Hello everyone, I’m Matthew McKenzie, and in this blog I want to raise awareness about the various forms of discrimination and bias that unpaid carers, especially those looking after individuals suffering from mental illness or cancer, might encounter. Moreover, I am deeply involved in addressing racism and discrimination, sharing my firsthand knowledge of these issues, particularly in the mental health system.
In this article, we’ll dive into some of the crucial terminology that are essential for anyone working within healthcare settings, caring for people from minority groups, or even interacting as patients themselves.
In this blog, I’ll focus primarily on the acute settings within general hospitals. Most of these terms and definitions, however, are broadly applicable across the entire mental health system. We will go over around 12 to 13 key terms, highlighting their relevance and providing examples to illustrate how they manifest in healthcare contexts.
You can also watch the video lecture off my YouTube Channel.
Discrimination
Discrimination in healthcare involves treating individuals unfairly based on their race, ethnicity, or other characteristics. This unfair treatment leads to poor health outcomes for those affected.
Welcome to another blog by Matthew McKenzie Carer activist. As a lived experienced member of the Race Equality Foundation. I am proud to present an exciting project that seeks to address the inequalities in health.
The London Anti-Racism Collaboration for Health (LARCH) have launched a new tool to help health and care organisations tackle systemic racial health inequalities.
The Race Equity Maturity Index (REMI) is the first framework of its kind, allowing organisations to track, measure and enhance their anti-racist activities using an evidence-based approach.
The REMI was designed with people and communities from across London, reflecting the diversity of both London’s population and its health and care workforce.
The REMI is intended to help all the parts of the health and care ecosystem meaningfully address the inequalities faced by Black, Asian and minoritised ethnic Londoners, which include:
Using the REMI, organisations can self-assess their progress in tackling these inequalities. The tool uses measurable indicators to categorise organisations into one of six stages of racial maturity, with clear pathways for progression between each stage.
Tackling Cancer Health Inequalities in Patients with Serious Mental Illness
Addressing health disparities, especially for patients with serious mental illness (SMI), is crucial in improving cancer treatment outcomes. This post by Matthew Mckenzie who facilitates the National cancer carer forum explores the multifaceted challenges faced by this vulnerable group and the necessary steps to tackle these inequalities.
To watch the video regarding Cancer and Serious Mental Illness, please click below.
Before continuing with the post, South East London Cancer Alliance. have just released their Cancer And Serious Mental Illness Information Resource. These have been co-created by SELCA, South London & Maudsley and the HIN, while working closely with people with lived experience of cancer and serious mental illnesses. You can visit and see the resources here: https://www.selca.nhs.uk/patients-and-carers/cancer-and-serious-mental-illness
The following sections might be of particular interest as they focus on cancer risks and screening.
Another blog post from Matthew McKenzie, author of “Race, caring and mental health”. In this post, Matthew explores the depressing results of top health inequality reports from 8 organisations.
If you want to watch the more detailed version of this post, then watch the video below, where you can explore the profound disparities in healthcare faced by ethnic minorities, revealed through key reports from NHS, Public Health England, CQC, and more. The video also presents the impact on mental health, maternity care, chronic diseases, and access to healthcare services.
Understanding Health Inequalities in the UK
Health inequalities have been a longstanding issue, particularly affecting various minority groups. These disparities in health outcomes are alarming and have become increasingly scrutinized, especially following the emergence of the COVID-19 pandemic. Matthew McKenzie, a carer activist and volunteer, delves into these pressing issues, focusing primarily on mental health and maternity care within minority communities. In this article, we’ll explore the findings from various reports and organizations concerning health inequalities in the UK and the urgent need for systematic reforms to achieve equitable health outcomes for all.
Health Inequalities: A Persistent Issue
The discussion about health inequalities is not new. Health disparities have been documented long before the recent revamping of the Mental Health Act, dating back to the initial implementation of the Act in 1983. Despite various efforts to address these issues, significant inequalities remain, affecting a wide range of services including mental health, maternity care, and primary care.
