The Covid-19 pandemic has been the most challenging period of our lives, taking a heavy toll on Londoners’ mental health and wellbeing. Since March 2020, Thrive LDN has been coordinating the region’s public mental health response to the pandemic.
As a Pledge Maker to reduce ethnic inequalities in mental health systems, the pandemic has highlighted the need for wider action to advance equality and to strengthen resilience across all levels (individuals, communities and systems), helping us ensure that in times of trouble we can support each other to maintain mental wellbeing and collectively cope with and overcome crisis.
This is particularly significant for racialised and minoritised communities in London who have experienced disproportionate negative outcomes, loss and trauma throughout the pandemic.
Thrive LDN’s approach to change focuses on the main systematic and institutionalised drivers and processes generating and perpetuating racial and ethnic inequities.
We know from the evidence base that proportionate universalism and participatory approaches directly address the marginalisation and powerlessness caused by entrenched health inequalities and, as a diverse and vibrant global city, we are working to empower those affected by health and ethnic inequities to influence change through participation and involvement.
At its core, Thrive LDN is a participation-driven partnership that engages with and responds to the needs and insights of Londoners.
As part of Thrive LDN’s pledge and commitment to redress ethnic inequalities in London’s mental health system, we are working with a number of partner organisations and Londoners themselves to disrupt pervasive power dynamics which currently exist and shift outcomes for racialised and minoritised Londoners.
Partner organisations include, but are not limited to, Black Thrive Global, South London Listens, The Ubele Initiative, Black People Talk, The Mayor’s Peer Outreach Team, The Centre for Society and Mental Health, Focus on Labour Exploitation, Toynbee Hall and Kanlungan.
The pandemic and the sequence of events which have followed has emphasised how important it is to continue to prioritise public mental health. Covid-19 has highlighted the need for wider action to advance equality and to strengthen resilience across all levels (individuals, communities and systems).
In some ways, the pandemic has strengthened partnerships with organisations and Londoners working to tackle racial inequalities as the need to collectivise and support each other to maintain mental wellbeing and collectively cope with and overcome crisis has been huge.
However, the strain and demand on organisations made up of and supporting people from ethnic minority backgrounds has been enormous since before the pandemic, and there are clear concerns around stress, burnout and collective trauma for a large proportion of London’s diverse population.
Recognising the lived experience of ethnic inequalities in access, experience and outcomes is a fundamental part of Thrive LDN’s approach.
One aspect of this work involves supporting Black, Asian and minority ethnic-led organisations to respond to the needs of communities and provide the tools and resources needed to ensure to collaborate and grow networks.
As part of the Mental Health Recovery Mission, the GLA and Thrive LDN are working in partnership with the Ubele Initiative to support the development of bespoke culturally relevant grief and loss training for London’s Black and minoritised communities.
This project is linked to the current work of BAMEstream which offers a bespoke Black-led bereavement service and a single point of access to free counselling for Black and other minoritised individuals and communities.
The intention is to extend the service so that it now offers training to those who support people from Black communities including those disadvantaged by virtue of having protected characteristics and from low socio-economic backgrounds living with grief, bereavement, and loss. Participants of the training will be upskilled with a focus on providing interventions that are culturally relevant.
As mentioned above, it is clear that the demand on partners such as the Ubele Initiative is significant and presents as a challenge to find sufficient time to work together on strategic opportunities.
Sustainability and longevity of this work will be maintained through the Mental Health Recovery Mission and the ongoing work of BAMEstream.
As a participation-driven partnership, Thrive LDN supports a community of individuals and organisations from across the health and care system and the voluntary and community sectors who can create the conditions for improvements in Londoners’ mental health. A key aspect of this is working in partnership with racialised and minoritised Londoners and organisations which support the needs of London’s ethnically diverse population.
A recent example of this partnership approach can be seen in the collaboration involved in responding to the Afghanistan Humanitarian crisis and supporting the mental health of the Afghan community in London.
