A new report finds that mental health services for
people from ethnic minorities are not meeting targets set out in
the National Service Framework. Derren Hayes
Mental health services have had their share of political
attention over the past five years. The government has published no
less than six policy papers since 1998 on how health and social
services should be working with adults with mental health
The most significant was the National Service Framework for
Mental Health in 1999, which set out how high-quality mental health
services should be developed and delivered. One of its key themes
was for services to be non-discriminatory and to focus on the needs
of ethnic minorities.
Despite this, a recent report by the Social Services
Inspectorate, based on a study of 19 councils between June 2000 and
September 2001, shows that mental health services across many areas
of the country are still poor.
The report finds that although some of the targets set out in
the NSF are being achieved, services are poorly co-ordinated and
not well publicised, managed or delivered. Also they are not
focused enough on rehabilitation and joint working across health
and social services is not happening.
One of its most significant findings is that mental health
services for ethnic minorities are not improving quickly enough. It
says mental health services do not understand the needs of
different communities, do not engage them enough in service
co-ordination and provision, and that there is an over-reliance on
voluntary and independent service providers.
The importance of this issue is made even clearer in the light
of the large number of people from ethnic minorities, particularly
African-Caribbean men, who are diagnosed with mental health
problems. In England, several studies have shown that
African-Caribbean people are between five and 10 times more likely
to be diagnosed with schizophrenia than the national average.
The report says that in some councils corporate targets on race
are reflected in social services plans but are rarely seen in
mental health services plans.
Claire Felix, services development manager for Rethink, formerly
the National Schizophrenia Fellowship, says it is taking time for
the two sectors to formalise joined-up strategic thinking.
She believes that a national mental health strategy, along with
national targets and penalties for not meeting them, would help to
formalise what services need to achieve.
Compulsory training in race-equality issues from the top down
would also enable the statutory sector to gain the knowledge and
skills needed to make services more responsive, she adds.
More support networks, developing a diverse workforce, and
better monitoring of services, treatment pathways and the needs of
clients would also help.
“Change needs to happen so that councils’ cultural competences
are developed,” Felix says. “The voluntary sector and local
authorities should come together, and service users need to be
encouraged to be involved in the shaping of services.”
Errol Francis, programme director of the Frantz Fanon Centre,
part of Birmingham Mental Health Trust, believes the problem lies
with service guidelines being too vague.
“Managers of services need a clear message of what it is they
must change and what defines a good service,” he explains. “We need
to have more detail of what goes wrong when services are below
The report says that mental health strategies lack understanding
of the demographic population they serve, the way different
cultures regard mental illness and how services should respond to
Francis believes this doesn’t go far enough. He says that
monitoring of diagnoses, treatments and outcomes of users of mental
health services, aligned with national benchmarks based on
percentages of population, need to be introduced.
This lack of understanding, combined with a health system that
he believes is institutionally racist, is the major cause of the
difficulties ethnic minorities face with mental health
This isn’t down to cultural differences,” Francis argues.
“There’s some type of stereotyping that has crept into the
The report finds that specialist services have been developed in
most local authorities, but that the majority of these are being
done by small, independent and voluntary organisations.
Ratna Dutt, director of the race equality body REU, says these
services – many of which are developed by local communities and
ethnic minority front-line staff – are more attractive to users
than services provided by the statutory sector.
“t’s a service that many feel more comfortable with because they
see people who come from their own background, who they can share
experiences with and who understand them better,” she says.
Dutt adds that, in areas with large ethnic minorities, local
authorities should be looking to work with the independent sector
to bring those services into the mainstream.
A survey of ethnic minority users of mental health services by
the Mental Health Foundation that is not yet published also finds
that the voluntary sector scores highly with this group.
The findings of the study will be revealed in a MHF report due
out later this year, which will also make recommendations on how
statutory bodies can learn from the voluntary sector to make
services more responsive
However, the SSI report says the success of the independent
sector has created a “reliance” on these organisations, many of
which lack resources and support, and that there is a tendency to
refer patients to them based on ethnicity rather than need.
While much can be learned from the experience of the independent
sector, Kiran Juttla, Diverse Minds development manager at mental
health charity Mind, says ethnic sensitivity alone will not change
“Outreach teams must ensure they have the right staff balance in
terms of ethnicity, skills, experience and knowledge, and that they
recruit staff with a track record of positive work with ethnic
minority mental health service users,” she says.
This is another criticism the report makes, which is because of
the absence of workforce profiling across the whole health and
social services. In addition, anti-discriminatory and equal
opportunities training, while being offered by many local
authorities, is still not mandatory and is taken up by less than a
third of staff.
Dutt says all this information points to a need to break down
what a “culturally competent” workforce actually means. “Just
because I have information about somebody’s culture doesn’t make me
culturally competent,” she warns. “It’s about how you use that
information to inform your practice.”
‘Modernising Mental Health Services: An Inspection of Mental
Health Services’ from
Case Study – ENFIELD
In Enfield, voluntary organisation the Ebony People’s
Association supports African-Caribbean service users, carers and
families, and promotes a better understanding of mental health
issues in the community. The project is part funded from Enfield
social services mental health grant allocation and by Enfield
Primary Care Trust. Steve Tall, the borough’s joint commissioning
manager for mental health, explains: “The organisation is
represented on our major planning and development forum and on our
Mental Health NSF team. We involve them in key discussions as we
work towards social inclusion, but we still have some way to
In 2000, the council organised a training event for social and
health workers in Enfield. “It raised awareness, educated and
provided information about ethnic minority groups and their mental
health needs. It can be very challenging for social workers to work
in that environment, and they were able to discuss and learn from
Case Study – LEEDS
Leeds Community and Mental Health Trust is highlighted as
achieving best practice in community profiling. Julie Sutton, carer
development worker for ethnic minority communities, says of its
community involvement work: “Our aim is to develop a culturally
sensitive service for carers of people with mental health problems.
I spent three months in consultation with carers about what their
needs and those of the community were. I found that a lot of carers
weren’t accessing services and weren’t meeting other carers in a
“The consultations were a way of giving them a voice and will
enable us to provide culturally sensitive care packages for carers
and those they care for. They felt that because of the system and
racism they had lost their voice and this was a way of making them
Sutton has set up the black and ethnic minority advisory group
to support her in her work. The group consists of carers, statutory
organisations and voluntary organisations, and ensures that
projects are appropriate and people with all type of experiences
and skills are involved in their development.