There have been some positive developments in ensuring equality and fair access in health and social care services, supported by legislation, but recent evidence shows that we still have some way to go. Some examples of health and social care inequalities have been evidenced for black and ethnic minorities (DH, 20079 DH, 2008 ) lesbian, gay and bisexual people (CSCI, 2008), disabled people (CSCI, 2009). and people with mental health needs and/ or learning disabilities (Mencap, 2008), (Disability Rights Commission, 2006) Some of the barriers to equality that these studies identify are, for example, physical access, communication, stigma, and low expectations. People with mental health needs are also likely to experience higher levels of deprivation and poverty (Thornicroft, 1991) and have a very high risk of failing to find and retain employment (Office for National Statistics, 2003). All aspects of the framework outlined in this guide would need to be in place in order to ensure fair access and equality and improve opportunities and outcomes for people with mental health needs, but this section deals with some specific equality issues.
Making it happen- Norfolk
My cultural background and communication needs are taken into account in assessment and self assessment and support planning.
Enough time is given to me so that I can explain my needs properly, or for a family member or advocate to explain them on my behalf.
There is continuity in the contact I have with professionals and I don't have to keep explaining things over and over again.
Examples of things that help with this:
- In health and social care assessments a whole life approach is taken, which includes, for example, taking into account the importance of culture, faith, relationships, family, caring responsibilities, a decent place to live, finance and employment, social and leisure activities
- There is a streamlined approach to person centred information that means people do not have to keep telling their stories over and over again
- Availability of interpreters, guides and advocates, including dedicated time slots where interpreters are on hand
- Flexibility in appointment systems to reflect an understanding that things may take longer if there are language or communication differences or if people have difficulty in speaking or expressing themselves
- Opportunities for people to find out about and easily access English for speakers of other languages courses
- Dedicated training for professionals in working with language and communication differences and working with interpreters
- Drop in facilities where people can get information in a range of formats and languages and check information they have received
There are no barriers to access and the quality of the services I am offered is the same for me as for everyone else.
There is a good choice of opportunities and services that take account of my particular needs.
Examples of things that help with this:
- Information in different forms and from different sources
- Dedicated teams, and voluntary groups that speak a range of languages and actively work locally to improve access and outcomes (for example to employment and financial advice) and also work with health and other staff to increase awareness and understanding of cultural and other differences
- Access to an employment adviser and to schemes like Pathways to Work (more info on partnership section)
- Anyone who is eligible for access to public funding for services is offered the opportunity to have a personal budget
- Promotion of information about personal budgets through local radio, community broadcasting and satellite channels that are designed for different communities and audiences
- Access to information technology and specific training and support to use it
- Availability of specialists with training and understanding of special needs
- Local organisations working with prisoners with mental health needs - for example, providing the opportunity to access training to talk about their experiences, so that professionals and services can have a better understanding and be more responsive
- Innovative approaches to involving people in planning and development, designed by people who use or have used services - for example, community events run by local people
- The involvement of mental health service user experts in the commissioning, contracting and procurement process
- Good, relevant data collection to inform commissioning, including what is working and what is not working for people
- Specific equality targets in commissioning and contracting, including equality principles as part of the criteria for evaluating tenders.
- Support and development of user led services (more info in the creative commissioning section)
- Dedicated action in helping people to recruit personal assistants who can meet cultural, linguistic and religious requirements - for example, advertising campaigns via local and community specific media
- Flexibility in the limitation in Direct Payments of payment to relatives (but ensuring that assumptions are not made that this might be the only option for some people)
- PCTs working with local authorities through local strategic partnerships and local area agreements to tackle wider social issues impacting on health and well being such as housing and employment as addressed within PSA 16.
I get a fair choice and opportunities are available to me even though I live in a rural area.
About 9.5 million people live in rural areas in England and this is a growing number. There are particular difficulties for people living in rural areas, such as variability in provision, stigmatisation and isolation, rural racism poor transport and housing poverty (SCIE, 2007).
