Post-pandemic we have seen mental health need greatly increase through large surges in referrals, especially for young people in crisis. While this highlights inequalities, it also makes addressing these needs more difficult due to staff shortages and sickness. However, it’s important to keep the focus on ethnic inequalities through this very difficult period so we are stronger on this when returning back to more normal times.
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 want 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, especially those from ethnic minority groups
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 Health System.
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:
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 Caribbean backgrounds.
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.
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 (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 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.
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 of these 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 DHSC 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 African and Caribbean Heritage 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 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.
North East London CCG (City & Hackney) 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.
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 learning from this approach with local partner organisations.
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.
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).
Objectives of this work include:
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 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 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 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.
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). Talk Changes closely monitors BAME community access and recovery and has strong links to grass roots community organisations.
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.
LBH commissioned Wellbeing Network is led by MIND and includes many local voluntary sector organisations in the wellbeing provision.
In August 2020, SWIM (Support When it Matters) Enterprises was commissioned to improve African/Caribbean referrals into talking therapies.
Key outcomes include:
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.
[1] Personalisation-in-Black-Asian-and-minority-ethnic-communities-TLAP-report.pdf (thinklocalactpersonal.org.uk)
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.
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 challenge.
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.
Family Action Counselling Service Update
The counselling provision continues to remain a popular service and referrals are typically made through parents or pastoral care staff in school with presenting issues related to low self-esteem, lack of confidence, historical child abuse, low mood and anxiety (including culturally sensitive topics).
Typically, girls are more likely to engage in the service than boys and the service receives positive feedback from those that attend sessions.
NVR Parenting Sessions Update
The NVR Parenting sessions provide 12 weeks of in-depth support to parents with a focus on a number of topics such as de-escalation techniques, parental presence, reconciliation gestures and exploration of the parents own parental trauma. Parents typically self-refer or are referred to the service seeking parental support.
The first round of NVR saw 28 parents sign up to (and complete) three programmes run by community organisations African Community Schools (ACS), Father2Father (F2F) and Black Parent Community Forum (BPCF).
The programmes reported positive outcomes (SUDs) and parents reported a decrease in parental stress and felt more confident to support their children. We are now in round two of the NVR parenting programme.
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.
We would be happy to share some of our projects described in this report, and to learn from projects happening across the UK, as we are keen to be innovative in our approach to tackling ethnic inequalities.
The 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.