Why is EMHIP needed?

There are persistent and significant ethnic inequalities in most aspects of mental healthcare in the UK. Broadly, these can be understood as differences in access, experience and outcome of mental healthcare i.e. differential access/referral to primary care and specialist mental health services, unequal care and treatment in specialist mental health settings, and disparities in outcome.

The nature and extent of this racially discriminatory pattern of mental health care has been known for over half a century and is confirmed by a substantial body of evidence, based on research, reports and reviews. There have also been several national and local inquiries on this topic yielding over sixty recommendations for change. However, nothing much has changed over the years. This is entirely consistent with the experiences of Black and Minority Ethnic (BME) communities up and down the country of the negative impact of racially discriminatory and iniquitous patterns of mental health care. The day to day experiences of people from BME communities confirm that mental health services continue to fail us. There is no parity between Black and Minority Ethnic groups and white majority population in access, experience or outcomes of mental health care.

Although problems in relation to race/ethnicity and mental health been known for a long time, there are no comprehensive plans or strategies to improve mental health care for BME groups. Previous government initiatives have been limited in their reach and impact. For example, the NHS initiative, Delivering Race Equality (DRE) in mental health was poorly funded, lacked sustained leadership, was largely concerned with organisational improvement and failed to engage local BME communities. Critically, there was no commitment to address systemic or institutional racism in mental health care. It came as no surprise when the whole programme collapsed a few years later, without making a dent on the ethnically unequal patterns of mental health care. While concerns about clinical safety and appropriateness of mental healthcare for BME communities have remained, this is no longer considered a priority within the NHS.

The UK is a rich country with a modern, well-resourced mental health care system as part of a publicly funded health service, free at the point of use. There is also specific legislation to reduce and eliminate race inequalities in the UK. The National Health Service, like other public bodies, is legally obliged to provide fair and equal services. Improving the quality of clinical care and patient safety are priorities for the NHS, making it more urgent to improve the mental health care of people from BME communities. However, ethnic inequalities remain entrenched in most aspects of mental health care in the UK. There is no aspect of mental health care in the UK in which BME people do as well as the white majority population. Generally, they fare much worse.

There are several reasons for the continuing failure to address ethnic inequalities in UK mental health care. First, academic and professional work in this area is more concerned with the likely reasons for the ethnically differentiated nature of psychiatric care, rather than the shortcomings in current services and nature of clinical practice that perpetuates this.  Second, there is a reluctance within mental health services, aggravated by a sense of helplessness and pessimism, for changing historically entrenched forms of care and treatment. No doubt, the complexity of the mental health care system and discrepant patterns of patient care experience make this a difficult task.  Third, despite various policy initiatives over the years, there is still no national plan or strategy to reduce and eliminate race inequalities in treatment and outcomes.  Fourth, political and professional leadership to challenge and correct the systemic nature of this problem is absent in both government and the NHS.  Finally, problems in this area tend to get framed through the prism of equity and social justice without connecting them to system failures in providing effective and safe mental health care. This may have hampered corrective, practical and clinically grounded interventions and changes.  

We do not need more inquiries or reviews. The problems are well understood and, despite the complexity of underlying issues, there is sufficient knowledge and experience to help us move forward. We can, for example, build on the experience and views of service users and black communities about what needs to change within mental health care. There are also practical examples of good practice from outside the system as well as small-scale interventions in the NHS we can draw on. Most critically, BME communities and agencies remain engaged with this issue and are willing to work with statutory providers to bring about change.

It is this agenda that is driving the Ethnicity and Mental Health Improvement Project (EMHIP).  Based on the actual experience of people living in South West London, we can change things for the better and further build on local collaborations and community networks.  We now have the opportunity to bring about positive changes and a fundamental reconfiguration of the mental health system, both inside and outside, by strengthening these links and ensuring that our statutory partners, along with community agencies, step up to the mark.

The Covid pandemic and Black Lives Matter movement have brought a renewed focus on racism in health and health care. More than any other time, mental health services and professionals must “commit themselves to be anti-racist towards care that facilitates social justice, rather than endorsing a racist and dehumanised system”. This task has never been more urgent. We now have a national pledge by senior leaders of NHS mental health trusts that they will start this process. The EMHIP interventions provide the template for the necessary actions and changes this will entail. No more excuses, no more delay – it is time to act.