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PCREF plan

Our plan for improving our services for people from marginalised ethnic, faith and cultural backgrounds

In November 2023 NHS England published the Patient and Carer Race Equality Framework (PCREF). The Framework says how the NHS should improve mental health services for people from marginalised ethnic, faith and cultural backgrounds. NHS England agreed to do this after the Independent Review of the Mental Health Act in 2018. The review made suggestions for improving the Mental Health Act, the law which says when you can be taken to a mental health hospital and treated against your wishes.

We have worked with local communities to agree our priorities for improving our services for people from marginalised ethnic, faith and cultural backgrounds.

Our priorities

  1. Piloting the use of Advance Choice Documents
    • The number of Black people detained under the Mental Health Act in our Trust has increased each year since 2021/22.
    • People with a Mixed ethnicity who are an inpatient in one of our hospitals are much more likely to be detained within 1-3 months of leaving hospital, compared to the average.
    • People from marginalised ethnic backgrounds are given a Community Treatment Order more often than White patients in our Trust.

    We want to reduce the number of patients from marginalised ethnic backgrounds who are detained under the Mental Health Act in our Trust.

    We will work with patients admitted to our hospitals under the Mental Health Act to create a document with information about what works to keep them well. There is evidence that working with patients to make a record of their needs (including cultural or faith needs) and how they would like to be cared for can help people stay well and reduce the need for them to be admitted to hospital under the Mental Health Act.

    Dr. Lade Smith, a Consultant Psychiatrist from South London and Maudsley NHS Foundation Trust, talk about how Advance Choice Documents can benefit Black people – watch the video here.

  2. Working with partners to develop Culturally Appropriate Advocacy services for our local area

    People admitted to our hospitals are usually very unwell. It can sometimes be difficult for patients to communicate their needs to our staff. An Independent Mental Health Advocate is someone who doesn’t work for the NHS. It is the advocate’s job to help patients communicate their needs and be involved in decisions about their care. In some parts of the country, people from marginalised ethnic, faith and cultural backgrounds get support from an advocate who recognises and understands their cultural and faith needs. This is called Culturally Appropriate Advocacy. We plan to talk to other public services about developing Culturally Appropriate Advocacy support for our local area.

    Find out more about how Culturally Appropriate Advocacy can benefit people from marginalised ethnic backgrounds here.

  3. Understanding and reducing restraint of people from marginalised ethnic backgrounds

    Restrictive interventions are actions that limit someone’s movement or freedom, for example, moving someone into a room on their own for a short time to stop them harming other people. Compared to White patients, we care for small numbers of patients from marginalised ethnic backgrounds in our Trust. While this can make it difficult to draw conclusions from our data, we do see some differences between ethnic groups in the use of different types of restraint. For example, even though the rate has decreased quickly, we know that over several years Black patients have been more likely to be mechanically restrained.

    We already have a programme of work to reduce the use of restraint in the care we provide to all our patients. We will focus on ethnicity to gain a better understanding of the complex reasons behind the use of restraint among patients from different ethnic backgrounds and reduce any unfair differences.

  4. Supporting people from marginalised ethnic backgrounds to get help early

    Our data suggests that people from marginalised ethnic backgrounds are struggling to get support for their mental health at an early stage:

    • Compared to White patients, a bigger percentage of adults from marginalised ethnic backgrounds (except Mixed ethnicity patients) who are admitted to one of our hospitals have never accessed mental health support from our Trust before.
    • The rate of referrals into our services is much lower for children and young people from Black, Asian and Other ethnic backgrounds.
    • Compared to White people, a bigger percentage of people from some marginalised ethnic backgrounds are referred to our services by the police and from A&E.

    We will work with community groups, our community mental health teams and partners that deliver mental health support in the community to encourage people from marginalised ethnic, faith and cultural backgrounds to get help for their mental health at an early stage, before they reach crisis point.

  5. Tackling barriers to accessing community mental health support

    Our data shows that when people from marginalised ethnic backgrounds do try to access mental health support from our community teams, they may find it difficult to attend their appointment:

    • The percentage of missed appointments offered to adults from a marginalised ethnic background is higher than the percentage of missed appointments offered to White patients. For example, in 2023-24 9.6% of appointments offered to White patients were missed, compared to 15.8% of appointments offered to Mixed ethnicity patients and Black patients, 12.4% of appointments offered to Asian patients, and 12.2% of appointments offered to patients with an Other ethnicity.
    • Among children and young people, the percentage of missed appointments offered to Black and Asian children is higher than the percentage of missed appointments offered to White children.

    We will work with our patients, carers and communities to develop a project which aims to better understand the reasons people from marginalised ethnic backgrounds feel unable to come to their appointment and remove these barriers to accessing care.

  6. Working in partnership with our communities, patients and carers to improve our services for people from a marginalised background

    We want to work in partnership with people from marginalised ethnic, faith and cultural backgrounds to improve our services and over the longer-term, to reduce the health inequalities they experience. We will work with our communities, patients and carers to design a system for people from marginalised backgrounds to give and receive feedback and participate in improving and developing Trust services. While the Trust already has systems in place for gathering patient feedback and supporting patients and carers to get involved in our work, we will work with communities, patients and carers from marginalised backgrounds to create or adapt approaches which are culturally sensitive, and which focus on understanding and meeting the needs of marginalised communities.

  7. Develop a plan to improve the quality and completeness of our ethnicity and religion data

    We record the ethnicity and religion of our patients on our patient record system, however, there are some gaps in the recording of this data. In 2024/25 85% of our patients had an ethnicity recorded on our patient record system, and 25.7% of patients had a religion recorded. There are also a number of patients whose ethnicity or religion is recorded as Not Known (the patient was not asked) or Not Stated (the patient was asked but chose not to answer). We will develop a long-term plan to improve the quality and completeness of the information we record about the identity of our patients, focusing on ethnicity, faith and culture in the first stage of this work.

  8. Upskilling our workforce

    We have a dedicated programme of work which aims to promote equality, diversity and inclusion in our workforce. As part of this we will develop our long-term approach to improving the skill and confidence of our staff in challenging racist language and behaviour and delivering culturally competent care.

  9. Supporting the wellbeing of our staff from marginalised ethnic, faith and cultural backgrounds
    We will work with our Cultural Diversity Staff Network to better understand the experiences and needs of our staff from marginalised backgrounds and review our staff wellbeing support to make sure it is culturally appropriate.

Delivering our plan

We have a Patient and Carer Race Equality Framework (PCREF) Steering Group which will make sure we deliver against our priorities. The group is chaired by our Director of Community Services and brings together staff from across the Trust who will drive forward the delivery of this work, and members of our local communities who have been involved in shaping our priorities. We have a detailed action plan which we will use to monitor our progress against each priority area. We will continue to meet with a wider group of community leaders and with patients and carers from marginalised backgrounds to review our progress and offer them an opportunity to shape this work as it develops.