Right from the very beginning we have taken our commitment as a Pledge Maker very seriously, and the pandemic has only amplified this feeling as we have experienced a disproportionate impact among our Black and minority ethnic populations. Reducing inequalities across our services for service users, families and colleagues is a core anchor across our organisational strategy, and being a Pledge Maker enables us to actively pause, reflect, challenge, and prioritise.
Organisationally we are developing our activity under our strategic priorities, based on the 4 priority areas of the Advancing Mental Health Strategy, specifically:
Locally, we are going through a piece of engagement with the wider organisation so that services can baseline their workforce and service user data to develop local plans with local ownership.
All activity is developed through the lens of being anti-racist and anti-discriminatory.
Traditional engagement activity has been complemented with remote access and engagement; some streams have seen more take up whilst others less. Many of our partners have a strong established relationship with the Trust and the pandemic has only enhanced that from our perspective.
Across the Trust we have started to implement our organisational strategy which has reducing inequalities as a fundamental integrated priority.
To enable more active use of data, our Performance and data team have launched the Trust’s internal Insights tool which enables active use of demographic data across service use and experience.
We have implemented the Black and minority ethnic charter in IAPT (Improving Access to Psychological Therapies). Staff identified that language and literacy barriers were limiting our engagement with South Asian communities.
Perinatal – Following the publishing of some high-quality research studying the barriers to access to treatment and experiences for some people from ethnic minority communities, the service is specifically recruiting staff from Black and minority ethnic backgrounds to ensure that the service can respond to service users’ cultural needs. There is also a particular focus on increasing referrals for women from a South Asian background.
In addition to working to increase referrals from under-represented groups, the service is also very conscious that the interventions offered need to be appropriate and effective for all women. For women for whom English is not their first language, the service provides interpreters, where needed, to ensure information is understood.
Translation of certain mental health concepts are, however, not always easy and can be particularly difficult when attempting to assess bonding and deliver psychological interventions. The service has therefore invested considerable time, as part of its Long-Term plan ambition to improve access to psychological therapies, to work on culturally adapting these therapies to women using the service.
Reach Out – To ensure that we progress our inequalities work, Reach Out has commissioned an evaluation to explore service users’ experience of inequalities in Secure Care. We also want to include staff and explore their understanding and their skills/abilities to address the issues identified.
The Reducing Restrictive Practice Collaborative – We have established a patient safety collaborative which we are being supported in delivering by the Institute of Healthcare Improvement (IHI) and involves 15 teams across our inpatient units. This has been designed with the intention of reducing restrictive practice and any disproportionality within that.
PCREF – BSMHFT is one of three national pilot sites to support the work of the Patient and Carer Race Equality Framework (PCREF).
Adapting Psychological Service Provision –There has been a concentrated effort within Secure Care and Offender Health to focus on addressing ethnic inequalities within the psychological service that is provided. A broad team of psychologists across all inpatients (including FCAMHS), community, Offender Personality Disorder and FIRST team services are involved.
There are three principal areas that are focused on:
(a) improving staff confidence working with ethnic difference
(b) improving clinical interventions accounting for ethnic difference
(c) addressing contextual recruitment practices.
These are all works in progress at various stages.
A recent deep dive has taken place in our Acute and Urgent Care services to understand the ethnicity of our inpatients’ admissions, S135/S136 detentions, Rapid Tranquilisation episodes and seclusion episodes. The findings from this deep dive with be shared with various committees and the next steps agreed to ensure sustainability and embedding of learning.
Bedlam Festival – www.bedlamfestival.co.uk
This year our co-opted partner is the Red Earth Collective as one of the key themes of the festival is inequalities in mental health.
In 2002, the first StereoHype event took place in London. Eight black men with lived experience of mental health issues worked with artists to turn their experiences into stories which they shared with an audience of friends and family.
Using spoken word, music, dance, film and theatre to engage and entertain audiences, and to stimulate conversations about black mental-health, StereoHype has evolved into an annual arts festival that celebrates the well being of Black people.
