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Black Thrive in LambethJacqui DyerMarch 2019
MHAR
MHAR – Terms of Reference:
• Rising levels of detention under the Mental Health Act ANDthe over-representation of people from Caribbean and African communities in mental health inpatient settings
• Within professional spaces we are often reluctant to acknowledge or address the ‘isms’ and it is important for this to be upfront so can address decision-making which biases against Black people. Note that within Black community spaces and within the ‘system’ data the ‘isms’ are starkly clear
MHARAC Terms of Reference
INDEPENDENT REVIEW OF THE MENTAL HEALTH ACT:AFRICAN AND CARIBBEAN WORKING GROUP (MHARAC)Purpose• The African and Caribbean working group (MHARAC) has been established to
support the aims of the independent review.• MHARAC will make recommendations designed to ensure that people of African
and Caribbean descent with mental health challenges receive the treatment and support they need, when and where they need it, are treated with dignity, and that their liberty and autonomy are respected as far as possible.
To achieve this, MHARAC will:• Give due attention to the implementation and practice of the Mental Health
Act as experienced by people of African and Caribbean descent or heritage. • Identify and critically evaluate a range of relevant evidence and data to
support thinking and recommendation development.• Identify and critically appraise aspects of relevant legislation, and consider issues
that may particularly impact people of African and Caribbean descent.• Identify effective practice and propose solutions to identified issues, which will
work in the best interests of people of African and Caribbean descent.
MHAR Recommendations
• Our core recommendations can be found in ‘The Experience of people from ethnic minority communities’ as well as in wider sections of the report – such as ‘Policing and the MHA’ and ‘System wide enablers – data’ Most are general recommendations but which will have their greatest impact on those of black African and Caribbean communities
• The development of the Patient and Carer Race Equality Framework (PCREF), an organisational competence framework (OCF) which will improve mental health service access and outcomes in black African and Caribbean people. OCFs can be developed in all organisations e.g. the police and local authorities, to improve outcomes in black African and Caribbean people with mental health problems.
• Ensuring the provision of culturally-appropriate advocacy services (including Independent Mental Health Advocates) for people of ethnic backgrounds, in doing so responding appropriately to the diverse needs of individuals from black African and Caribbean communities.
• Raising the bar for individuals to be detained under the Mental Health Act, as well as any subsequent use of Community Treatment Orders.
• Providing the opportunity for people to have more of a say in the care they receive, ensuring that people from black African and Caribbean heritage are involved in the care and treatment plans developed for them and thus increasing the likelihood that they are more acceptable.
• Increasing the opportunities available to challenge decisions about the care offered and received in a more meaningful way.
• Addressing endemic structural factors through the piloting and evaluation of behavioural interventions to combat implicit bias in decision-making.
• Reducing the use of coercion and restrictive practices within inpatient settings, including in relation to religious or spiritual practices. Seeking greater representation of people of black African and Caribbean heritage in key health and care professions
• Endorsing ongoing work to explore how the use of restraint by police is reduced, encouraging police services to support people experiencing mental distress or ill health as a core part of day-to-day business. Extending the powers of the Mental Health Units (Use of Force) Act, ‘Seni’s Law’, to seclusion.
• Improving the quality and consistency of data and research on ethnicity and use of the Mental Health Act across public services, including criminal justice system organisations and Tribunals.
Why do we need Black Thrive?
Research shows that, for example:
• Common mental disorders such as anxiety and depression are most prevalent among black women
• Black men are more than 10 times as likely to have experienced a psychotic disorder within the past year as white men. (Source: Race Disparity Audit)
People of African and Caribbean backgrounds in the UK suffer disproportionately with regards to mental health and wellbeing.
Why do we need Black Thrive?
This is tied up within a number of other inequities:• In Lambeth, found that 70% of patients in secure psychiatric
settings of African or Caribbean descent (despite making up just 26% of Lambeth’s population) (Source: Surviving to Thriving Report, 2014)
• Black adults in the general population are the least likely to report being in receipt of any treatment (medication, counselling or therapy) – around 7% of them reported receiving treatment at the time compared with 14% of White British adults. (Source: Race Disparity Audit)
• Black people are four times more likely to be detained under the Mental Health Act than white patients (Source: Mental Health Act Review)
About Lambeth
Lambeth’s Population: 328,000Famous landmarks located in Lambeth include:• The London Eye• The National Theatre and South Bank• The Headquarters of the MI6 (British
Secret Intelligence Service)• The Black Cultural Archives• The Brixton Academy• The Oval Cricket Ground
About Lambeth
Source: Lambeth Equality Commission Report, 2017
Our visionBlack communities in Lambeth thrive, experience good mental health and wellbeing, & are supported by relevant, accessible services, which provide the same excellent quality of support for all people regardless of their race.
What is Black Thrive?
Black Thrive is a systematic response to a systemic problem.
Black Thrive is built on the idea that people and organisations from a wide variety of backgrounds are needed to tackle mental health inequalities. As such, Black Thrive gives a platform for statutory organisations, community members and health specialists throughout its three-tier structure, underpinned by a shared measurement system
It draws upon the Collective Impact model developed in the US…
This model presupposes that no single action or organisation can solve an entrenched social issue; rather, everyone with a stake in the issue must be brought together and engage constructively.
