North East London ICS (City & Hackney Place Based Partnership)

Partnerships

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

  We are working as an integrated system across health and both local authorities.

• Are you commissioning and/or partnering with black and minority ethnic VCSE organisations and service user-led organisations? If yes, please provide a snapshot of what is being commissioned, and the nature of the partnerships, below:

  Yes, we are commissioning black and minority ethnic VCSE organisations. Please see our response to Pledge commitment 1.

   

   

Pledge commitments

• Initiate fundamental service level changes to reduce ethnic inequalities in access, experience and outcomes.

  We have commissioned services specifically for ethnic minority clients (Core Arts, Growing Minds and Open Minds).

  The Growing Minds project is comprised of four different components:

  Ø  Family Action Counselling Service

  Ø  Non-Violent Resistance (NVR) Parenting (a 12-week parenting programme)

  Ø  Tree of Life programme for young people between 11-18 years of age

  Ø  Mental Health First Aid Instructor Training

  The project has been running for over 1.5 years and was commissioned to provide emotional wellbeing support to young people and parents from African and Caribbean backgrounds.

   

  Update on Growing Minds

  Please see the summary below:

  Growing Minds has been evaluated by an external evaluation company (Fiveways) and the initial results are shared here. Plans are currently being discussed to explore what parts of the programme will be carried forward and how, based on the findings from the evaluation report.

  The Family Action Therapy Service

  This service offered up to 16 sessions of “active” counselling for children and young people from African and Caribbean Heritage (ACH) backgrounds delivered by an ACH counsellor. A total of 123 people received this service and completed their support sessions between February 2020 and February 2022.

  All participants in the qualitative research (5) reported that they had a very good experience of the therapy and it had left a lasting impact on their lives. Since having therapy, they have seen the good days outnumber the bad days. This qualitative feedback is supported by the quantitative service monitoring data:

  • 78% of all service users (76) reduced the severity of their depression, for 7% it stayed the same and for 16% it increased.
  • 77% of all service users (77) reduced the severity of their anxiety, for 6% it stayed the same and for 17% it increased.

  The Non-Violent Resistance (NVR) Training

  The NVR programme (sometimes re-named “Tools for Teenage Years” by partners) was for parents whose children may be experiencing emotional wellbeing or behavioural challenges at home or at school. The 12-week programme focuses on topics such as de-escalation, parental presence, reconciliation gestures, and understanding both children’s and parents’ trauma. Thirty-five parents/carers accessed the first two tranches of NVR training delivered by community partners up to January 2022.

  The Tree of Life in Schools

  The aim of the Tree of Life element of Growing Minds is to give space to young people from ACH backgrounds to believe in their own abilities, acknowledge their dreams and talk about difficult experiences in a safe environment.

  Tree of Life is delivered by Peer Leaders from the community in school settings with groups of young people aged 11-18.

  The pilot is still ongoing and the results will not be finalised until the end of the pilot in July 2022, but the initial findings show that all the schools that participated (10 secondary schools out of 14 approached) are requesting a second and third group within the first year of the pilot.

  Focus groups are being carried out in three schools. The results have not been analysed yet, but early quantitative data from the pre and post questionnaires completed by students (52) show:  

  • In the sessions, I felt safe to share my thoughts and feelings – 81% agree
  • It really helped that the trainers were young people from ACH backgrounds – 92% agree
  • I felt the trainers did a good job – 100% agree
  • I would recommend Tree of Life to my friends – 90% agree

  In addition:

  • 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 The Advocacy Project to coordinate and support a dedicated service user representative group. They attend all our joint mental health steering committee meetings and have a rolling agenda slot for reporting.
  • The Advocacy Project attended the last Synergi conference and presented. Their fixed agenda item slot has been moved to the first agenda item as they reported frequently being presented as the last item.
  • 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.

  Update on data:

  • We have looked  at mental health inequalities data and have produced recommendations.

  Overall, data completeness has improved over time. There is room for improvement around the collection of data on sexuality, disability and wider determinants of health.

  Feedback from the City and Hackney Integrated Care Partnership Communications and Engagement Enabler Group, held on 9 March 2022, included improving communication with service users about why the data is being collected, how it will be used and ensuring language is not a barrier. 

  Please see the charts below for data on CAMHS and IAPT services:

  

   

  

  • London Borough of Hackney (LBH) 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 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.

  • LBH also commissions the Mental Health Wellbeing Network (WBN), which is run by MIND and has specific reach into ethnic minority communities, offering therapy and activities to improve wellbeing. Both report into our joint mental health steering group to ensure integration.

  • BAME representation has increased among clients of the WBN following a reprioritisation process to encourage greater uptake.

  • LBH has overseen the provision of funding from the Department of Health and Social Care’s Better Mental Health Grant. This in-year funding has been allocated to a range of community providers to offer mental health interventions with a focus on reaching underserved groups to tackle the impacts of Covid-19 on mental health. Partners, including Coffee Afrique and SWIM Enterprises target ACH communities.

  • 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 Clinical Commissioning Group (CCG) jointly commission a street outreach mental health team which has successfully reduced S136s within the City of London. This service has been expanded to cover a greater number of hours for a period of six months, and an evaluation is being conducted by the City and Hackney Public Health team.