This Autumn, the Red Earth Collective, in partnership with poet, author and TV presenter Sue Brown and Vocal Performer Dr Judith Bruce-Golding, Founders of Nakuona Arts, worked with a group of emerging black artists (all with lived experience of mental health), to create new work exploring their diverse experiences through music, performance poetry, storytelling and song.
The result of their collaboration is one of the many highlights of the Bedlam Festival 2021, with a performance for service users, carers and staff at the Tamarind Centre, a medium-secure mental health service, and two public performances in the City Centre and Birchfield.
IAPT developed a culturally sensitive treatment group within Birmingham Healthy Minds acknowledging ethnic, cultural and spiritual beliefs, and overcoming language barriers. We found that 95% of service users reported a positive experience, decreased headaches and better sleep.
IAPT have also developed a session for carers and families to help increase their understanding of mental health and run sessions for colleagues to help them recognise what is culturally important within the South Asian community.
Their work has been recognised by NICE (National Institute for Health and Care Excellence) as an example of excellent practice, and they are now helping other trusts to follow in their path.
Perinatal – Research is informing future service models.
Reach Out has commissioned an evaluation to explore service user experience of the inequalities in secure care to identify actionable steps to address inequalities. This research is being led by an Expert by Experience.
Patient Safety Collaborative – The projects are at an early stage of development.
PCREF – We are a member of the PCREF steering group, and are developing a communication pack and engagement plan to gather feedback about our Black and minority ethnic patient experiences, and that of the wider local community. This is currently being collated by our externally commissioned community partners.
All our activity is driven through the integrated strategic priority of reducing inequalities which is being embedded across the governance of the Trust. It is not a add on or an afterthought.
Our commitment is sustainable by design as it is data driven with a focus on improving experience and outcomes for our Black and minority ethnic populations.
We are developing integrated dashboards so we more fully understand the extent of ethnic inequalities for our service user and staff groups. We are utilising data on ethnic inequalities with regard to our patient safety indices and within the patient safety collaborative, the latter of which addresses reduction of restrictive practice within inpatient environments.
We are actively trying to update our information systems to include refugee/asylum seeker status.
Being a PCREF pilot site provides a robust framework that will enable the Trust in measuring, reporting and monitoring the extent of health inequalities within our pilot sites.
The Trust’s Equality Approach first steps are ‘Data with Dignity’ engagement sessions, which will enable services to draw a baseline in relation to inequalities information. This baseline will then be utilised to report the nature and extent of ethnic inequalities and progress made.
The Somali Guide, produced by Kim at Tamarind, won a national award which informs users about the Somali culture. The guide has been co-produced with local community members.
The dashboard has been developed and launched.
We are further developing and refining our data sets.
The PCREF engagement is currently being concluded for the first round and organisation competencies will begin to be co-created.
The pace of development of the integrated dashboard being impacted on by the pandemic.
The integrated dashboard, as it grows, will embed inequalities information based on impact. Services are becoming more data and outcomes driven, driving the sustainability of this approach.
From a systems perspective, our peer engagement will also provide check and challenge in ensuring progress
Implementation of Syrian Vulnerable Persons Resettlement Scheme – Our aim is to provide mental health support to a community which has experienced and witnessed trauma, violence and the effects of war at first hand, as well as displacement from their homes.
We are also supporting partner agencies that are helping refugees to make this transition less stressful. As part of this we, are offering a range of free courses for our staff, partner agencies and Syrian refugees. This is a United Nations and UK government-sponsored programme.
Secure Care Services Intergeneration Project – “Elder’s Project” – This project is supported by the SCC Reach Out Equalities Task & Finish Group. The project emerged from a response to the literature regarding the disadvantage of Black African-Caribbean service users within mental health settings. The project team have matched Elders from the Black Caribbean community with service users and have presented this work to the Quality Network Forensic Mental Health Annual Forum.
They are in the process of capturing the evaluation data and writing this up for publication.
Shifting the Dial is a partnership between BSMHFT, Birmingham Repertory Theatre, First Class Legacy and the Centre for Mental Health which received National Lottery funding and aims to develop a Birmingham-based brotherhood of 300 young African Caribbean Men who feel mentally stronger and healthier.