A part of taking action on this commitment involves Thrive LDN utilising the principles of co-production as the basis for all engagement with community partners. Steps are taken to better understand who has power when important decisions are being made, better understand the cultural context, and in doing so confront processes that do not consider the needs of community partners.
Overall, this approach has transformed the way in which we create and sustain partnerships.
In terms of this example, a series of resources have been produced in partnership with the Afghan Association of London, Afghan Association Paiwand, the Refugee Council, the ESRC Centre for Society and Mental Health at King’s College London, and Good Thinking.
The ability to form trusting and equitable relationships with community partners from racialised and minoritised backgrounds takes time.
The principles of co-production and participatory approaches are key enablers for Thrive LDN’s theory of change.
Thrive LDN will be held to account by an Advisory Board with representation from community leaders from racialised and minoritised backgrounds and by Londoners themselves to ensure that the approach continues to disrupt unequal power balances when working in partnership.
Through the development and endorsement of the London Public Mental Health Review, Thrive LDN and partners have identified a series of actions to ensure inclusive and sustainable change in Londoners, their communities and the complex systems which exist across the region.
When considering the actions necessary to influence change for public mental health and the support required to move from current states to the future where progress is made on ethnic inequalities, we have developed a structured approach base on (1) interrelated enablers that create the conditions for improvements in Londoners’ mental health – equity, participation and wider determinants and (2) direct action that drives outcomes to improve the mental health of Londoners.
We acknowledge that it will only be possible to achieve improved opportunity for good mental health and wellbeing when there is collective and sustainable effort to drive equity, enable and sustain active participation, and improve the factors which shape the conditions in which Londoners live, work and grow for all of London’s ethnically diverse population.
The work has been in development since April 2021 and was recently discussed and endorsed by members of the London Health Board. It is too soon to report on the outcome of the work.
Since May 2020, Thrive LDN and partners have established a research and community insights function to:
The aim of this function is to create an infrastructure which brings together progressive approaches to research and policy development. The Public Mental Health Review mentioned above sets the right conditions for this through championing the importance of system leadership for Integrated Care Systems, cross-sector working and implementing mental health in all policy initiatives at regional, sub-regional and local level.
Responding to the need to have a pragmatic view of research and intelligence relating to the impact of Covid-19 on Londoners’ mental health and wellbeing, Thrive LDN established a research and community insights function, with a dedicated team carrying out ongoing work to examine the effects of the pandemic on Londoners. This new function informs real-time action to offset and prevent negative effects of the pandemic and regularly publishes working papers and briefings summarising findings and suggested actions for partner organisations.
So far, in this journey to take action and support the timely and progressive research and policy development, we have been challenged by the lack of available representative research, data and intelligence of London’s diverse population.
Representativeness is consistently identified as a limitation across sources of data and information, with a lack of sufficient information available on the needs of different disadvantaged and marginalised communities, including racialised and minoritised groups and all those with protected characteristics.
This challenge is perpetuated by the acknowledged impact of years of structural racism and inequality which has compounded the mistrust, suspicion and fear between marginalised communities and power structures such as government, health and social care or the police.
The Thrive LDN research and community insights function is now an established feature of the public mental health system across London.
Maybe as Thrive LDN is keen to be involved in and represented at the third Pledge progress update but recognises that Pledge signatories from racialised and minoritised backgrounds are best placed to share their insights and updates.
To ensure that pledge commitments are embedded across all aspects of Thrive LDN activities and actions presented within the Public Mental Health Review for London to collectively achieve change.
It is important to acknowledge that the level of systemic change required will not be easy. It is necessary to have a structured approach to the change management processes required which acknowledge the experiences of London’s diverse communities and unfair outcomes, while utilising the strategic opportunities which currently exist with the development of Integrated Care Systems.
We will only overcome ethnic inequalities in mental health and wellbeing when all systems use their power to improve people’s health and harness a multitude of opportunities to overcome the greatest health challenges for mental health and wellbeing.
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 continued engagement with regional and sub-regional partners across London to share insights and create opportunities to work together.