Trusts have received draft guidance requiring them to address key areas of inequality in the way that Black and ethnic minority people are treated in mental health
"We support initiatives like this which look to undo some of the harm done by institutional racism in the NHS and wider mental health services, and proactively make the system a fairer, more equitable place for all." Ariel Breaux Torres, head of race equity, Mind
Mental health trusts have been told by NHS England to appoint a board member responsible for improving racial equality and to develop plans to tackle systemic racism.
The draft guidance from NHS England, circulated just before Christmas, says that providers will be required to draw up a Patient and Carer Race Equality Framework (PCREF) by March 2024. Each framework will be expected to outline how the trust plans to improve access, experience and outcomes for ethnic minority groups. The plans will be expected to cover all services, including talking therapies and secure inpatient services.
A full national rollout of the guidance is expected in the spring. Four pilot sites, including South London and Maudsley Foundation Trust and Birmingham and Solihull Mental Health FT, have already implemented PCREFs.
The 2018 Mental Health Act review noted that Black people are detained under the Act at four times the rate of white people, and are 10 times more likely to receive a community treatment order after being an inpatient. NHS statistics show that the rate of people from Black ethnic backgrounds being restrained in mental health care has more than doubled in the past six years.
One of the 2018 review’s key recommendations for addressing the high rate of detention was that trusts should create PCREFs, which “should focus on several core areas of competence: awareness, staff capability, behavioural change, data and monitoring, and service development.”
In a foreword to the guidance, Jacqui Dyer, NHS England’s mental health equalities lead, wrote that proactive attention to “consistent barriers” faced by Black and ethnic minority people in mental healthcare, such as a lack of cultural safety and structural discrimination, “can no longer be delayed”.
Ariel Breaux Torres, head of race equity at the mental health charity Mind, welcomed the guidance: “We support initiatives like this which look to undo some of the harm done by institutional racism in the NHS and wider mental health services, and proactively make the system a fairer, more equitable place for all. Disproportionate rates of sectioning and detentions have continued to rise for years on end, with Black people now nearly five times more likely to be sectioned under the Mental Health Act than white people and much more likely to be forcibly or chemically restrained against their will. Racism like this must be stamped out.”
As well as appointing an executive lead for PCRF at board level, providers will be expected to report their performance against measures such as detentions under the Mental Health Act, ethnic minority access to services and diversity of workforce to the board.
Each trust will also be required to develop a local PCREF plan setting out actions it will take to address areas of inequality, timeframes and intended outcomes. The plan must be developed, implemented and reviewed with input from ethnic minority communities.
The draft guidance is very welcome. Evidence shows that Black people are far more likely to be subject to physical, chemical and mechanical restraints in mental health care than white people, with the gap widening in the past five years. The NHS Race & Health Observatory is already doing good work in identifying and tackling ethnic inequalities in health care. It is now time for trusts to address these disparities and to do so in a transparent way. The creation of formal plans, along with the appointment of a board member with responsibility for tackling racial inequality, is an important first step in achieving this.