Focus on Minority Groups
Health inequalities do not solely affect ethnic minorities. They also encompass groups such as the LGBTQ+ community, travelers, and even certain regional populations within the country. However, the emphasis often lies on ethnic minorities due to the distinct challenges they face.
Key Findings from Health Inequality Reports
Several organizations have conducted extensive research to document and understand the health disparities present in the UK. These reports consistently highlight the unequal treatment and outcomes experienced by minority groups.
NHS Race and Health Observatory Report
In 2022, the NHS Race and Health Observatory released a comprehensive report on ethnic disparities in health services:
Mental Health: Black adults are more than four times as likely to be detained under the Mental Health Act compared to white adults. Ethnic minorities also face higher rates of coercion, including being restrained and put in seclusion.
Maternity Care: Black women are four times more likely to die during pregnancy or childbirth compared to white women. Asian women are almost twice as likely to face similar fates.
Primary Care Access: Ethnic minorities report greater difficulties in accessing GP services and obtaining referrals for tests and treatments, leading to a lack of trust in healthcare services.
Public Health England Review on COVID-19
The impact of the COVID-19 pandemic has further exposed underlying health inequalities:
Mortality Rates: The death rates from COVID-19 were significantly higher among Black, Asian, and minority ethnic groups compared to white groups. Black men were 3.3 times more likely to die from COVID-19 than white men. Similarly, Bangladeshi and Pakistani communities were twice as likely to die from the virus.
Socio-Economic Factors: Ethnic minorities were more likely to be in frontline jobs and live in overcrowded housing, increasing their vulnerability to COVID-19.
Systematic Inequalities: The pandemic highlighted the systematic inequalities in access to health services, with ethnic minorities suffering higher risks due to socio-economic disadvantages and pre-existing health disparities.
Marmot Review on Health Inequalities (2010-2020)
The Marmot Review, followed by its 2020 update, explored health inequalities across the UK, focusing on how deprivation, ethnicity, and other social determinants affect life expectancy and health outcomes:
Life Expectancy Gap: Ethnic minorities, particularly black and South Asian populations, face lower life expectancy and higher rates of chronic conditions compared to white populations.
Social Determinants: Ethnic minorities are disproportionately affected by poor housing, low income, unemployment, and education disparities, which contribute to long-term health inequalities.
Care Quality Commission (CQC) Reports
The CQC has consistently highlighted inequalities in accessing and receiving healthcare:
Mental Health Care: Black and other ethnic minority groups are more likely to be subjected to compulsory mental health treatment and face challenges in accessing early support.
Discrimination and Communication Barriers: Language barriers, cultural misunderstandings, and institutional racism contribute to poorer health experiences for ethnic minorities.
Organizations Addressing Health Inequalities
Various organizations are actively working to address these disparities and promote equitable health outcomes:
The Race Equality Foundation
The Race Equality Foundation has published several studies highlighting the experiences of ethnic minorities within the NHS:
Poor Health Outcomes: Ethnic minorities are more likely to report poorer health outcomes, delayed diagnoses, and negative experiences within NHS services.
Language and Cultural Barriers: Language barriers and the lack of culturally appropriate services lead to worse health conditions for ethnic minorities, particularly in accessing dementia care services.
NHS Workforce Race Equality Standard
The NHS Workforce Race Equality Standard focuses on the experiences of staff from ethnic minority backgrounds:
Discrimination Among Staff: Ethnic minority staff, particularly black and South Asian healthcare professionals, report higher levels of discrimination, harassment, and bullying, which can affect the quality of care provided to patients.
Impact on Patient Care: Discriminatory treatment of ethnic minority staff may be linked to poorer outcomes for ethnic minority patients, as staff experiencing racism are less engaged and less able to deliver high-quality care.
The Need for Systematic Reforms
The consistent and robust findings from these reports underscore the urgent need for systematic reforms to address health inequalities:
Institutional Racism: Addressing institutional racism within healthcare settings is critical to ensuring equitable treatment and outcomes for all patients.
Cultural Competence: Improving cultural competence and language services within healthcare can help bridge communication gaps and provide more culturally sensitive care.