…but is adapted for Black Thrive’s needs
Steering CommitteeCommunity leaders, Public Health Lambeth, Mental
Health Trust, CCG, Children’s Services, Police
Facilitating team providing hands-on project leadership
Hosted by Healthwatch Lambeth
Shared Measurement
System
Providing critical data for evaluation
Led by Public Health Lambeth
Working groupsPrevention, Access, Experience, and Children &
Young People
All forums with 50/50 representation between “system” and community representatives
Co-production based on our values
1. Inclusion2. Equity3. Openness4. Respect5. Understanding6. Action-focussed7. Learning8. Evidenced9. Perseverance10. Integrity
Working together for a positive outcome,
underpinned by our values
Shared outcomes across all partners
15
Focus on and use of prevention to promote
and improve health and wellbeing is
increased amongst black communities
Prevention
We have developed 14 outcomes with statutory and community partners that map against the major goals below.
Access to appropriate services is improved to better meet the needs of black communities
Access to Appropriate Services
Experience of care and support is
improved for black communities (service
users, families, and carers)
Experience
Address the unique needs of children & young people in the areas of prevention, access and experience.
Chi
ldre
n &
Yo
ung
Pe
op
le
Focus on both bottom up and
top down
Consistent and honest dialogue is required to
identify shared goals
Addressing the
imbalance of power
Transparent accountability
Change must happen at the
core of institutions
What we think is important
Learning from first 18 months (1 of 3)
• Black Thrive is filling a gap in Lambeth in how the black community engages with the statutory stakeholders; creating a community around this
• Mental health inequalities are uncomfortable to discuss – but Black Thrive seeks to facilitate this in the spirit of collaboration, not confrontation.
Some particular challenges to respond to:
• Changing membership
• Need for more leadership opportunities
• Going forward, Black Thrive must continue to provide space for people to share their own traumatic experiences and support this to inform policy and solutions.
1. Community engagement is uniquely strong in Black Thrive but must be maintained
Learning from first 18 months (2 of 3)
• We have already seen culture shift within Lambeth
• Although there is a lot going on locally, there are key opportunities we focus on (e.g. the Living Well Network Alliance)
• Recognise the intersectionality in communities: LGBT+, age, faith, etc.
Some particular challenges to respond to:
• Common agenda not yet common – necessary condition for Collective Impact to be successful (see Appendices for full list)
• Everyone needs support to engage (not just volunteers)
• Backbone team capacity is limited
• Voluntary and community sector capacity has been reduced in Lambeth and there is currently no umbrella organisation to bring them together as providers of services (in particular, BME-led).
2. Black Thrive’s planning team role is to drive system change via available avenues
Learning from first 18 months (3 of 3)
• SMS has taken longer than expected: delayed recruitment, complex process of negotiations around data sharing, embedding an appropriate co-production process into SMS development.
• SMS will create a unique and distinctive evidence base of racial inequality and good practice (akin to the impact of Race Disparity Audit nationally).
Some particular challenges to respond to:
• Must challenge current data-collection practices within partner organisations, especially recording of ethnicity data
• Engage community further with the SMS, ensure that it is a tool that all stakeholders – from partner organisations to the wider community of Lambeth – use and value.
3. Developing a meaningful Shared Measurement System (SMS) represents a culture shift
Five principles of a collective impact approach
1. It starts with a common agenda. That means coming together to collectively define the problem and create a shared vision to solve it.
2. It establishes shared measurement. That means agreeing to trackprogress in the same way, which allows for continuous improvement.
3. It fosters mutually reinforcing activities. That means coordinating collective efforts to maximize the end result.
4. It encourages continuous communication. That means building trust and relationships among all participants.
5. And it has a strong backbone. That means having a team dedicated to orchestrating the work of the group.
Taken from Collective Impact Forum: https://collectiveimpactforum.org/what-collective-impact
We are making use of frameworks to simplify the question of system change
System change = shift in the conditions that hold a complicated problem in place
Policies Resource flowsPractices
Power dynamicsRelationships &
connections
Mental models
Structural change required
Transformative change required
Note: this is an adapted version of the “inverted pyramid” found in FSG’s Waters of System Change Report (2018). We have decided to flip the triangle as, for our work, mental models are often considered the most important aspect of the change wewant to see.
Our development timeline
Black Thrive concept developed by Social Finance, Jacqui Dyer and Healthwatch Lambeth
Several community events to test interest, and understand the right approach, alongside 1:1 statutory engagement to how to embed approach and develop levers for change.
August ’17 – Formal launch and start of ‘Delivery phase’
Black Health & Wellbeing Commission (BHWC)
Co-chaired by Jacqui Dyer, set up in response to the death of local resident Sean Rigg, who died after being restrained by police officers during a schizophrenic episode.
August ’16- ‘Consolidation phase’
A year long pre-launch phase to develop the structures of Black Thrive and agree priorities
2014
2016
2015
2018
2017
April ‘16 - ‘Development phase’
A series of meetings bringing together community members and ‘system’ to test the approach and see if there was a partnership to be had, leading to development of partnership agreement.
First year of delivery
Detailed on next slide
Summary of progress made to date
We launched Black Thrive on core budget of £1.9m. This has allowed us to achieve the following during the 18 months of delivery:
• Facilitation team: established with Director (Patrick Vernon) and grown in strength since then – with full-time working group manager (Victoria Cabral), part-time communications support (Sadiki Harris), and interim programme support (Harriet Ballantine). New Director, Natalie Creary, joined us in January from the Health Foundation.
• Steering Committee: The Steering Committee have been meeting every month, maintaining strong support and regular attendance from senior leaders within key statutory organisations to provide strategic leadership.
• Working Groups: The Black Thrive Working Groups have developed action plans for 2018/19 and are now in the process of carrying these out.
• Shared Measurement System: A Public Health Specialist has joined the Black Thrive and Public Health teams and has driven forward the production of a co-produced dashboard (expected to be published May 2019)
• Evaluation: A five-year evaluation in partnership with Sheffield Hallam University has commenced.
Thank you!
Cllr Dr Jacqui Dyer MBE, KCL Hon Fellow
Chair Black Thrive
