The following is an article written by Melba Wilson, National Programme Lead, Equalities in Mental Health and was published at www.blackmentalhealth.org.uk
Many readers of the Black Mental Health UK website may be familiar with the background and genesis of the Delivering Race Equality in Mental Heathcare programme (DRE). It was a significant development in the long process to improve the outcomes and experiences of people from black and minority ethnic communities, who use mental health services. DRE is a five year action plan (2005-2010). It is the government's response to the inquiry into the death of David Rocky Bennett, who died in 1998 in an NHS facility. The DRE action plan was published in January 2005. It addresses a number of acknowledged inequalities in BME communities' experiences of services, including:
adverse pathways of care - for example people from some communities are more likely to access services through the criminal justice system or social services, and less likely to have been referred by a GP;
very high rates of admission to hospital for some BME groups (three or more times higher than average), and elevated rates of detention, coupled with longer lengths of stay; and
a restricted range of services - Asian patients have been less likely to be offered psychological therapy, for example
The DRE action plan contains 78 specific actions based on three main building blocks
better, more culturally appropriate and responsive services;
better engagement of services with their local communities; and
better use of information and evidence
This all adds up to huge complexity within a high profile programme. That complexity has to do, in part, with our constituency - people from African and African Caribbean communities, Asian communities, refugees and asylum seekers, and people who immigrate from Eastern European countries. The complexity is also evident in the passion and commitment which people who work with and through the programme bring to it. Dealing with this level of complexity requires patience, clarity; focus and, most importantly, an ongoing willingness to listen and to reflect on changing circumstances and evidence. At the same time, it is also important to be aware of differing perspectives and priorities.
I noted earlier, that one of the catalysts that gave rise to the DRE programme was the death of David ‘Rocky' Bennett - a young, African Caribbean man. This has rightly led to a major focus within the DRE programme on work to do with the position of young black men, who use mental health services. That focus continues, and is entirely appropriate. Newer evidence, however, is telling us of the growing disproportional numbers of black women who are coming into mental health services. This, too, requires framing clear responses to address the situation. I believe the DRE programme is well placed to support the development of solutions to the challenges which face people from diverse communities who use mental health services. We are now part of a wider Equalities Programme within the new National Mental Health Development Unit (NMHDU). This enhances opportunities to work more closely with colleagues who focus on other issues of equality, e.g., gender and age.
We all feel this is a productive way of working - one which acknowledges that people with mental health problems do not live their lives in silos of race, or gender or age. When they come into contact with services, they can and should expect to have a service which meets their needs in a manner which reflects their humanity. Within the DRE programme, and the broader work on equalities and mental health generally, there is a continuing commitment to work in this way. For example, the new mental health strategy currently being developed within the Department of Health is indicating the need to ensure work with BME communities remains a priority. It contains a welcome focus on improving equality of access to high quality care; and also on the importance of undertaking the work from a social justice perspective. This is to be welcomed; and it is equally important that people from diverse communities have an awareness of emerging policy such as this - so that we are in a better position to make our views known about how services need to change to reflect our needs as people.
The building blocks of the DRE programme are a good way of trying to do this. In relation to appropriate services, for example, community development workers (CDWs) are doing some very good work around the country with primary care trusts, mental health trusts and others. This work is aimed at improving services. Two new reports - one looking at the impact of CDWs and the other providing guidelines to help organisations make better use of CDWs will be published in the next two months. These should add to the knowledge and information which can lead to improvements in services. Likewise, over the next six months, the DRE programme will be producing a range of publications which set out the learning from the 18 Focused Implementation Sites(where work has been underway for the past 2 years to test out new ways of providing services); highlighting the work of the 80 national community engagement projects which were funded through the programme; and sharing evidence from a large body of research which we have commissioned. One of these pieces of research is an audit of prescribing practice in relation to BME communities.
In addition, the DRE Dashboard is gathering evidence on how people from BME communities are accessing community services. All of this work is important and relevant; and it is our intention to make it widely available. We have a new mental health equalities website now which will contain much of the learning from DRE, as well as be a resource generally.
Finally, I often say that the DRE programme is aiming to achieve nothing less than organisational and attitudinal change. It takes time, it takes resources (human and financial) it takes commitment and it takes partnership. Join us in helping to bring about that change.
Melba.