The Reach Out Provider Collaborative is leading on a co-production approach in relation to the understanding of recovery within the secure setting.
Afghan Crisis response – This is very similar to the Syrian Vulnerable Persons Resettlement scheme. Our aim is to provide mental health support to a community which has experienced and witnessed trauma, violence and the effects of war at first hand, as well as displacement from their homes. We will be exploring how we can add refugee/asylum seeker status to our data collection systems and exploring culturally appropriate family therapy services and therapeutic models of care.
Appointment of Clinical Inequalities Lead in Secure Care – This is a service specific role that will lead on Health Inequalities within Secure Care settings.
Across the organisation we have selected three services to be pilot sites for the development of the national PCREF. These services are Perinatel, IAPT and Secure Care.
We are currently within the engagement phase of the PCREF development which has enabled partnership working with a number of organisations:
Syrian Project – Develop mental health resilience and strengthen the capacity of 200 refugees and to develop the capacity of 90 practitioners across sectors working with Syrian refugees to better understand and address their needs and develop a therapeutic model for practitioners to work with Syrian refugees.
Elders Project – Community Elders are being recruited from various backgrounds including faith, sports, and music to support service users during their admission in Secure Care.
Elders will be providing support in a range of methods including 1:1 support and group socials. Support will include community integration and involvement, including service users’ period of transition from hospital to discharge into the community and providing hope for recovery within a community overrepresented in secure mental health settings.
Shifting the Dial – Groups of young African and Caribbean men in cultural activities run by First Class Legacy and The Rep at a range of places within Birmingham and Solihull, working alongside artists and facilitators who they can relate to, trust and can inspire them for their futures.
The scheme works to strengthen the mental health resilience and wellbeing of the men involved, improve their self-esteem and self-belief, assist their personal development and life skills, increase economic opportunities, raise mental health awareness and encourage inclusion. It also addresses the weathering effects of racism, discrimination, negative self-image, and invisibility.
Over 100 people have engaged in prioritising the competencies within the PCREF.
Being mindful of the need to rebuild trust and confidence with communities. Acknowledgement with communities of the limited progress historically while sharing good practice.
The risk of confusing communities with different strands of work.
Sustainability will be assured through building the addressing of inequalities into the core reporting requirements of the organisation and through advancing the principle of becoming an anchor institution.
As an NHS provider, we need to be addressing the needs of our communities and addressing ethnic health inequalities is by the nature of our population, a priority, with sustainability being the critical factor.
We are a member of the National Mental Health Inequalities Steering Group (advancing mental health inequalities). We are also a member of the Patient Race Equality Framework (PCREF) Steering Group, one of three pilots working on the PCREF.
In June 2020, following the death of George Floyd, all staff received a letter from our CEO highlighting how change must be about all of us reflecting and determining to change in line with our values, recognising that we all have more to offer of ourselves personally and professionally to being truly inclusive, compassionate and committed.
We have recruited an Equalities Lead as part of the CMHT transformation to advance the health inequalities agenda within the Community Mental Health transformation programme. This is with the intention of creating longevity and sustainability to reduce health inequalities going forward.
We are working towards how the NHS can improve outcomes and experiences for Black and minority ethnic communities accessing mental health services.
The impact of the pandemic, which has given rise to further inequalities, while at the same time increasing the demand on the mental health system.
The PCREF is an explicit strategic priority with further priorities working towards addressing ethnic health inequalities embedded across the organisational five-year strategy.
A service evaluation into the increased mental health detentions, including Community Treatment Orders (CTOs) is currently taking place involving senior frontline clinicians reviewing CTO case records, together with a focus group of Approved Mental Health Professionals (AMHPs) and service users to evaluate the quality of CTO detentions.
The findings from this service evaluation will guide an action plan for improvement in practice, the findings are due to be presented in January 2022.
