Although inequity in service provision for people from Black and minority ethnic communities has received recent attention since the statutory requirements of the new Equality Act (2010), issues with data monitoring and paucity of published research into experiences of crisis and service access for people from Black and Minority Ethnic communities make drawing evidence based conclusions challenging42.
However a number of reports provide some guidance in this area:
- Key areas for action across mental health services that have been identified in a National Institute for Mental Health in England report43 and reinforced within the Department of Health strategy ‘Delivering race equality in mental health strategy’ include44
- reducing and eliminating the current ethnic inequalities in mental health service experience and outcome;
- developing the capabilities of the mental health workforce in providing appropriate and effective mental health services for a multicultural population;
- investing in community development approaches aimed at achieving greater community participation and ownership of the mental health improvement agenda.
- Specific actions for crisis service development recommended include:
- Crisis services and residential alternatives to hospital admission should be culturally competent and accessible to people from Black and minority ethnic communities.
- Patients under enhanced Care Programme Approach have crisis plans in place that specifically address how to minimise the risk of coercive interventions.
- Ethnic monitoring has been mandatory in public services since 1995 and provides an opportunity to identify patterns of service use to support improvements including across acute pathways and application of the Mental Health Act45 46
- Community engagement approaches are important in reaching into Black and minority ethnic communities and there is an acknowledged need to link these with strategic needs assessment processes47
- Specific Initiatives such as the integration of a Pakistani link worker into everyday clinical practice appear to improve pathways of care between community and mental health services48.
- Specific therapies that have been identified as useful in crisis intervention such as CBT are gaining interest in relation to the applicability and acceptability amongst diverse ethnic groups49.
- In relation to rurality, application of CRHT within a mix of rural and urban communities found differences in levels of medical input, access to inpatient beds and hours spent travelling versus direct service user contact within more rural communities50.
- Specific therapies that have been identified as useful in crisis intervention such as CBT are gaining interest in relation to the applicability and acceptability amongst diverse ethnic groups51.
- A relationship between outcome of CRHT interventions and inequalities has been identified, with people who have an enhanced level of mental health need, are older or who live in the most deprived areas experiencing poorer outcomes52.
- Application of CRHT within a mix of rural and urban communities found differences in levels of medical input, access to inpatient beds and hours spent travelling versus direct service user contact within more rural communities53.
- Equality impact assessments for services are required to address inequity in services across all equality target groups. These are of particular importance in ensuring access to less coercive services for people from Black and minority ethnic communities in crisis54.
- Equality impact assessment templates have been developed to identify and address health inequity in services55.
- An equity lens can be applied to clinical guidance to identify whether they effectively address inequity in service provision56.