Agenda item

4.1  The Chair stated that this issue had arisen from Members suggestions (e.g. "Language and cultural barriers in mental health commissioning and provision”) but also from the Annual Scrutiny Survey.  The purpose of the item was to get an overview of the work strands of ELFT, our key mental health provider, relating to tackling inequalities in the provision of local mental health services.

4.2  He welcomed:

Lorraine Sunduza (LS), Chief Nurse and Deputy CEO, ELFT

Dean Henderson (DH), Borough Director for City and Hackney, ELFT

Malcolm Alexander (MA), Hackney Keep Our NHS Public

He added that the Commission had received questions from KONP and MA had shared Healthwatch’s joint report with the Patients Forum of London Ambulance Service, from Nov, entitled ‘Mental Health Emergency - Crisis in our A&E departments.

4.3  Members gave consideration to the report “Tackling inequalities in local mental health service’ an updated version of which was tabled.

4.4  LS and DH took members through the report in detail.  It covered

Equalities is integral to our service goals

Improving the experience of community mental health services for global majority residents

‘Let’s Talk’ report - key themes and ELFT’s response

A glimpse into the future

Mental Health Units (Use of Force) Act 2018

Core strategies for reducing restrictive practices

Use of force data for City & Hackney

Use of force impact data

Patient and Carers Race Equality Framework

PCREF - leadership and governance

PCREF - organisational competency

PCREF - patient and carers feedback mechanism

Next steps

4.5  Members asked detailed questions and the following was noted:

a) Chair asked about early intervention service users being more representative of the community than users of acute services and about trends in the ‘use of force’ data set and strategies for reducing restraining practices. LS described the challenges here in detail and explained how the mental health use of force Act operated.

b) The Chair asked about seclusions/restraining and where the disproportionality is evidenced. LS explained that unfortunately you are more likely to experience this if you are Black African or Black Caribbean but she explained how the Patient and Carers Race Equality Framework pilot was operating at each level to tackle this ongoing challenge.

d) Members asked about the training currently within the system and about how cultural diversity is being promoted within the workforce. DH gave examples of cultural awareness training in action among the teams and LS described Race and Privilege sessions and the role of the ‘freedom to speak up’ guardian, as examples. LS detailed the staff wellbeing actions and about the use of mentoring and ‘trialogue’.

e) Members asked about poor recovery outcomes for Black and Caribbean men and on diversity within BAME groups themselves. DH replied that the focus had to be on early intervention to improve outcomes, particularly for young Black men. He also detailed how discharge care plans had been improved.

f) Cllr Turbet-Delof (Council’s Mental Health Champion) asked about replacing the term ‘BAME’ with ‘global majority’; about readmission rates and support for patients on antipsychotics; about cultural awareness training; about interpretation and translation services and about mental health support for staff. LS illustrated the changes by describing how they used younger members of staff more to engage in the training of wider staff and about the work on bespoke care planning to support certain groups such as trans/non binary people. She also outlined the work of the Language Shop on interpretation and translation and agreed that they would be changing the terminology.

g) Members asked about the criteria for early intervention service and on funding for advocacy services. DH replied it was merely the first presentation of a psychotic illness, which was the key criterion. They offer it to everybody when they appear in crisis. There is typically 2 or 3 yrs of comprehensive support and after that if they still need support they would be transferred to a Neighbourhoods Team or to their  Recovery Team but they’d hope that patients would be in a much better place by then. On Advocacy he stated that they do need more resources to be put in this service and that is being recommended.

h) Members asked about the use of seclusion and restraints; on the need for greater granularity in the breakdown of diversity data; on specific support to Turkish-Kurdish community and about support for victims of trauma e.g. torture. LS replied that at the local and ward level they look at specific groups in full detail but there also has to be a level of Trust-wide data analysis for other purposes but both are available. As regards traumatic experiences, they are mindful in care planning about ‘trauma informed care’ and the need not to re-traumatise people, so they try to understand what adverse experiences people may have been through.  On seclusion and constraint, it always has to be a last resort and it is, and they are very mindful of that but it will sometimes be necessary to protect staff and the patient from harm.

i) MA asked about inclusion of John Howard Centre (forensic) patients in diversity monitoring; on Dementia and CAMHS services being sent out of the borough. LS replied that the equalities work definitely includes JHC and she had worked there for 13 years. There was much work in relation to service user engagement and some ideas adopted elsewhere actually came from JHC. A high proportion of service users do come via the criminal justice system. 

j) The Chair also asked about reducing out of borough placements and possible use of St Leonard’s. DH replied that there were no plans to bring more services to St Leonards. In relation to CAMHS and Dementia, it was an issue of scale. 15 acute CAMHS and 12 acute Dementia beds were in place in NEL but to bring this back to borough level they would struggle to be viable. The local east London provision worked well and the issue about localising is one of scale. They had had a stand alone service at Orchard Lodge in Hackney but it became unsafe as it was just a single ward and so was moved to Mile End to be part of a more effective joined up service.

4.6  The Chair thanked officers for their excellent presentation and commended the degree of leadership and passion in the service.

RESOLVED:

That the report and discussion be noted.