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Reflection on challenges in commissioning to address racial disparities at a local level

This reflection highlights the challenges faced by black and minority ethnic communities in accessing and receiving appropriate mental health services in Brent. It emphasizes the need for a more inclusive and culturally appropriate approach, as well as the importance of involving community organizations and individuals in the commissioning process. Opportunities for improvement are also identified, including the involvement of diverse communities in co-production and the utilization of qualitative data in service evaluation.

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Reflection on challenges in commissioning to address racial disparities at a local level

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  1. Reflection on challenges in commissioning to address racial disparities at a local level Brent Mental Health User Group

  2. Addressing experiences of black and minority ethnic communities using services to deal with mental health issues • High percentage of African Caribbean men subject to the Mental Health Act - and in secure settings • Continuing stigma and discrimination resulting in lack of trust in services so less likely to access services at an early stage • More likely to be given particular diagnoses which have a long-term effect on their lives, including social exclusion • Focus on medication as the solution to mental health issues so lack of use of recovery approach • Experiences linked to social determinants of health not addressed

  3. Addressing experiences of black and minority ethnic communities using services to deal with mental health issues • Continued use of the medical model which often does not resonate with individuals • Lack of access to more creative approaches such as self-directed support to meet social care needs • Therapeutic approaches which are not culturally appropriate • Use of systems that exclude those whose first language is not english and lack of interpreting • Effects of lack of attention to other aspects of individuals’ identities eg gender, sexuality, physical and or learning disability, age...

  4. Challenges • Lack of use of wealth of data gathered locally eg about populations in Joint Strategic Needs Analysis • Lack of use of wealth of knowledge about the experiences of local black and minority ethnic communities held by community organisations – and user and carer groups • Lack of funding available to user, carer and community groups to engage with individuals and local communities • Focus of commissioners on service provision in the voluntary sector and not acknowledging our role in representing our communities

  5. Challenges • Lack of engagement with community organisations by statutory specialist mental health services in relation to service provision • Individuals not consistently involved in co-production of design, redesign and evaluation of services • Key performance indicators negotiated in contracts focusing on quantitative data • Effects of monitoring being carried out by contracts rather than commissioning • Lack of strategic involvement of individuals using services locally

  6. Challenges • Lack of organisational memory and consistent approach to engagement and good practice evidenced by ‘grey’ research produced by user and community groups • Lack of learning from and acting on individuals’ experience and what has been experienced as positive and helpful • Over-reliance of statutory specialist mental health services and commissioners on information purely from Friends and Family Test and national surveys to indicate satisfaction as don’t incorporate ideas for improvement

  7. Opportunities • Involve individuals from diverse communities – and user, carer and community organisations in co-production in relation to the NHS Long-Term Plan to create appropriate models of care that directly address negative experiences of services – ensuring time and resources • Ensure that user, carer and community groups are funded and their different roles are acknowledged and acted on • Ensure that information and recommendations from ‘grey’ research is valued, incorporated in thinking about models of service provision – and acted on

  8. Opportunities • Learn from approaches that have been successful and embed rather than replace them – giving them a profile and sharing knowledge across CCGs • Ensure that key performance indicators incorporate qualitative evaluation and information • Ensure that statutory service providers are incorporating meaningful qualitative information and utilise existing structures eg creating dashboards to measure attention to provision that is culturally appropriate and directly addresses racial disparity and other equalities

  9. Opportunities • Create structures that facilitate strategic involvement of individuals from diverse communities and organisations that represent their experiences • Ensure organisational memory as opposed to successful approaches being dependent on particular staff members – continue to find ways of incorporating what has been successful

  10. Produced by Fiona Hill Brent Mental Health User Group fionahill1@icloud.com 07986 376522

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