Ensuring the Birmingham and Solihull (BSol) Community Transformation has addressing ethnic inequalities at its heart. This is supported through the wider ICS Health Inequalities and People Board priorities
The Reducing Restrictive Practices Collaborative is working to ensure that any practice changes are embedded and sustained.
The PCREF activity and engagement also aims to build capability and confidence among our communities.
Findings for the CTO work programme currently being concluded.
While engaging communities in the PCREF, we have also been highlighting good practice that can be integrated into Community Transformation to ensure inclusive and sustainable change.
Community Transformation update:
Considerable steps have been undertaken to work with our Experts by Experience (EBE) networks, third sector colleagues and our own BSoL Public Health data to map areas of high health deprivation and health inequalities.
Two roles that we have invested in to look at long terms strategies to improve our approach is a dedicated EBE lead, and Equalities lead for BSoL, working across providers to join up All BSol partners in our approach to address health inequalities.
In addition, we have looked at current service demand working with GPs and VCSE colleagues to capture areas of potential need, mapping what provisions are available and where there might be gaps.
Where we have identified gaps, these are the areas we are looking to work with VCSE organisations on, to consider additional service needs and tendering for those services (in line with the LTP aims) using the now agreed BSoL VCSE framework.
Also, we have started working with local community leads to consider how we have a presence in faith-based areas across the city. Most recently by attending a Bangladeshi forum to consider need, and towards the end of this month we are linking with leads from the Nishkam Centre who work with the Sikh community to consider how they can have a place within our neighbourhood MDTs to ensure the voice of their communities are heard and reflected in our approaches.
This also includes things such as having all documentation available in multi-language format, provider pop-up clinics in temples/gurdwaras/communities centres and access to interpreters. We are also looking at our overall approach to our workforce ensuring we continue to build a BSol workforce reflective of our population across all partners.
A Reducing Inequalities workstream has been identified within the Reducing Restrictive Practices collaborative with a focus on ethnicity, age and gender.
The pandemic and impact has resulted in a reconsideration of time frames.
This work is, by design, sustainable.
When deciding what research to support, reducing Ethnic Health Inequalities is a heavily weighted factor.
The R&I team continue to support and facilitate all staff who are active in research.
Working closely with teams and individuals, providing guidance and support and ensuring they are aware of the latest funding rounds available.
We provide support to develop new researchers and offer support to the Trust’s Executive Team to lead on areas of interest and relevance.
We actively manage Research and Service Evaluations in all areas across the Trust and ensure that research outputs are disseminated and implemented as appropriate. To embed this further we need to identify ways of making information, guidelines and outputs from local research that is relevant to the pledge accessible.
We are looking to develop links with academics/experts in Black and minority ethnic research to collaborate on future research.
We are engaging our LEAR (Lived Experience and Research) Group to support in evaluating the equality of access to diverse groups when reviewing and approving locally developed and/or sponsored research when the research question supports this. The LEAR group will also pilot governance routes for the PCREF.
The established staff Back and minority ethnic network and the newer allies’ network have been pivotal in driving policy development.
Current research studies include:
PAAM – Accessibility and acceptability of perinatal mental health services for women from ethnic minority groups (PAAM study).
The aim of this research study is to conduct interviews with South Asian and Black women with perinatal mental illness to explore:
ADAPT – facilitating access to the dementia care pathway for people living with dementia and their families who are from South Asian communities.
Interviews with our staff to conduct reviews on dementia resources/barriers within South Asian communities
UK REACH – United Kingdom Research Study into Ethnicity and COVID-19 outcomes in healthcare workers
Questionnaire study that was conducted to capture outcomes of health care workers.
Views of Mental Illness and help-seeing within the Sikh Community – This study aims to explore the perceptions, understanding and help-seeking behaviours for mental illness among Sikhs who reside in England.
The study particularly explores personal experience of having a diagnosis of psychosis, and the experience and views of their carers.
Interview: 1 – 1.5 hours to complete
Black Women’s Experiences within Secure Psychiatric Settings – Despite notable over-representation in secure mental health settings, there remains limited literature which captures the lived experiences of Black women in these environments.