Socio-Economic Supports: Addressing socio-economic disparities, including housing, income, and education, can reduce long-term health inequalities and improve overall health outcomes for minority groups.
Inclusive Policies: Developing inclusive policies and practices within healthcare institutions can foster a more supportive environment for both patients and healthcare staff.
Conclusion
Health inequalities remain a significant challenge in the UK, disproportionately affecting minority groups. Despite various efforts and reports highlighting these disparities, there is still much work to be done. Addressing these inequalities requires a comprehensive and systematic approach, focusing on institutional racism, socio-economic factors, and cultural competence within healthcare services. Only through sustained and concerted efforts can we hope to achieve equitable health outcomes for all, ensuring that everyone has access to the care and support they need.
Welcome to the March 2022 update of my Ethnic mental health carers forum. The forum is aimed at those from a diverse ethnic background who care for someone suffering serious mental illness. The forum also covers areas under South London & Maudsley NHS trust and also Oxleas NHS foundation trust, but forum does allow ethnic carers to attend from other service areas. Just to note, I am also the chair of Carers UK Ethnic or BAME advisory group.
Speakers for my March 2022 forum where
Abigail Babatunde – Research Associate on the Advance Statements Project (AdStAC)
Karen Edmunds – Head of Equality and Human Rights presenting on Oxleas Equalities projects
Karen Edmund presents on Equalities updates at Oxleas NHS services
Karen felt that after the introductions of members of the BAME group, that Oxleas are in the same place as some other NHS trusts are in terms of carer involvement, but she admitted there is more work to do. Karen talked about how they are developing what’s called an “Involvement hub”, which is been led by Jacqueline, who’s Oxleas NHS assistant director of involvement with her team.
Karen feels there has been reasonable amount of service user involvement, where people work with experienced practitioners, but when it comes to carers and community organisations, there is a lot of work to do and they haven’t been quite maybe quite as good as some other NHS Trusts out there.
Karen spoke on the following topics on what Oxleas is working on regarding equalities.
Workforce Equality:
Workforce Race Equality Standard (WRES) -reporting and annual action plan
Workforce Disability Equality Standard (WDES) – reporting and annual action plan
Manage our multifaith chaplain + Chaplaincy contract with Lewisham and Greenwich Trust
Service User Inequalities Group (new)
Patient and Carer Race Equality Framework (new)
Staff and patients / service users / carers
Equality Delivery System 2 (EDS2) annual report
Public Sector Equality Duty
Equality and Human Rights Policy, Equality and Diversity training
Freedom of Information requests related to equality
Lastly to enable Oxleas to become an early adopter of the Patient and Carer Race Equality Framework (SLaM have been involved in the pilot phase)
Karen then spoke about building a Fairer Oxleas Delivered actions Year 1
Improving cultural competency:
Cultural intelligence and inclusive leadership training for the Executive team and 50 senior managers
Inclusive leadership workshops open to all managers
Comfortable talking about race workshops open to all managers
Living our values training for managers to deliver a values session with their team
‘In Each Other’s Shoes’ film about microaggressions, plus a guide on microaggressions
Team talks to show ‘In Each Other’s Shoes’ and discuss it
Building a Fairer Oxleas section on the Ox (our intranet)
Race Resource pack with articles, short films, and useful links to external resources
The outcome will look to improve all experiences of their Black, Asian and minority ethnic staff, which will help improve the experience of Black, Asian and minority ethnic service users and carers
Karen explained The NHS Race and Health Observatory review February 2022 found that:
Ethnic minority groups experienced clear inequalities in access to Improving Access to Psychological Therapies IAPTs; overall, ethnic minority groups were less likely to refer themselves to IAPT and less likely to be referred by their GPs, compared with White British people.
Evidence was identified for inequalities in the receipt of cognitive behavioural therapy (CBT) with ethnic minority people with psychosis less likely to be referred for CBT, and less likely to attend as many sessions as their White counterparts
The review provided strong evidence of clear, very large and persisting ethnic inequalities in compulsory admission to psychiatric wards, particularly affecting Black groups, but also Mixed Black & White groups and South Asian groups.
