Malik Gul, Director, Wandsworth Community Empowerment Network, and Consultant Psychiatrist Professor Sashi Sashidharan lay bare the story behind the longstanding inaction to tackle ethnic inequalities in mental health systems and explain why their Ethnicity and Mental Health Improvement Project, which puts co-production with the community at its centre, is primed to make a difference in south west London.

Synergi Collaborative Centre Stroke

Navigating the fault lines for co-produced change in south west London

We often hear that the issues related to reducing Black and minority ethnic (BME) mental health inequalities are complex and intractable. While the circumstances that give rise to poor mental health in BME communities are indeed complex, including racism, poverty and marginalisation, tackling the discrimination our communities face in access, experience and outcomes of mental health care is a straightforward issue. After all, several reviews and reports on BME mental health over the last 40 years have identified mechanisms and processes to improve mental health care for BME communities.

However, over the years nothing much has changed. The main reason for this has been the lack of commitment and leadership across our public agencies to get on with the task at hand. This is where the complexity lies – the unconscious and systemic bias, the lack of diversity in decision making processes and the inability of health systems to work in genuine partnership with BME community agencies outside of their institutional boundaries.

It took us a while to figure this out. We, along with many others, had become frustrated by the lack of progress and change, but soon recognised that those who are responsible for creating and perpetuating this problem are not going to be the ones who will fix it.

Communities need to demand accountability for the spend of their public funds, and for the services that they are entitled to receive. Without an active and involved civic society, decision making will remain the preserve of a limited and elite group of people who will always default to the consensus of their peers. This has certainly been the case with BME mental health, framing it as a complex and intractable challenge, constantly deferring action, thus normalising inequalities. The statistics no longer shock. The harms and injuries impacted on BME people are no longer seen or heard.

It was to our communities that we returned to address this problem; to the leadership, and assets to help us: the churches, mosques, temples, voluntary groups, youth centres, sports clubs, neighbourhood associations and social networks, rich and abundant with skills, knowledge and lived experiences.

It is within these informal spaces and places that habits and behaviours that shape and inform health and wellbeing are embedded and sustained. By the time people come into ‘formal’ services, such as GPs, hospitals, social services, A&E and the police service, matters are already likely to have deteriorated.

The key to reducing inequalities, prevention, early intervention and active social inclusion are more likely to be achieved through places where people are already at, surrounded by people who they know, and where they feel safe and secure. Joining the dots across a thriving and diverse network of community leaders and facilitating them by working together to develop a platform to drive change and improvement through multiple systems became our mission. Mobilising, supporting and enabling these assets are the building blocks of the Ethnicity and Mental Health Improvement Project (EMHIP).

We have centred much of this work around the Wandsworth Community Empowerment Network (WCEN) Annual Mental Health Conference, co-produced with the New Testament Assembly Tooting, which has acted as a ‘holding space’ for the building of relationships and connections, and the emergence of new ideas and ways of working.

At the 10th year conference in 2018, David Bradley, the CEO South London and Maudsley NHS Foundation Trust (SLaM), accepted that he could no longer defend the institutional processes that were proving to be a barrier to delivering the changes that were required. Further delay and prevarication were ethically and politically unsustainable, and he made a commitment to lead and enable a programme of change, in collaboration with local communities with shared decision making and co-production at the heart of it.

A South West London BME Mental Health Expert Panel was established to lead this change programme. The panel consists of leaders from the local NHS, including the mental health trust, national experts, service users, carers and community leaders and BME-led mental health voluntary groups. The task set was clear: operationalise and implement the existing evidence base on tackling ethnic inequalities in mental health care. This Expert Panel commissioned the EMHIP Intervention Plan, co-produced with all stakeholders, and finalised in March 2020.

As WCEN approaches its 12th conference, we are poised to implement the EMHIP Intervention Plan.  We are at the beginning of the tasks at hand, which is to ensure that year on year, there will be a marked reduction in ethnic inequalities in mental health services in south west London.

As we move from plan to full implementation, the challenges remain significant. Pathways into services will be redesigned, so that people are able to receive services in ways that work for them. Local relationships and expertise will be unlocked and enabled to co-produce care and support. New models of service provision, appropriate to the needs of diverse communities, will be developed. Institutional cultures will be transformed so that being black is no longer associated with coercion and  inappropriate mental health care.

We anticipate resistance to our programme of change.  However, we are confident that we will be able to navigate fault lines and negotiate these challenges by creating new co-produced spaces while relying on a much broader range of expertise than previously available, to deliver better mental health care experiences and outcomes for BME communities.

For too long we have been existing in our own localities, often isolated, seeking to address a challenge that we have in common. Change is coming. There is no longer any excuse for continued delay and prevarication. Communities must be supported, engaged with and invested in. Leaders must lead.

The Synergi Statement of Intent calls for us to work together and collectively in addressing long entrenched inequalities and the systemic racism that is embed in our mental health services. We know what needs to be done and how to do this. Let’s get to work. Black Lives Matter – everywhere.