The detrimental impacts of racial inequality affecting our Black, Asian and Minority Ethnic (BAME) colleagues, service users, families, neighbours, friends and communities are at this time very much magnified and there for us all to see, whether that be through the disproportionate impact of COVID-19 or racism and discrimination, brutally brought back into sharp focus with the killing of George Floyd.
We already have plenty of information to evidence that discrimination and inequalities exist. We know our BAME colleagues are less likely to gain promotions, and 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 it. As a specialist mental health provider organisation, every day we seek to meet the needs of people with complex and multi-faceted conditions, we apply trauma informed practice and we do make a difference in doing so. This is no different, not if we apply our passion, our intellect, our experiences, our reflective approach and our wealth of knowledge in trauma informed practice, we can make a positive difference to inequality and discrimination.
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.
We as an organisation are committed to making progress on reducing ethnic inequalities in the mental health system and this is in line with our new values of compassion, inclusion and commitment.
BSMHFT wanted to address access, experience and outcomes in all of our services, but with a particular focus on perinatal mental health services, inpatient secure mental health services, and IAPT – Improving Access to Psychological Therapies.
We wanted to improve cultural competency of our clinical staff, and as such to provide training on the “Power Threat Meaning Framework”. We aim to address the inequalities and inequities with regards to restrictive practice, notably practice with regard to seclusion, segregation, rapid tranquilisation and restraint. We developed an increased research focus on ethnic inequalities. We are committed to addressing staff experience of ethnic inequalities, particularly focusing on recruitment, promotion, retention and staff experience.
We aspire to become an anti-racist organisation, and as such address any development issues for Board and senior leadership teams.
We are working in partnership with:
We have implemented the IAPT charter in IAPT (Improving Access to Psychological Therapies) – staff identified that language & literacy barriers were limiting our engagement with South Asian communities.
Perinatal – our team recently published sone high quality research studying the barriers to access to treatment and experiences for someone from ethnic minorities, which was a large population-based study and will inform current and future service models.
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.
Restrictive practice – we have established a patient safety collaborative which we are being supported in delivering by the Institute of Healthcare Improvement (IHI); this involves 15 teams across our inpatient units. PCREF – BSMHFT is one of three national pilot sites to support the work of the Patient and Carer Race Equality Framework.
IAPT developed a culturally sensitive treatment group within Birmingham Healthy Minds acknowledging ethnic, cultural and spiritual beliefs and overcoming language barriers. 95% of service users reported a positive experience, decreased headaches and better sleep. They 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 & 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 so as 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, we are developing a communication pack and engagement plan in order to gather feedback with regard to our BAME patient experiences and that of the wider local community and this will take place between 1st June – end of August 2021. We are commissioning a range of community organisations to support us with the data collection.
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 further developing and refining our data sets.
The pace of development of the integrated dashboard being impacted on by the pandemic.
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 and as smooth as possible. 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” 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. Whilst the initial target cohort is African-Caribbean service users, the project progression is anticipated to benefit service users from any background.
Shifting the Dial is a partnership between BSMHFT, Birmingham Repertory Theatre, First Class Legacy and 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.
Syrian project – develop mental health resilience and strengthen capacity of 200 refugees, develop 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, providing hope for recovery within a community overrepresented in secure mental health settings.
Shifting the dial – groups of young African 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.
Being mindful of the need to rebuild trust and confidence with communities. Acknowledgement with communities of limited progress historically whilst sharing good practice. Risk of confusing communities with different strands of work.
We are a member of the National Mental Health Inequalities Steering Group. We are also a member of the PCREF Steering Group, one of three pilots working on the Patient Race Equality Framework (PCREF). In June 2020, following the death of George Floyd, all staff received a letter from our CEO highlighting our change has to 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 are working towards how the NHS can improve outcomes and experiences for Black, Asian, minority ethnic communities accessing mental health services.
Impact of the pandemic which has given rise to further inequalities, whilst at the same time increasing the demand on the mental health system
Through a range of community projects as detailed previously, we are endeavouring to implement sustainable and real change.
This is an ongoing piece of work.
Ensuring sustainability at the end of funding periods.
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 Trusts 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 BAME 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. In addition, the Perinatal Team have recently appointed a full time research fellow to develop more research in this area.
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 that showed significant discrepancies between women of different ethnicity. 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 services less. Now an NIHR (National Institute for Health Research) funded project, the PAAM study of ethnic minorities’ access and utilisation of mental health perinatal has extended this review nationally.
There are 10 service evaluations and research projects being undertaken/currently in progress, and we are currently supporting two nationally led research teams to deliver in partnership with our communities, and 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.
Yes, as we consider this pledge to be very much in line with our strategic objectives, the values of our organisation, and our aspiration to be an anti-racist organisation.
Through the work within Perinatal Mental Health Services, IAPT and Secure Care Services, we will address issues of ethnic inequalities with regards to access, experience and outcomes.
We are working as a member of BSol STP which is addressing specific work with regard to inequalities and includes eight 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
In October 2021, Synergi plans to 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 our ongoing commitment to the aspirations of the national Pledge and contribution of outcomes of our own ongoing work as an organisation and mental health system.
We would be willing to provide feedback of any ongoing work in particular our activity with regard to research and outcomes of the national pilot of the Patient and Carer Race Equality Framework (PCREF).
We already have plenty of information to evidence that discrimination and inequalities exist. We know our BAME colleagues are less likely to gain promotions, and 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.