  Other areas of progress

  North East London CCG (City & Hackney) was the most successful CCG in the UK, achieving the highest percentage of National Health Service England (NHSE) health checks for people with severe and enduring mental illness. People from ethnic minorities are overrepresented within this group.

  Within LBH, the Diversity and Inclusion Leads have implemented an innovative approach to addressing racialised trauma among staff, following feedback from peer support sessions. The feedback for these sessions has been overwhelmingly positive, and we are seeking to share the learning from this approach with local partner organisations.

  Update: The Street Outreach Team has been recurrently commissioned with extended hours. We have again managed, despite Covid, to achieve the completion of 60% of serious mental illness (SMI) health checks.

• Measure, monitor and report the nature and extent of ethnic inequalities and progress made.
  • As outlined under Pledge commitment 1, 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 and Hackney work analysing the impact of pandemic on health inequalities in City and Hackney. 

  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 on 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 City and Hackney  response.

  Update: We have done a large analysis of our IAPT provider referrals. We are in the process of looking at the analysis in detail, but of immediate concern are the numbers dropping out of treatment – which are higher in BAME groups. We can report in more detail in our next update.

• Work in partnership with local black and minority ethnic communities, service users and relevant community agencies.

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

  • The Hackney Caribbean Elderly Organisation was commissioned to deliver a dementia outreach and awareness raising programme to our local BAME community. This was to inform 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 among 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) Enterprises 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. In quarter 3 2021/22, an assertive outreach survey was devised, based on raising awareness in the ACH community and on how to self-refer to the service. A total of 190 surveys were collected; across mental health work at SWIM including the digital element, 16 self-referred for mental health support; follow-up contact with 81 respondents who provided their contact details, which will include signposting and monitoring of additional self-referral.

  • Attending pilot blended team meetings in Clissold Ward and Hackney Marshes ward to develop PCN communications.

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

  • Chat Works Hackney has recently launched. The initiative is led by SWIM Enterprises, a black-led organisation rooted in the borough through generational family ties. SWIM integrates into current practices in African and Caribbean cultural life to improve life outcomes, health and wellbeing.

  • City and Hackney currently commissions three local VSO providers to provide IAPT services to our Charedi (7% of population), Turkish and Kurdish communities (6% of population) and the African and Caribbean heritage communities (20% of our population). Talk Changes closely monitors BAME community access and recovery and has strong links to grass roots community organisations.

  • In 2021, City and Hackney Integrated Care Provider (ICP), North East London CCG, Derman, Bikur Cholim, Mind and Homerton University Hospital Foundation Trust, won the HSJ (Health Service Journal) Value Award for Mental Health Service Redesign Initiative – Culturally Focused IAPT for Communities by Communities.

  • IRIE MIND – Mind in the City, Hackney and Waltham Forest’s organisation run by and for African Caribbean Heritage people, has been commended as a best and promising practice example, reflecting the hard work and commitment to black excellence of the IRIE team since its launch in 2019.[1]

  • City and Hackney has the highest rate of BAME IAPT recovery in London, and access rates for the top three 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 postcode comparing access and deprivation.                                                                                                 

  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.

  • LBH 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.
  • The LBH commissioned Wellbeing Network is led by MIND and includes many local voluntary sector organisations in the wellbeing provision.     

  Update: A pharmacy project was initiated with Irie MIND to address service users’ concerns about SMI medication. This proved to be very successful and we hope to carry on this dialogue within the PCNs .

  East London NHS Foundation Trust (ELFT) inequality project

  Marie-Michelle Mousse, Project Manager, Community Mental Health Transformation Programme, ELFT, said:

  Part of ELFT’s strategy is to improve the quality of life for all we serve, improve experience of care for service users, and one of the trust’s priorities for 2021-22 is around Race, Privilege, Equality and Diversity.

  The trust is committed to challenging prejudice and discrimination wherever this affects service users and staff, and putting equality and diversity at the heart of our organisation’s culture.

  The trust has launched a Quality Improvement  programme on Pursuing Equity, and it has been designed in partnership with Public Health, People Participation, the Service User Lead Team, the trust’s networks and the Quality Improvement Department. The programme is supporting over 30 teams across the trust, those wanting to use Quality Improvement methodology to tackle an aspect of equity in their area of work.

  Below are other developments taking place in ELFT:

  • ELFT is one of the 4 PCREF pilot sites
  • The PCREF Patient Carer Race Equality Framework was one of the key recommendations of the independent review of the Mental Health Act agreed by the government. The development of the PCREF is being overseen by the PCREF Steering Group chaired by Dr Jacqui Dyer, Mental Health Equalities Adviser to NHS England and NHS Improvement. The steering group was established in May 2020 and reports to the taskforce, with members including patients, carers and staff from the four PCREF pilot sites.
  • The PCREF pilot sites will be undertaking community engagement in 2021 on the PCREF competencies and the best way to measure them, to develop and test their local PCREF approach.
  • As in the NHS Long Term Plan there is a need for particular attention to be paid to improvements in care for young adults aged 18–25, and older adults, Complex Emotional Needs, BAME and Disordered Eating.  As part of the way that community mental health is changing, there are specific workers with lived experience working with each of these communities in East London, to help strengthen their support. Service users are at the heart of all discussions and are at the heart of their care.
  • The trust currently holds two BAME Implementation Groups in Newham and Tower Hamlets based on a report created by service users and the BAME Worker called the Let’s Talk report, which looks at implementing the report’s recommendations.  This is being implemented from Directorate level down, London-wide. They are in the process of setting up the third group in Hackney, and every month they come together at the Community Mental Health Transformation Board to give feedback and updates.

