The new framework is designed to help NHS trusts and mental health providers address the unequal treatment of racialised minorities
“The PCREF must be at the heart of the mental health services of the future – starting today. It has the potential to create system change that will benefit everyone. To fulfil that potential, it needs to be implemented in full, with the necessary resources provided and the time to bring about sustainable change to services and systems." Andy Bell, chief executive, Centre for Mental Health
A new framework for promoting racial equality in mental health services has been published by NHS England.
The creation of a Patient and Carer Race Equality Framework (PCREF) was a major recommendation of the 2018 Independent Review of the Mental Health Act. Published last week, the document sets out a framework for NHS mental health service providers to tackle the racism in mental health provision.
The document notes that people from racialised and ethnically and culturally diverse communities “are more likely to be detained under the Mental Health Act and are more likely to be detained in hospital for longer when compared to other ethnicities.”
NHS England has identified 12 key legislative and regulatory requirements, which apply to trusts and mental health providers, and “which impact upon racialised and ethnically and culturally diverse communities”. The document states that to implement these requirements, each trust and mental health provider “will be expected to embed the PCREF in their governance structures.” Every trust and mental health provider should have in place a nominated executive lead accountable for the delivery and oversight of the PCREF, the framework says.
Trusts and mental health providers must, it adds, “actively demonstrate how they are reducing inequalities for racialised and ethnically and culturally diverse communities.” A lead person must be responsible for collecting data broken down by ethnicity and publish the data at the end of each financial year. That data should include, for example, the number of cases of detention under the Mental Health Act, and the cause and duration of these detentions, as well as the number of times restraint was used, and the number of deaths in inpatient units.
In a joint statement, Claire Murdoch, national director for mental health and Professor Tim Kendall, national clinical director for mental health, welcomed the publication of the framework: “The anti-racism approach of the PCREF is a significant step for mental health service provision to tackle race inequalities and inequities, indeed lack of attention to this aspect has created decades of poor care. We are proud to stand with trusts committed to becoming anti-racism organisation’s and who want to encourage a culture of safety and sense of belonging for all those who access mental health services.”
Andy Bell, chief executive of the Centre for Mental Health, noted that people from racialised communities in England have “far poorer experiences of mental health services, with less access to talking therapies, much higher rates of coercion, and poorer outcomes.” He described this as “an injustice that has to end.”
Bell added: “The PCREF, created through the leadership of Dr Jacqui Dyer, provides a framework for mental health services to shift the dial on race equality. It sets out the systemic changes that service providers must take to be able to offer anti-racist, anti-oppressive mental health care to everyone.
“The PCREF must be at the heart of the mental health services of the future – starting today. It has the potential to create system change that will benefit everyone. To fulfil that potential, it needs to be implemented in full, with the necessary resources provided and the time to bring about sustainable change to services and systems.
“Previous attempts to address racial inequities in mental health services have been under-resourced or stopped before they had a chance to make a lasting difference. So the PCREF must be given the time and resources to work for the communities that are currently so poorly served by the NHS.”
The publication of the Patient and Carer Race Equality Framework, recommended five years ago by an independent review, is welcome, if overdue. People from racialised minorities are much more likely to be detained under the Mental Health Act and, once detained, tend to stay in hospital for longer periods. An important first step to addressing this is to collect data broken down by ethnicity, and we are pleased to see that the framework requires this. Although tackling racism in health care is an ongoing project, we hope that this framework will help trusts to focus their attention both on how racialised minorities are being failed and to develop approaches that will lead to greater equality. The long overdue reform of the Mental Health Act could also have helped tackle racial inequality, so it is disappointing to see it omitted from the King’s Speech.