16-17 - EQUITY: Chat Room

With women disproportionately facing challenges to their mental health – particularly women of colour – how should health policy makers and clinicians be responding?

Dr Jacqui Dyer, President of the Mental Health Foundation, Mental Health Equalities Advisor for NHS England, and Jon Salmon, an Associate Director at Ketchum, share views from a health equity panel event.

There are certain aspects of the debate about how to tackle mental health that are often ignored, but need to be addressed urgently. This has become painfully clear in the wake of the George Floyd case in the US and the growth of Black Lives Matter into a global movement. There needs to be much more focus on the treatment and experiences across different parts of society and among cultural groups.

Mental health cannot be viewed in isolation. Experience of wider societal factors such as education, employment, childcare and housing are all social determinants of health. For women of colour there are specific challenges too that are not necessarily experienced by other racialised groups, with the impact on mental health manifesting itself differently.

The Adult Psychiatric Morbidity Survey, which is carried out in England, has previously highlighted, for instance, that black women have a markedly higher incidence of post-traumatic stress disorder than other ethnic groups – more than double that in Asian and white communities. It is a trend that has still not been properly evaluated and requires much deeper research to determine the factors behind it.

When it comes to framing policy that addresses inequity in mental healthcare provision effectively, we need a more sophisticated approach. Indeed, we need proper acknowledgement that there is inequity in care and that there is not a model of psychiatric support built around provision of mental health services that is based on access, service experience and outcomes.

We need an approach that addresses the particular conditions causing mental health trauma in the first place and which ultimately require treatment for that trauma. It must also, however, reflect the wider factors they may be experiencing in society such as oppression, discrimination and disadvantage.

We’ve not been as successful as we need to be in the context of mental health services better responding to needs, other than providing a prescriptive medical model of psychiatry that does not respond to lived experience.

One way of trying to address this has been developed by Black Thrive – founded in south London as a result of the death of a black man failed by the then mental health system and supporting authorities.

Black Thrive has been developed within the community to ensure such failures are not repeated and it strongly advocates co-production between organisations and community members to co-design services that address diverse needs.

In society, there’s a lot of rhetoric, a lot of description about how terrible things are and we have libraries full of that, but we need to move from awareness to action.

In contrast, Black Thrive aims to empower community groups, carers and service users to drive action that leads to meaningful and tangible transformation of services. It helps examine the barriers that women experience and also what other groups such as employers can do.

One action that has been introduced is establishing emotional emancipation circles located in communities, which aim to discuss and explore issues before they reach a point of crisis.

Failure is not an option – we need to urgently undertake the transformative work to our services so that we reduce the flow into crisis and further families do not suffer from the loss of loved ones. The impact on caregivers must not be understated either including the physical, emotional and mental toll that they suffer on a daily basis.

A key initiative that is being introduced in England is the Patient and Carer Race Equality Framework – after all, it is the patients and carers who have the most important voice when looking at service improvement or transformation.

Working with communities, it is a way of co-producing mental health services and is a framework that holds mental health Trust systems to account. Furthermore, it ensures there is progressive improvement in access, experience and outcomes across mental health services for race groups across all service areas.

It’s an exciting development as it centralises the activation of communities who are experiencing these disparities, to be the engine to drive how the services are shaped differently. It also helps enhance an NHS mental health Trust’s organisational competency such as co-production, working in partnership, cultural awareness and better use of data.

This changes the trajectory of the data as the Trust is building different pathways working with its communities. At the same time, you are starting to build trust and confidence in mental health services, which become more reflective of what’s needed in a community rather than a perceived idea of psychiatric care that is not necessarily reflective of what’s needed.

This encourages people to engage with mental health services a lot earlier rather than leaving it until they are in crisis and having to be brought in off the street. This is recreating the mental health provision.

There are aspects related to mental health that must come into sharp focus if we are to properly address inequity in mental health provision.

There needs to be research into the connection between violence perpetrated on women and the impact on their mental health. This must also take into account that there is a disproportionate over-representation of black women requiring mental health services.

In the final analysis, there’s a gap in our understanding of the intersectionality between race, gender and disability and the wider issue of mental health. Knowledge of these links is fundamental to leveraging support policies and igniting service transformation.

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