Welcome to the brief september update of my BAME mental health carers forum. The forum focuses on updates, information and queries regarding mental health services and how they impact on ethnically diverse carers who are caring for someone suffering mental ill health.

The speakers for September were

Mushtaq kahin – Her projects reaching out to the community
Macius Kurowski – South London & Maudsley NHS Equality Manager on Equality updates
Dr Stephen Goggins – South London & Maudsley NHS on carer’s strategy

Mushtaq presents on her project

Due to me being a member of Barnet, Enfield & Hagingly MH trust Service User & carer group, it was not long before I found out they were also working on reaching out to their communities. I also have some members of that group attend my carers forum. I invited Mushtaq to speak about her projects. She currently works for Barnet, Enfield & Hagingly MH welness team.

She is the community engagement practitioner. So what she does is engage with the acute services wards. She helps with the formulation meetings, discharge meetings and she sees what kind of help and support that she can give before patients are discharged. Her main role is for people who don’t have care coordinators, so she has to liaise with families and carers as well. In fact she is carer herself, although she never realized she was a carer going back from a young age.

She used to translate to her parents on English, where she navigated the mental health system in Holland in the UK. She noticed many difficulties especially if your from an ethnic minority where she is from a Somali background.

Mushtaq is also a Registered Nursing where she actually trained at the Maudsley. She does have fond memories of South London & Maudsley and maybe one day she might come back. She is a guest lecturer at London Southbank University to teach training associates. Mushtaq started talking about how she volunteers for a project which is at “Mind in Harrow” where she has been involved in the project for about six years. The project mainly works with carers and families and people who have mental health illnesses in the Somali community, but it’s also open to other communities.

Mushtaq talked about what the word BAME means to her and although she was aware of the differing opinons about the word BAME, she slight agreed with it, but she did mention that in the terms of ethnic minorities, we do not suffer the same problems and it is important minorities get to use their voice and have a chance at being represented.

She talked on how she lived in London since 2002 and how she worked mainly in midwifery and then moved on to general nursing as well as five years of work in mental health in West London. She has worked with quite a few mental health NHS trusts from South west London & St Georges, Maudsley, Camden & Isinglinton MH NHS Trust and now Barnet, Enfield & Hargingley NHS trust. So she feels she has a good idea on comparing services within her own experience. Mushtaq spoke about the Somali community and how they tend to suffer from mental health illnesses at the higher rate, one in three compared to the British communities, which is a population in adults, would be around one in six on mental illness. She mentioned in general, people from ethnic minority backgrounds tend to have low access rate to mental health services unless they hit high end services.

Mushtaq spoke more about the projects she works on regarding carer support for the Somali populations because there’s a lot of fear and mistrust. People feel like there’s a lot of negative thinking because in her culture, once you become mentally unwell, they believe there’s no recovery. So while working with the Somali communities it is important she goes out and works with outreach services or cultural workers, Link workers or an even also working alongside with Imams at mosques. This is because the first line of treatment can be from the spiritual world. There can be difficulties but it is important that if people need medication, they should be referred to a Good mental health trust, which unfortunately does not often happen, this can then lead to an element of exploitation.

She feels religious leaders should be regulated. She believes mental health trusts have a responsibility with working with community groups. for example, providing outreach clinics in mosques, synagogues, temples where they should recruit people or at least also sponsor them for apprenticeships. This is because there’s not enough ethnic minorities practicing therapy or mental health nurses, psychiatrists, consultants, and they have a duty due to little equality in care as well, and also in excess of care.

Macius Kurowski presents on Integrated Equalities Action Plan (IEAP)

Macius updated us on what he usually comes to the forum on where he reports on how Maudsley is doing as a trust to support black and minority ethnic service users. Macius mentioned he is happy to be questioned about these updates including “What about carers?”. So this is just a bit of a progress report.

Macius wanted us to be the judges on how well things are doing as he welcomed feedback from members. Macius also mentioned they have tried to make certain changes for this year, although importantly that is only part of the reason he is here. Since he is not here to say everything’s fine or to say that all these numbers are more important than the fantastic experience or service.

Macius spoke about what outcomes have been achieved, what outcomes have partially been achieved and what outcomes have not been achieved.

What is Maudsley’s ntegrated Equalities Action Plan? The IEAP 2018 21 contains SLaM’s service delivery and workforce equality objectives where It meets South London & Maudsley’s Equality Act obligation to publish one or more equality objectives at least every four years.

The IEAP outcome framework shows what differences the equality objectives made. The mid year 20/21 outcome framework shows mixed performance across South London & Maudsley with some progress but there is more to do.

