The challenges facing people from Black, Asian and Minority Ethnic (BAME) communities in accessing appropriate mental health support are well known and frequently rehearsed. Year on year, the Care Quality Commission highlights the higher rates of detention and compulsion for people from BAME communities, the longer stays in hospital and poorer outcomes.
Addressing these disparities was the focus of a roundtable that I attended recently at 10 Downing Street. It is difficult, if not impossible, to separate the inequities for people from BAME communities from the political and social climate that we now find ourselves in. The political forces and immigration policies shaping the experience of people from BAME communities in England today will, undoubtedly, impact negatively on their mental health and wellbeing.
We need look no further than the Windrush scandal and the increase in racist attacks and racist actions associated with Brexit to evidence this. Second, wider social policy that reduces the life chances of people from BAME communities, through overt or covert exclusion from education or employment opportunities and career progression, including in the NHS.
Third, local government austerity measures that have led to valued community initiatives having to close or limit their activities despite their capacity to engage with people with high levels of need. Fourth, NHS policy and investment that is narrowly focused on physical health and acute care coupled with mental health policy that sets out with an ambition to reduce inequalities, but does not usually provide the data, resources or governance to enable local systems to properly implement this and ensure that those in greatest need are well supported.
Finally, a Mental Health Act Review that has failed to really grasp the nettle of a rights based approach and the principle of reciprocity. Despite this, the Review did strengthen the focus on race disparity, which I welcome, and the meeting at Downing Street signalled a commitment to making progress. Indeed, the Review recommendations included the development of an organisational competence framework, the Patient and Carers Race Equality Framework (PCREF) to address the individual and structural factors that lead to inequity for ethnic groups.
With this state of affairs clearly in their sights, many people – mainly but not exclusively from BAME communities – are also advocating for change and leading innovative projects to make a tangible difference to people’s lives. At the heart of this endeavour is lived experience, engaging with the people most affected to learn and identify the implications for redesigning local systems and investing in local communities.
Such initiatives are actively exploring how to open up spaces for dialogue between community members and those that gate keep the resources and, thus, some of the potential solutions, for achieving a better, fairer mental health system.
In Lambeth, for example, Black Thrive, a partnership of people from local communities with system players, are working together for change using a collective impact model. Their aim is to achieve relevant, accessible services for all, regardless of race, through a greater alignment of goals among stakeholders of the partnership, collaborative problem solving and ongoing learning and improvement in working relationships and practices. Similarly Synergi, through the development of a national initiative, Creative Spaces has adopted a systems approach to bring together commissioners, providers, advocacy groups, service users, public and local government to have deliberative discussions to create impactful solutions.
Catalyst 4 Change, based in Birmingham, is also working with local communities and organisations (and Synergi) to support grassroots activities and build capacity using creative methods to engage a diverse range of partners in a progressive dialogue. At the Institute for Mental Health, we have a Youth Advisory Group of young people from a wide range of ethnic minority backgrounds to work with academics and shape our research so that we can generate knowledge that is relevant.
Alongside the energy and ambition of individuals and community-led organisations, the push for greater equality from national and local organisations, such as the Centre for Mental Health and Lankelly Chase, has far from abated. The Equality Act 2010 and the public sector equality duty provide a context for public authorities to advance equality of opportunity and eliminate unlawful discrimination. There is also guidance available for local systems on how to make progress, notably the Local Government Equality Framework, the recently published Advancing Mental Health Equality the development of the PCREF.
It is also heartening to see a clear focus in the Mental Health Act Review to reducing the disproportionate number of people from BAME communities detained under the Act and recommending changes to ensure they have a greater say in their care. Anthony Salla, from ACCOUNT, and I are working together with service users, carers and advocacy organisations to develop a model for culturally appropriate advocacy that will enable people detained under the Act to have a stronger voice and be central to decisions about their support.
The findings from our study on the role of the voluntary sector in supporting people in a mental health crisis has underlined their important contribution of community organisations, often not badged mental health, to offer support that enables people to get on with their lives and not become embroiled in a mental health career.
All of these initiatives, and others, recognise the necessity for policy and accountability frameworks that support local system partnerships and grassroots activity, ensuring that lived experience is central and that collaborative partnerships with local stakeholders are developed and learnt from.
However, positive developments can be hampered by wider government policy and initiatives that are problematic and, thus, bear scrutiny for their potential to, at best, restrict and, at worst, sabotage local progress and transformative collaborations.
To ensure that in the forthcoming decade we do not consign BAME mental health to the pile of intractable social problems, together we need to weather the storm, keep clearly sighted on our goal with people with lived experience at the heart of our endeavours. Only then will we have moved closer to achieving a fairer mental health system and better mental health for all.
Dr Karen Newbigging is a Senior Lecturer, HSMC, University of Birmingham.