The study proposes to help tackle the existing research gaps by addressing the following research question: “What are Black women’s experiences of fairness and unfairness in secure psychiatric settings?”
One off interview with participants
The following are research studies in the pipeline:
HEXITIME – Research for all.
Research database platform to share research skills, with specific focus on bringing together a broad range of cultural/ethnic groups.
CAFI – The effect on relapse of Culturally Adapted Family Intervention (CaFI) compared to usual care among African and Caribbean people diagnosed with psychosis in the UK.
COPACT – Experience-based investigation and co-design of approaches to prevent and reduce Mental Health Act use.
Workshop-based study to explore service user experiences of being detained under the Mental Health Act, gathering perspectives from a range of ethnic/minority ethnic groups
British Pakistani women’s experiences of support following a perinatal loss during the Coronavirus pandemic within the United Kingdom – This study aims to explore British Pakistani women’s experiences of support and service appropriateness following a perinatal loss (miscarriage, termination, neonatal loss, stillbirth) within the UK healthcare service.
As a result of information shared at the Black and Minority Ethnic Network, recruitment guidance has been issued across the organisation highlighting race inequality. Conversations at the Network have also enabled the addition of microaggressions related to race being embedded into the Dignity at Work policy.
The perinatal research team led by Dr Jelena Jankovic undertook a piece of work (Accessibility of perinatal mental health services for women from ethnic minority groups in Birmingham and Solihull (SE0185)) to look at the access rates to secondary mental health services for women in perinatal period which showed significant discrepancies between women of different ethnicities.
As a result, the Perinatal Mental Health Service changed. The service appointed ethnically/linguistically diverse peer support workers appropriate to the local community to work with women from ethnic minority communities who were accessing the services less.
Now an NIHR (National Institute for Health Research) funded project, the PAAM study of ethnic minorities’ access and utilisation of the Mental Health Perinatal Service has extended this review nationally.
There are 10 service evaluations and research projects being undertaken/currently in progress, and we are also supporting two nationally-led research teams to deliver in partnership with our communities. We will continue to support colleagues in Reach Out, Perinatal and BHM services to access NIHR portfolio research by regularly reviewing the national portfolio of projects and targeting those that meet the requirements of the Pledge.
The main challenge with all research is identifying research leaders with the expertise to progress research in this area beyond local evaluation, although this still remains paramount. Discussions with our academic partners are in play.
Access to translation services can be a limiting factor and most projects do not come with funding to cover this or with study documents in different languages. Access to funding for all research has been impacted during the pandemic.
Sustainability is factored into the research projects and scope.
Yes, as we consider this Pledge to be very much in line with our strategic priorities, the values of our organisation, and our aspiration to be an anti-racist organisation.
We are working as a member of BSol STP which is addressing specific work with regard to inequalities, which includes 8 streams of work:
1 – Inequalities as core ICS business
2 – Data on inequalities
3 – Community engagement
4 – Covid-19 response & inequalities
5 – Prevention
6 – Role of anchor institutions in reducing inequalities
7 – Digital inclusion
8 – Population health management
The ongoing impact of Covid-19 with regard to increasing demand on the mental health and its impact on exacerbating ethnic inequalities.
The need for transformation to meet demand.
Impact of Commission on Race & Ethnic Disparities (CRED).
On 25th November 2021, Synergi will host a National Pledge Alliance Symposium for Pledge Makers, Pledge Supporters, Synergi Creative Spaces partners and communities of interest, inspired by Pledge commitment 4: To provide national leadership on this critical issue.
Through sharing of good practice and challenges, building Action Sets approach if possible. Also, building a critical friend relationship.
We already have plenty of information to evidence that discrimination and inequalities exist. We know our BAME service users are more likely to be subject to Mental Health Act detentions, restraint and seclusions.
Discrimination is complex and multi-faceted, but this is not a reason not to act now to address is. Martin Luther King said “In the end we will remember not the words of our enemies but the silence of our friends”. We cannot be silent on this. Our silence is complicity. It’s time for us to truly live up to our values, to act and make a change.