2020/21 IEAP outcomes achieved were

• Improving experience and reducing variations in experiences of care for lesbian, gay, bisexual and transgender (LGBT+) service users.
• The Lambeth directorate equality objective to improve the LGBT+ experience.
• Increased number of Black, Asian and Minority Ethnic staff at Band 8a, 8b, 8c, 8d, 9 and VSM
• Maintaining parity in the experience of and fairness in relation to
• career opportunities for LGB Staff.
• Increased number of female Staff at Bands 8a

2020/21 IEAP outcomes partially achieved

• Reducing ethnic variation in the use of restraint
• Improving experience and reducing variations in experiences of care for religious service users.
• Croydon and Behavioural and Development Psychiatry (BDP), Lewisham and Southwark equality objectives
• Effective use of equality impact assessments within Quality Impact Assessments
• Increased number of Black, Asian and Minority Ethnic staff at Band 7
• Improving Black, Asian and Minority Ethnic staff experience of career opportunities
• Improving experience and careers opportunities for LGB Staff.

2020/21 IEAP outcomes not achieved

• Improving experience and reducing variations in experiences of care for Black, Asian and Minority Ethnic and disabled service users.
• CAMHS and PMOA equality objectives
• Eliminating over representation of Black, Asian and Minority Ethnic staff in disciplinary proceedings.
• Improving the experience of and fairness in relation to career
• opportunities of disabled staff.
• Reducing the gender pay gap.

Macius then moved on to talking about where lessons were learned in looking back on the IEAP for 2018/21

Lessons learnt:
Importance of outcomes focus
Improved availability and use of data to measure change and be accountable
Improved co production and partnership working

Impact of Covid 19:
Impacting on delivery (e.g. Memory Service and wards)
Limiting data available for evaluation
Continued commitment and action on reducing inequality despite challenges
Covid and BLM emphasising the need to deliver real improvements

IEAP 2021/23:
Lessons learnt built into development of IEAP
Focus on equality outcomes not fully achieved by the previous IEAP

Next was the IEAP (2021-23) equality objectives for Trustwide service delivery

1.Improve access and experience of care for our Black service users (PCREF)
2.Reduce ethnic variation in use of restraint.
3.Improve care and reasonable adjustments for service users with Learning Disabilities or Autism to reduce use of restraint.

Workforce
1.To increase number and percentage of BAME staff in senior posts, in line with make up of the workforce as a whole
2.To eliminate disproportionality of BAME staff in disciplinary hearings

3.Increase disabled staff perception of career progression

Directorate
1.Improve access to CAMHS borough community services for Asian and Black young people
2.Increase the proportion of BAME people referred to Memory Services at an earlier stage
3.Improve access to virtual reality vocational training for Forensic BAME service users
4.Improve care to Black service users on Leo by implementing the “Trusted Friend” project
5.Improve access to DIALOG interventions in the Lewisham PCMHS for BAME service users
6.Improve access to psychological therapies to Black males in Southwark CMHT teams

Dr Stephen Goggins – South London & Maudsley NHS on carer’s strategy

Dr Stephen Goggins is South London & Maudsley’s Head of Psychology & Psychotherapy for the Lewisham Adult Mental Health directorate. With South London & Maudsley joining the Triangle of Care membership, Stephen focused on how it gave the organisation a major boost on it’s carer’s strategy.

Stephen presented on SLaM’s earlier model of engagement with carers and how it had limitations.

Dr Stephen pointed out the following

• Carers being excluded at certain points of the care pathway
• Failure to share information on risk assessment and care planning (see SUI reports and recommendations)
• Requests by carers for information, support and advice not heard
• Carers unique and expert views and history of the service user can be missed

Dr Stephen mentioned the Triangle of Care principles.

1. Carers and the essential role they play are identified at first contact or as soon as possible thereafter
2. Staff are “carer aware” and trained in carer engagement strategies
3. Policy and protocols re; confidentiality and sharing information are in place
4. Defined post(s) responsible for carers are in place
5. A carer introduction to the service and staff is available, with a relevant range of information across the care pathway
6. A range of carer support services is available

with regular assessing and auditing to ensure these six key elements of carer engagement exist and remain in place.

It was refreshing to see the lewisham section of SLaM working hard on triangle of care and I hope to see the boroughs of Southwark, Lambeth and Croydon continuing to work hard with the triangle of care. The boroughs of Greenwich, Bromley and Bexley are with Oxleas, however Oxleas NHS mental health trust is not a member of Triangle of care, so I am not sure what the plans are as yet, but they do have a carer’s strategy where we hope to get engagement off my Greenwich MH carer forum or my BAME MH carer forum.

This concludes the brief September update for 2021