Personal budgets could provide an answer to some of the difficulties that people who live in rural areas have in finding the right help and support to live their lives. However, there needs to be a recognition that health and social care policies and programmes must ‘recognise and address rural circumstances' and ‘ensure equitable outcomes in rural areas' (Commission for Rural Communities, 2008).
Examples of things that help with this:
- Geographical and community specific promotion of personal budgets, and the provision of the right advice, advocacy and support to take advantage of them
- Information made available locally - for example, in local shops, GP practices, or via church and parish magazines
- Good consultation and direction from people in rural areas about what is needed and what will work
- Community development and practical support for the development of local clubs and activities
- Community transport schemes
- Creative use of mobile services (e.g. mobile libraries) and of local venues (e.g. lunch clubs in local pubs)
- Market development and support for small, local voluntary groups and social enterprises
- Systems and services that can be flexible and adapt to local circumstances
- Good contingency planning for the management of crisis and if things go wrong
SIGNPOSTS
equality in health and social care and beyond
1. Will community-based support services make direct payments a viable option for black and minority ethnic service users and carers? Dr Ossie Stuart, Social Care Institute for Excellence, 2006, London. www.scie.org.uk
8. Sharing Voices in Bradford (SVB) A community development charity that works with black and ethnic minority communities to provide culturally sensitive mental health services. www.sharingvoices.org.uk
9. Rural Emotional Support (REST) service, Staffordshire. This is a service run by a voluntary organisation providing emotional support and practical help for people living in agricultural communities. www.staffordshirementalhealth. info/details.asp?courseId=104
2. Delivering Racial Equality website: In January 2005, the Department of Health published a five-year action plan, Delivering Race Equality (DRE) in Mental Health Care. DRE aims to help mental health services provide care access that fully meets the needs of BME patients and build stronger links with diverse communities. www.actiondre.org.uk
3. Lakhani,M (2008) No Patient Left Behind: how can we ensure world class primary care for black and minority ethnic people? London: Department of Health. www.dh.gov.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndguidance/dH_084971?IdcService=gET_ fILE&dId=165661&Rendition=Web
4. Race for Health (2006) Towards Race Equality in Health: a guide to policy and good practice for Commissioning Services. Manchester: Race for Health www.raceforhealth.org/storage/files/Race_for_Health_commissioning_ guide.pdf
5. MIND website with information about mental health discrimination and how to challenge it. www.open-up.org.uk/resources
6. Vision and progress: Social inclusion and mental health. www.socialinclusion.org.uk/publications/NSIP_vision_and_Progress.pdf
local services
7. Health and Advice Links services based in GP surgeries in Tower Hamlets and Hackney - offer advice on a wide range of issues such as housing, debt, and employment.
The services are managed by Social Action for Health, a community development charity that works alongside marginalised local people and their communities. It operates mainly in East London with staff recruited from local people trained to work with their community in their mother tongue. www.safh.org.uk/safh_php/networks.php?gi_session_name=gi_ session_49d0e28dbc3af
10. Department of Health Equal Access Framework Part of the Personalisation Toolkit. http://www.dhcarenetworks.org.uk/Personalisation/Topics/
11. Information about rights to access, treatment and support. http://www.equalityhumanrights.com/your-rights/rights-in-different-settings/health-and-social-care/access-to-services-treatment-and-support/mental-health/
12. Newman J, Hughes M (2007) Modernising Adult Social Care - What's working? London DOH. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndguidance/dH_076203
Rurality
13. Manthorpe J, Stevens M (2008) The personalisation of adult social care in rural areas, Cheltenham: Commission for Rural Communities. www.ruralcommunities.gov.uk/files/cRc%2078%20Adult%20Social%20 care.pdf
14. Bowden C and Mosley M (2006) The quality and accessibility of services in rural England: a survey of the perspectives of disadvantaged residents Wolverhampton, ADAS.
www.defra.gov.uk/rural/pdfs/research/quality-accessibility-services-rural-eng-report.pdf
15. Rural Emotional Support (REST) service, Staffordshire. This is a service run by a voluntary organisation providing emotional support and practical help for people living in agricultural communities. www.staffordshirementalhealth.info/details.asp?courseId=104
