The resource (NCCMH, 2019; available below) was developed to help tackle mental health inequalities in England.
It was commissioned by NHS England to support the delivery of the Five Year Forward View for Mental Health and the NHS Long Term Plan. The documents can be used by commissioners and providers to develop their own plans for tackling mental health inequalities in their local areas.
How to use this webpage
- View the four practical steps to improve equality
- Download the full resource, which contains:
- key principles
- facts and figures, and the case for change
- the detailed four-step process, with descriptions of techniques and approaches
- the commissioning cycle and key recommendations for advancing equality at each stage
- Download the appendices and helpful resources.
Four practical steps
The resource contains four practical steps to improve mental health equality in your local area:
1A: Use existing data and resources
Use existing data and resources to answer questions about the local population, mental health service use, available services in the community and to understand experiences and outcomes:
- population and statistics
- community assets 'mapping; or local directories
- data on service usage
- experience measures
- outcome measures
Break down the data by demographics, protected characteristics and other characteristics.
1B: Work with communities
Work with communities to gain a more in-depth understanding of inequalities from those affected: the community, people with lived experience, carers and the workforce:
- run focus groups
- distribute surveys
- enable input from community groups
- enable input from other services that work with people who are at risk of experiencing mental health inequalities
- make involvement accessible, easy and fair
Challenges in identifying inequality issues
- Demographic data is not always captured and where it is captured, it can be inaccurate or unclear
- Data from difference sources is not always amalgamated, which can make it hard to use
- Distrust in services can mean people are not willing to share experiences or raise issues
- Cultural and language barriers
- Service information is not always accessible to all
- Data can hide certain populations such as refugees, asylum seekers and people who are homeless, perpetuating patterns of isolation
- Data may not always be accurate
- Co-occurring conditions such as substance use problems may obscure mental health needs.
Research to better understand what could be done to solve the issues identified in the previous steps.
What could be done to solve these issues?
- Ask the community
- See Methods of working with communities to understand inequalities in step 1B
- Identify positive practice
- What action was taken? How was this set up and delivered? What positive impact did it have?
- Services, areas or localities that have taken positive action to tackle inequalities should be used as examplars
- Refer to the existing evidence base
- Assess the effectiveness of interventions and methods for addressing mental health inequalities in the local area
What is already being done locally?
Understand the existing initiatives of local authorities or other areas of health and social care to avoid unnecessary duplication and to enhance joined-up working.
2B: Formulate plans
Formulate plans for taking action. Use reliable methods and involve people with lived experience in the process. Some examples of how this could be done are:
- Nominal group technique
- Quality improvement approaches (theory of change, driver mapping)
2C: Set out key priorities
Set out key priorities : start small if needed. Ask people with lived experience for their views and opinions to identify:
- the immediate priorities in your local area
- what small changes can be made
- the short-term, medium-term and long-term solutions
3A: Create a strategy
Create a strategy guided by SMART goals. Be sure to consider:
- staff and facilities required
- timeframes and scheduling
- ensure equality impact assessments (EIAs) are completed.
3B: Implement the strategy
Implement the strategy for change. The interventions chosen will depend on the needs of the local population and the steps already taken to indeitfy inequalities and generate ideas for change.
Some key facilitators to interventions include:
- Maximise accessibility and affordability by locating services where people live
- Provide choice in care, offering a diversity of treatment options such as outreach, home-based care, street clinics and help over the phone
- Ensure staff are adequately trained to provide culturally appropriate alternatives to mainstream care
- Offer services or activities online, offering flexibility in time and place, low effort and (sometimes) anonymity
- Take a collaborative agency approach, integrating different services to support specific communities
Governance and accountability
Build additional governance structures into plans to ensure all actions taken are justifiable and effective.
4A: Collect data and measures
Continuously collect the qualitative and quantitative data needed to meaningfully assess, review and evaluate the service.
Data should measure the impact of the service or initiative on inequalities. Important tools and resources include:
- patient-reported experience measures (PREMs)
- patient-reported outcome measures (PROMs)
- self-assessment tools (such as those developed by the College Centre for Quality Improvement (CCQI)
- data on access (broken down by demographics)
- NHS England STP Progress dashboard
- benchmarking performance to measure the impact of change
4B: Provide opportunities to feedback
Provide appropriate opportunities for feedback from people who use services, families and carers, community members and the workplace. Collate qualitative and quantitative data to paint a richer picture.
Ensure that opportunities for feedback are equal, accessible and fair, See Step 1B for Methods of working with communities to understand inequalities.
Collect staff views, feedback and opinions through
- accessible platforms for staff to provide feedback; these can be in-person sessions or online forums
- staff-identified training needs collected as part of the appraisal process (this can be anonymised as appropriate)
- staff satisfaction surveys.
4C: Review data and feedback
Involve people with lived experience in this process.
Evaluation and review should be used to influence further commissioning and service provision decisions. It should help commissioners and providers understand what is or isn't working, identify gaps or needs and plan to tackle these in the future.
About the AMHE resource
This resource outlines comprehensive and practical steps for commissioners and service providers to reduce inequalities in an achievable and measurable way.
It provides detailed guidance and methods on how to identify and reduce inequalities related to mental health support, care and treatment.
It will also support commissioners and service providers to evaluate and review their services, to measure the impact of changes and to identify areas for improvement.
The resource was co-produced with stakeholders including experts by experience, arms-length bodies, commissioners, providers and third sector organisations. Its development included a systematic mapping review, focus groups etc. from other work that is happening in this area.
The Appendices and Helpful Resources contain supporting documents including the case for change, positive practice examples and details of work taking place in other organisations that has been driving improvements in mental health equality.
If you have any questions or comments about the documents, please contact firstname.lastname@example.org.