established service providers that aims to provide a new approach to address mental ill health and improve emotional wellbeing amongst working age population (18-65) men and women of ACH heritage in the Hackney community. One of its four strands is to develop a digital platform that will increase young black men’s and women’s awareness of, and access to, a range of services in Hackney that provide emotional and mental health support, while creating interest through interviews and stories about culture, arts, business and politics in the borough and beyond.

  In August 2020 SWIM (Support When it Matters) was commissioned to improve African/Caribbean referrals into talking therapies. Key outcomes include:

  • Developing a joint outreach model with Talk Changes (our IAPT provider), Developing social media platforms with relevant details on how to access talking therapies.
  • Undertaking a review of ACH user journey in Talk Changes services.
  • Raising awareness in the ACH community about talking therapies including BAME specific services.
  • Attending pilot blended team meetings in Clissold Ward and Hackney Marshes ward to develop PCN communications.

• What has been the outcome so far?

  Data and analytics have been used to monitor social media social media/digital outreach models.

  City and Hackney currently commissions three local VSO providers to provide IAPT services to our Charedi (7% of population), Turkish & Kurdish communities (6% of population) and the African and Caribbean heritage communities (20% of our population).

  In addition, Talk Changes closely monitors BAME community access and recovery and has strong links to grass roots community organisations. City and Hackney has the highest rate of BAME IAPT recovery in London and access rates for the top 3 BAME communities are in line with BAME population sizes.

  All IAPT providers work closely together through the Psychological Therapies Alliance and have been asked to monitor the following.

  1. BAME access rates overall and per specific community
  2. BAME recovery rates
  3. LGBTQ Access rates
  4. Older Adult Access rates
  5. Access rates per post code comparing access and deprivation

• What challenges have you faced actioning this Pledge commitment?

  Although we are pleased with having comparatively good recovery rates for treatment- as previously mentioned, these are still not equitable with the general population, and we need to improve our ethnicity coding.

  The London Borough of Hackney have instigated an accountability board, chaired by a member of the young black men’s project. This will have a responsibility to hold all system members to account in our work on reducing inequality and improving outcomes for ethnic minority groups.

  The Improving Outcomes for Young Black Men (YBM) programme and partnership involves residents with lived experience and particularly young Black men in a community accountability board that provides challenge and steer to the programme of work which includes a significant strand on addressing mental health issues.  The board brings together residents with service leads in a collaborative venture to ensure that the work reflects and is informed by the experience and understanding of community members.

  The YBM programme has supported young people’s shift from seeing themselves as participants in the Partnership to drivers of change within it, increasing representation at YBM Partnership Meetings and Mental Health Workstream meetings and supporting young people to lead on delivering change.  For example, two young people delivered a workshop at a Mental Health event at Homerton Hospital.

  Six youth leaders participated in a Public Health workshop for the whole public health team and key integrated commissioning workstream leads, in which priorities for future work were identified.  Young people have been co-facilitating mindfulness sessions at Youth Clubs and also played a key role in setting up the Pembury Cool Down Café, a peer led mental health crisis drop in centre for young people.

• Any other comments

  The London Borough of Hackney commissioned Wellbeing Network is led by MIND and includes many local voluntary sector organisations in the wellbeing provision.

   

   

• What steps have you taken to action this Pledge commitment?
  • We attend the national PHE webinars on health inequalities and have representation on the Synergi Board.
  • We have joined the Centre for Mental Health campaign for reducing health inequality
  • We have had a letter published in the BMJ on inequality in health – https://www.bmj.com/content/370/bmj.m2748.full.

   

   

• What challenges have you faced actioning this Pledge commitment?

  Obviously Covid has been our biggest challenge- we have not had time as a system to participate nationally as much as we would like. In addition, major changes within the CCG, which has now become part of NEL, are very recent and need time to settle.

   

• What steps have you taken to action this Pledge commitment?
  • We continue to work with our voluntary sector and to be led by service user opinion within all our commissioned services.
  • We continue to use the five ways to wellbeing locally as a framework for good mental health promotion and will be linking with the Thrive London/Newham initiative to develop specific faith and culturally competent resources to promote that across our system which are to be launched shortly. We are developing our five to thrive website currently.
  • fivetothrive.net
  • We are determined to ensure that good mental health has the same importance as good physical health. This has special significance following the pandemic and its effects on ethnic minority groups. We will build on both Local Authorities’ commendable pandemic response for mutual aid which included training support staff around mental health, dementia and signposting to services.

• What has been the outcome so far?

  Voluntary sector capacity at this time, health priorities around vaccination, staff wellbeing. Sustainability also depends on being able to recurrently fund projects of importance- so funding will be an ongoing problem.

• What steps have you taken to action this Pledge commitment?

  We hope that our whole system work across CCG/London Borough of Hackney and the City of London through our inequalities framework mapping will link well into all national initiatives across health and social care.

  Focusing on inequalities will allow us to support policy development locally and nationally.

  This work is currently progressing well and we will have further developments to report in our update in six months.

  However, we have been learning from the pandemic and need time to work on the large increase in mental health crisis presentation, especially in the young.

  This may affect timescales. Covid has exposed inequality issues so starkly that we need to time to process this, especially as so many staff members across health and local authorities have been affected personally by illness and family bereavement.

• Are you going to contribute to the second Pledge progress update in November/December 2021?

  Yes, we are happy to do this. Hopefully by then the effects of Covid on staff and service users will have settled and system members can concentrate on planning rather than reacting to the emergency.

Next Steps

• What are your Pledge priorities over the next 6 months?
  1. To develop the Growing Minds and Open Minds projects for our residents from African and Caribbean communities.
  2. To improve ethnicity recording for data analysis on access and outcomes of treatment and present a full dashboard of outcomes.
  3. To work as a system across health and local authority partners to maximise out potential for inequality reduction and improved mental health. This means promoting wellbeing and staying well, in addition to improving treatment outcomes and the physical health of people with severe and enduring mental illness.

• How would you contribute to this National Alliance?

  We would be happy to share some of our projects described and to learn from projects happening across the UK, as we are keen to be innovative in our approach to tackling ethnic inequalities.

• What leadership role would you be willing to play in this National Alliance?

  We are committed, as a system, to work on inequality in mental health and would be happy to contribute to any national asks as they develop.

Your Statement of Intent

• Why is the Pledge important to your overarching mission to reduce ethnic inequalities in mental health systems for ethnic minority people with lived experience of severe mental illness?

  The Synergi National Pledge provides a space for a structured commitment to reduce inequality in mental health systems for people from ethnic minorities across our whole system partnership.