There was also evidence of harsher treatment for Black groups in inpatients wards, e.g., more likely to be restrained in the prone position or put into seclusion.
More bad news was on how black children were treated in the NHS
Parents reported their children facing the same barriers to accessing services as reported for adult mental health services. Two studies of young Black men showed that they were deterred from seeking help by their knowledge of injustices in mental health services relating to Black Caribbean and Black African populations. Two large national studies found that ethnic minority children were more likely to be referred to CAMHS via social services, education or criminal justice pathways. This was particularly stark for Black children who were 10 times more likely to be referred to CAMHS via social services (rather than through the GP) relative to White British children.
Karen then talked about Oxleas new Service User Inequalities Group
She then moved to its aims which was to explain that it will help deliver Oxleas’s strategy on service user access and inequalities
This will be done by looking at their data on the ethnicity, disability, gender identity, religion, and sexual orientation of patients compared to the local population which will lead to clear actions to tackle inequity of access, experience and outcomes.
Karen the talked about how Supporting Oxleas staff to deliver inclusive care on Proposed actions to tackle inequalities
This is on how all services have a generic email for patient contact to provide an alternative to phone contact Clear information in a range of formats in plain language on what each service provides, referral criteria, and how to get access Disability access guides to key sites available on public website.
Oxleas NHS will be an early adopter of the Patient and Carer Race Equality Framework Engagement with local communities and use this feedback to target service development where it’s needed most Scope care pathways where we can pilot inclusive assessments, factoring culture, ethnicity, disability, sexual orientation and gender identity Patient experience data by protected characteristics will be routinely produced, analysed and reviewed by services to identify differences of experience and then plan actions to address these.
Questions from Carer members
You shown what Oxleas are doing for CAMHS and Adult service, but what about older Adults?
Its an interesting and important presentation, but I am wondering why a white woman is presenting on equalities regarding disadvantages of black people, does Oxleas employ representing the communities it serves?
With the impact of COVID on ethnic communities, what does Oxleas have in place to reduce the impact?
I am interested in how Oxleas are going to work with the Patient Carer Race Equalities Framework, arent Oxleas service area’s mainly white?
Lastly a question from myself is I do not see hardly any ethnic patient/carer grassroot groups that Oxleas is able to engage with. How will ethnic patient and carer groups be empowered so they SEEK engagement and hold Oxleas accountable on services to ethnic communities?
Abigail presents on the Advance Statements Project (AdStAC)
Abigail spoke on how South London & Maudsley are working to promote advance statements for Black and African, Caribbean people. This is because of the high detention rates and especially with black people being more likely to be detained under the Mental Health Act.
It is important to promote why having to work with staff service users, and carers and supporters to understand how to get advanced choice documents or advanced statements can work for black people.
Welcome to a brief update of my february ethnic mental health carer forum. As usual the forum is an engagement platform for those caring for someone suffering mental illness from an ethnic background. I run the forum via zoom with the support of several mental health trusts.
Speakers at my carer forum for February were
Lisa Fannon the Public Health Training and Development Manager for Lewisham updating on Health inequalities
Ellie Wharton Senior Project Manager for Health Innovation Network
Engagement from the Police on mental health
Lisa Fannon presents on health inequalities project
Lisa wanted to update us on the health inequalities project. Since last month there was a discussion with KINARA who attended and talked about the work that they are undertaking in the community, specifically around the Birmingham and Lewisham health inequalities review that is being undertaken with the African and Caribbean communities.
That work has now been concluded and she has received a report. Lisa hopes that they will be able to launch all of that information with an event that’s taking place soon. Lisa reminded that some of us may have received the invite to that event already, but she wanted to ensure that as a community group that we were aware what is happening.
The event will be overseen and organised by Public Health Lewisham. They will also plan to have a additional event following the one just mentioned and it will specifically be for community members. This will be essentially a second in series of events around health inequalities where they are aiming to bring together community groups, and members of the health and social care and health and social care leaders talk about health inequalities. Lisa wants this to be done in partnership with the health and well-being to address health inequalities in Lewisham, and bring together everybody to discuss the situation.
