New tools to tackle inequalities in mental health care by involving patients in service design

Press release
09 May 2019

Local health system leaders can now access tools to support advancements in mental health care for groups experiencing inequalities. The NHS funded tools have been developed by the National Collaborating Centre for Mental Health (NCCMH), in partnership with patients, carers and mental health commissioners and mental health service providers, to support health system leaders achieve and duplicate best practice.

‘Advancing Mental Health Equalities’ (AMHE) sets out how commissioners and providers can identify local need, design and deliver better mental health service, and evaluate success at a local level. 

 ‘Working Well Together – Evidence and tools to enable co-production in mental health commissioning’ - documents case-studies of different ways patients and carers can be involved in commissioning decisions. 

Commissioners should identify local need by building relationships with community groups to better understand the mental health needs of groups experiencing health inequalities. These include people living with disabilities, people experiencing homelessness, and (LGBTQ+) communities.

People with experience of mental health care should be consulted in the design of services to help determine which issues need immediate action and to identify the best solutions.

The delivery of services will be shaped by each local community but could include improving accessibility to services and ensuring staff are adequately trained to provide appropriate alternatives.

Steps2Change, delivered by Lincolnshire Partnership NHS Trust, offers talking therapies for residents experiencing anxiety, depression or stress. By monitoring access to services and communicating with different groups they now offer on-site appointments for migrant workers at local factories.  

Drawing on recent data, the AMHE guidance shows:

  • Black people are disproportionately more likely to be detained under the Mental Health Act than white people.
  • Nearly half of transgender people under the age of 26 report they have attempted suicide
  • Between 20% and 40% of people with learning disabilities also have a mental health problem
  • eople in lower income groups are more likely to have unmet mental health treatment requests compared with higher income households
  • 50% of people sleeping rough in London in 2017/18 had a mental health support need
  • A service that has been commissioned based on the principles of co-production is more likely to be cost-effective, responsive and have high satisfaction and health outcome rates from people using it.

Commenting on the guidance Consultant Psychiatrist Dr Lade Smith, who is a co-author of the AMHE report, said :

“Many people from marginalised communities often miss out on the mental health care they need.

“The AMHE resource gives commissioners the guidance they need to deliver equality of access, experience and outcome for all who need mental health care, regardless of who they are.”

Claire Murdoch, NHS England’s national director for mental health, said: “Improving the provision and access to mental health services and giving patients greater choice and control over their care is a central theme of the NHS Long Term Plan.

“This toolkit offers local areas practical tips and support to ensure the services they create work for everyone affected by mental illness, irrespective of background and where health inequalities do exist, what health system leaders can do to overcome them working closely with communities.”

Isaac, 37, has lived with bi-polar disorder for 21 years, said:

“As a member of the BME and LGBTQ+ communities I have often found it difficult to get the right support for my mental illness. 

“I have struggled with bipolar disorder for most of my life and have been in and out of crisis care.

 “But my life has dramatically improved since writing my care plan with help from mental health staff.

“Services now respond to my needs and I get treatment in the community, close to my friends and family.”

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