What Are Adult Mental Health Services Doing to Improve the Outcomes for Black Service Users? a Mixed Method Analysis of Black Psychologists’ Perspectives and UK Mental Health Trust Data

Abstract

Background: Within mental health services, Black people tend to have poorer experiences of mental health services, in terms of access, treatment and outcomes. Institutional racism has been cited as one of the main causes for the differences. Over the years, several national race equality policies, initiatives and pieces of legislation have been introduced across the public sector to try and address these issues. However, since the introduction of the Equality Act (2010), it seems that race equality has effectively been taken off the national agenda, with mental health services having to develop or draw on their own resources to adequately tackle this issue. Aims: Little is known about what Mental Health Trusts (MHTs) are doing to tackle these issues. Even less is known about any specific attempts to improve the outcomes of those who are most marginalised within and by mental health services, that is, Black people. Therefore, the current study was developed to find out what mental health services are currently doing to improve outcomes for Black service users, and to contextualise the current race equality landscape within MHTs. It was also hoped that this study would capture good practice, as well as areas where MHTs could improve. Methods: Freedom of Information Requests (FOIRs) were sent to all the MHTs in England to find out directly, what they are currently doing to address this problem. Findings were analysed using descriptive statistics. Interviews with 10 Black Clinical Psychologists, analysed using Thematic Analysis, were also carried out to capture their perspectives on this matter, and contextualise the findings from the FOIRs. Results: Responses to FOIRs indicated that of the 56 MHTs contacted, only two had developed a race equality strategy that attempted to address the needs of Black service users specifically. The majority of the remaining MHTs relied upon initiatives that had a broader focus, such as the Equality and Diversity System 2 (EDS2) and the Workforce Race Equality Scheme (WRES), to address disparities in outcomes for Black service users. The thematic analysis of the interviews supported these findings. Themes were reflective of the professional and ethical dilemmas participants experienced when attempting to address disparities in outcomes in the absence of a national policy, initiative or programme. Factors that maintained racial disparities in outcomes and the burden of race were explored. Participants also provided valuable recommendations about how, in the current context, disparities in outcomes could be better addressed within MHTs. Discussion: The impact of institutional racism, workforce race inequality, unstandardised processes for monitoring and capturing outcome and ethnicity data across the NHS and methods and systems, and the absence of a national race equality strategy on the current findings are discussed. The limitations of the study are also explored, along with recommendations about future research, including regular race disparity audits by the government.