Top flight associates in mental health and social care delivering service improvement
BME Mental Health Improvement: Have we given up trying?
By Hári Sewell
Posted: Thursday July 3 2014
Applications for the Positive Practice in Mental Health Awards were lowest for the category for Evidence of Improvement in Black and Minority Mental Health. Considering that one category received 45 applications and the the next lowest category was 12, the figure of 6 for the BME category tells its own story.
Examples of positive practice in relation to improved outcomes in mental health for people from Black and Minority Ethnic (BME) Groups are few and far between. This is what is seems.
Organisations across the country were invited to submit nominations for the national Positive Practice in Mental Health Awards organised by Breakthrough (http://www.positivepracticeinmh.com/) . Information and invitations were sent out via personal contacts, established networks nationally and through a significant social media campaign. Without detracting from the excellent applications that were received, it is striking to note that there was a significantly low number of applications for the BME category. To put it into perspective, the highest number received for a category was 45. For the BME category it was 6. The nearest low category applied for received double the amount of applicants.
I had two main reasons in mind when I offered HS Consultancy’s sponsorship of the BME Evidence of Improvement category. Firstly to highlight potential sites for learning in order to add energy to the work to improve outcomes for BME people in the absence of a clear or discrete national policy or regulatory framework covering this agenda. Secondly, I had been struck when undertaking research for the Department of Health (published by the NHS Confederation and Afiya Trust as ‘Making Progress on Race Equality in Mental Health’) that organisations were able to report on very positive activity but few were able to cite improved outcomes linked to specific action that they had taken. (See the report here http://www.hsconsultancy.org.uk/updates/19-making-progress-on-race-equality-in-mental-health-report-out-now).
The low number of applications for the BME Evidence of Improvement Awards may be corroboration of the evidence reported in the Making Progress on Race Equality report. In fact, at a general population level the Care Quality Commission has over the past four years, in the Mental Health Act reports and the final Count Me In census report, presented data to suggest little evidence of improved outcomes for people from BME backgrounds.
On 23rd October 2014 in Sheffield at the Positive Practice in Mental Health Awards ceremony we shall celebrate all the positive practice delivered by applicants, including those in the BME category. I still have questions however as to the reasons why few organisations or individuals were able or willing to submit bids in the BME category. Perhaps one reason is just that there is not much positive practice out there. It is not plausible to suggest that organisations did not know about the opportunity because given the fact that one category received 45 applications, the coverage nationally was clearly effective. The awards website and information circulated provided information on all categories.
Perhaps factors influencing the dearth of applications include the absence of discrete policy leadership and this has meant that providers and commissioners are no longer giving their previous levels of attention to the BME agenda in mental health, as they had done under the Delivering Race Equality in Mental Healthcare policy. Maybe austerity has seen the deletion of a lot of specialist roles addressing race inequality and as a consequence there had been little capacity for scanning organisations and their networks for examples of positive practice. It is probable that those who had previously held these specialist posts would have played a key role in making organisational applications.
I have never said this publicly before but I do believe that there is widespread malaise in relation to the BME mental health agenda, alongside the few who are still energetically pursuing improvement. I believe that this comes from having tried and failed to deliver improvements for BME people in key indicators such as higher than average utilisation of inpatient beds, community treatment orders and forensic services, amongst many others. The inherent conflict in the orthodoxy of psychiatry is also exposed in this arena, namely the belief that it is possible to treat a biomedical condition but at the same time collectively throwing up hands in despair at the fact that redressing the inequalities for certain BME groups is beyond the capabilities of modern biopsychosocial models of psychiatric services. Of course binary reductionist conceptualisations do not capture the whole story. There are of course many who appreciate the complexity of the challenge; the ability of psychiatric services to make a difference but also an acknowledgement of the reliance on partnerships and structural approaches. The malaise I believe exists also arises from what remains for many, an unanswered question, “What works?” This brings us back to the awards and the reasons set out earlier why HS Consultancy sponsored the Evidence of Improvement category.
Whatever the reasons for the low number of bids for the BME Award we are thankful to those who have begun to raise their heads above the parapet and have submitted applications. The search for what works or what good looks like will continue beyond this year’s awards. Discovering what works and what good looks like requires people to keep trying, whilst capturing their learning.
We must however seriously face the evidence that there is still not widespread improvement in outcomes for BME people in mental health. Given that leaders in policy and practice have been aware of ethnic inequalities in mental health for decades surely this is not a tolerable position?