Sheffield is pioneering the enhanced pathways approach to mental health services that links the mainstream to key parts of ethnic minority communities. Natalie Valios reports
Black and ethnic minorities account for 21% of referrals to the five main acute care units in Sheffield hospitals, but only make up 11% of the city’s population (2001 census).
The figures reflect the picture nationally, where inequalities in the way people from some ethnic minorities experience mental health services is well-known. To combat this, the government published a five-year action plan in 2005 – Delivering Race Equality (DRE) in Mental Health Care.
The Enhanced Pathways In Care (Epic) project in Sheffield is one of 80 community engagement projects involved in the DRE programme. It works with Sheffield’s Pakistani community – the largest ethnic minority in the city.
Rashna Hackett spearheaded the project when she moved to Sheffield to join a new team – the Sheffield Crisis Assessment and Home Treatment Team set up to serve the whole city – as consultant nurse for acute care at Sheffield Care Trust in 2005. Hackett, currently on secondment to the Care Services Improvement Partnership as race equality lead for Yorkshire and Humber, realised there was a lack of ethnic minority mental health services and where they did exist, they were not linked to mainstream services.
“When the team was established it was important to try to focus on areas of inequality so we had to be clever as to how we were going to improve outcomes for ethnic minority people,” she says.
“We wanted people to be able to access statutory care via trusted community organisations so that they felt secure.”
So Hackett drove around Sheffield to familiarise herself with the area and stumbled across the Pakistani Muslim Centre. Going in to introduce herself, she found the huge centre catered for weddings as well as hosting various social activities such as lunch clubs, crèche, and English classes. As the hub of the Pakistani community, Hackett knew she had found the perfect place.
Some at the centre doubted it could provide a mental health service so Hackett met its board and presented evidence. She also started making contact with imams (Muslim religious leaders), who said they would support the move and talk about it in their mosques.
“I was invited to the centre’s agm and given a 10-minute slot to talk about what I wanted to do in Sheffield and that was the start of Epic – it had a name and support from the community.”
Epic works in partnerships with imams and the centre, and the chief executive of Sheffield Care Trust meets community leaders regularly. The centre now has a gym and offers exercise and cooking classes for patients and their carers. The centre has played a key role in supporting patients undergoing home treatment and in raising awareness of mental health issues in a non-threatening way.
“The whole community feels comfortable with the set-up,” says Hackett. “We don’t have parents of young women worrying about them being at the centre.”
Epic’s objective is to reduce the length of hospital admission times, as well as promoting home treatment. Of the latter, Hackett says: “Usually there are day services or cafés to which we could take a patient, but that would be inappropriate for, say, Mr Khan because going out for a coffee with a single woman is not what he would do. But I could take Mr Khan to the centre where even using the gym would be more acceptable because there would be other Pakistani men there, the food would be appropriate and he would get the support of staff there.
“The centre provides a more social aspect to recovery, it’s much more holistic and culturally acceptable.”
Imams have formed a vital link between the Pakistani community and the statutory sector, especially with the delivery of home treatment.
“Before, when a patient became ill, they might have believed that black magic was responsible and so would have been reluctant to go and see a clinician. But now, the imams are providing prayer with advice on where to go for help.”
Hackett gives an example: “A couple of weeks ago I was shopping and bumped into a woman we’d looked after. She was hallucinating and hearing voices. She didn’t think we would get her better because she believed it was black magic. It was only when I involved the imam that I started to see a recovery. He convinced her through prayers that if there was any black magic he would help in getting rid of it but he couldn’t do it on his own and he thought the doctors and nurses were trying to help her.”
She has also found that patients who don’t want to engage with the service are more willing to talk to her if she takes an imam with her. “It started to reduce the risk of taking patients in under section and improving their experiences – that’s the enhanced bit.”
The results are good: in-patient length of stay has fallen for 12.5% of Pakistani patients as community treatment options have been extended. There is more satisfaction with services, while numbers being referred for treatment have increased as awareness of mental health conditions has grown in the community. And those suffering a relapse after leaving hospital are coming forward for treatment sooner.
Funding from the DRE has led to training last year for 60 nurses working at the Longley Centre, an acute psychiatric unit in Sheffield. “The training looked at how nurses might respond to issues relating to race in the contexts of assessments, care plans and treatment. We challenged their assumptions and asked them to think creatively about how to care for patients.”
The training is now being extended to the whole of the acute directorate in the city.
So successful has the project been in the Pakistani community that is has now been mainstreamed and Hackett is looking to Epic 2. She was approached by members of the African-Caribbean community, which wanted a similar project. At the same time the Health Foundation was advertising its leadership awards so Hackett approached an African-Caribbean voluntary organisation and suggested putting in a joint application. They were successful and now eight of them are being trained in leadership skills.
“So I’m developing a similar pathway for the African-Caribbean community. But I’m restless. I want to start Epic 3 and I’ve been talking to the Somali community. That’s my next one.”
Read the DRE document
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