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
• Supporting our five staff networks (BAMEx, Disability, LGBTQ+, Mental Health, Women)
• Building a Fairer Oxleas (BAFO)
• Policy development
• Enquiries related to workforce equality

Service User/Patient and Carer Equality

• Accessible Information Standard (AIS)
• Policy development
• Patient complaints related to equality issues
• Manage the Interpreting contract
• 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.