  We will be able to update on the work of the BAME implementation group in the next progress report.

  [1] Personalisation-in-Black-Asian-and-minority-ethnic-communities-TLAP-report.pdf (thinklocalactpersonal.org.uk)

   

• Provide national leadership on this critical issue.
  • We attend the national Public Health England webinars on health inequalities and had representation on the Synergi Advisory Board for phase I.
  • We have joined the Centre for Mental Health campaign for reducing health inequality.
  • We had a letter published in the BMJ on inequality in health. https://www.bmj.com/content/370/bmj.m2748.full.

   Challenges: 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 North East London, are very recent and need time to settle.

  Update: We are now moving to becoming an Integrated Care System, and the system is committed to contributing to national campaigns

   

• Ensure inclusive and sustainable change in our localities and communities.
  • 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 LDN/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 (www.fivetothrive.net), which will link into the wider Thrive London BAME initiatives.

  • 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.

  Challenges

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

  Update: We have obtained funding for a five to thrive Wellbeing Worker to promote the five ways to wellbeing within voluntary sector groups, many of which work with minority ethnic groups.

  Dr Anu Kumar, Clinical Lead for Patient Participation and Involvement, Inequalities and Sustainability for the Integrated Care System (ICS) is setting up a conference locally to address inequalities.

  He said: “The ICS in Hackney and the City of London brings together partners from different cultures delivering health and social policy. This Inaugural Conference seeks to embed shared principles of Equity, devise ways of working across traditional boundaries and uncover gaps so as to work more effectively going forward.”

• Support timely and progressive research and policy development.
  • We hope that our whole system work across the 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 time. However, we have been learning from the pandemic and need time to work on the large increase in mental health crisis presentations, especially in the young. This may affect timescales. Covid has exposed inequality issues so starkly that we need time to process this, especially as so many staff members across health and local authorities have been affected personally by illness and family bereavement.

  • North East London CCG (City and Hackney) Mental Health Team is working with City and Hackney Public Health Intelligence Team and Population Health Hub to help identify inequalities in referral and treatment pathways of IAPT services for service users living in deprived areas as well as racial and ethnic minority service users.

  Update on supporting research or policy:

  Anna Garner, North East London CCG Inequalities Lead, said: “We want to improve collection of data by services and organisations on equalities dimensions so that we have robust data to identify where there are inequalities in access to, experience of and outcomes from services. We are conducting a review to look at where inequalities data is being collected by services, how complete this is and where there are gaps. We are hoping to identify system-wide recommendations on:

  • Implementing an aligned minimum dataset for mental health services – improving completeness of data, and ensuring that we are using consistent descriptors of equalities dimensions;
  • Analysis, reporting and use of inequalities data – to ensure that we are using the data we have, to identify and tackle inequalities;
  • And supporting organisations and services to implement these.”

  We continue to support Synergi and use the NHS Race & Health Observatory for support to make local decisions around inequalities.

  We are also members of the Inequalities Health Alliance: https://www.rcplondon.ac.uk/projects/inequalities-health-alliance

   

• Are you going to contribute to the fourth Pledge progress update in November 2022?

  Yes, we will.

Next Steps

• What are your Pledge priorities over the next 6 months?
  • Our priorities are to consolidate the work looking at data on mental health service access, and from an analysis of use be able to better design service change to ensure equity of access and outcomes for all ethnic minority groups.
  • We will continue to work with our system partners on wellbeing

Synergi National Pledge Alliance

• As a system leader, what do you think the Synergi National Pledge Alliance’s top three priorities need to be?
  • Work more with providers of mental health services, such as the Cavendish Square Group and other provider groups.
  • Address other groupings such as the GLA.

• What do you think the Synergi National Pledge Alliance’s top three policy priorities need to be?

  We are happy to share ideas and outcomes of work.

• How do you want to collaborate with other Pledge Makers through the Synergi National Pledge Alliance for it to be impactful and influential?
  • Through information exchanges, such as conferences.
  • Maybe within the new Integrated Care Systems (ICS) structures, we could try to ensure that each ICS nominates a Synergi champion as each ICS will now be looking at inequalities, and inequality in mental health for people from BAME backgrounds remains one of the most striking issues to be addressed.

• How is the Pledge enabling you to reduce ethnic inequalities in mental health systems for ethnic minority people with lived experience of severe mental illness?

  Our Integrated Care System will continue to address inequalities as our highest priority, and reducing inequalities for different ethnic groups within mental health services is a key part of our strategy.