There of course will be opportunities to look at some of the achievements of this work, but also to discuss further action on what needs to be done to tackle health inequalities. Lisa mentioned they will look at what kind of plans that they are hoping to undertake across this year and what future needs is happening at the event.
The event will run in the evening at a Community Centre, where she has sent in advance of this meeting, information about the event to Matthew.
Ellie Wharton presents on the Health Innovation Network
Ellie wanted to tell us about the mental health patient safety network event, which is part of their mental health safety improvement programme. Ellie apologised for the acronyms flying around on the programme, but thanked us for inviting her to join and speak at our ethnic carer group.
Ellie agreed with some members that health inequalities is such an important topic, which is why they have chosen it for their second event to focus for the safety network. Ellie talked about what the Health Innovation Network is, which is an Academic Health Science Network (AHSN) for south London, one of 15 AHSNs across England.
The AHSN exist to speed up the best in health and care. They have been commissioned by NHS England and Improvement to focus on Mental Health Safety. Which involves developing a Safety network and supporting quality improvement work in certain areas (such as restrictive practice).
Their principles are central to how the programme runs: • co-design with people with lived experience • Creating shared learning, connection and Joy • Foundations of systematic QI • Engaging with inequalities where they exist • Working with their foundations and all the good things that already exist
Ellie then pointed out a member of my ethnic carer forum and stated one of the members was involved in the event. This is when the carer member spoke on her section regarding health inequalities and carers.
Ellie then talked about the mental health safety network.
The network is an interactive designed to bring together individuals across the system with the shared goal of improving mental health safety it is co-hosted by the HIN and the 3 south London Mental Health Trusts (South London & Maudsley NHS Trust, Oxleas NHS Trust and South West London & St George NHS Trust). It’s purpose is to create value through sharing learning, creating connections and building energy and capability in safety improvement
The event welcomes people who share the MH safety network’s goals of improving mental health safety. Registration is open to people with lived experience of mental health services, including carers, clinical and managerial staff from NHS, independent and private health and social care providers, commissioning leads, local authorities, voluntary sector partners, police, emergency services and other system partners.
Ellie then talked to us about the agenda of the event.
Mental health Police engagement from South London
The forum gets engagement from the police every now and then. This is mostly because the police have an interest in mind while helping those in a crisis, they want to connect and reassure carers. The police talked about what sites they cover this being Sutton, Croydon and Bromley although its quite a small team.
Their main sort of role and objectives is being a direct liaison with the NHS and mental health trusts. There are other objectives dealing with assaults against NHS, racial assaults against NHS staff where the perpetrators is having mental health issue.
The police then talked about section 136 and how they have been dealing with a lot of escalations. The police think the section is being overused. They think there’s things that they can do as a team to prevent that. There was also some talk about what they can do to help with people out in the streets dealing directly with mental health issues.
The police try and get out and about to the hospitals as well. They have got a police liaison officer that works at the hospital and who deals with crime at other Hospitals.
In a nutshell the police work directly with mental health patients once they were coming into contact with police.
Welcome back and thanks for stopping by. Have you ever heard of PCREF? There was a blog about it in 2019 regarding mental health inequalities for black people. Mental Health outcomes for those from the Afro-Caribbean community has been very poor for a long time. So there has to be some form of change, but how can this go about? I think it starts with the community and a way for black people to come together and query how mental health services and support the community.
The blog about health inequalities from NHS England is below.
South London & Maudsley short for SLaM are one of the mental health trusts looking to work with the black community on ways to support wellbeing and close the inequalities gap.
I recently made a short video as an intro into black health inequalities, although its not going to be the only video I am working on.
They are looking for members of the Black community to attend a series of events SLaM call ‘Fit for Partnership’. These events well focus on four boroughs they run services.
Croydon’s Black Community: Tuesday 19 January, 6pm – 8pm: Register here
A Caring Mind 