Our plan for improving our services for people from marginalised backgrounds

In 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. This law explains when you can be taken to a mental health hospital and treated even if you don’t want to.

We have worked with local communities to agree nine 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 risen every year since 2021/22.
  • Mixed ethnicity patients in our hospitals are more likely to be detained within 1-3 months after leaving hospital than the average.
  • People from marginalised ethnic backgrounds are given a Community Treatment Order more often than White patients in our Trust.
  • We aim to lower the number of patients from marginalised ethnic backgrounds detained under the Mental Health Act in our Trust.

We will work with patients admitted to our hospitals under the Mental Health Act. Together, we'll create a document that shares what helps them stay well, and how they'd like to be cared for. This will include their faith or cultural needs. There is evidence that doing this can help people stay well. It can reduce the need for them to be admitted to hospital under the Mental Health Act again.

Dr. Lade Smith is a Consultant Psychiatrist from South London and Maudsley NHS Foundation Trust. Watch her 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

Most people admitted to our hospitals are very unwell. They can sometimes find it hard to tell staff what they need. 

An Independent Mental Health Advocate is someone who doesn’t work for the NHS. They help patients share their needs and have a voice in decisions about their care.

In some parts of the country, people from marginalised ethnic, faith and cultural backgrounds can get support from a specialist advocate. These advocates are better equipped to recognise and understand different their cultural and faith needs. This is called Culturally Appropriate Advocacy. 

We plan to talk to other services in our area about developing Culturally Appropriate Advocacy support.

Find out more about how Culturally Appropriate Advocacy can help people.

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. 

In our Trust, we look after fewer patients from marginalised ethnic backgrounds than we do White patients. This can make it difficult to draw conclusions from our data. But we do see some differences in the use of restraint between ethnic groups. For example, even though the rate has dropped quickly, we know that Black patients have been more likely to be mechanically restrained over recent years.

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 find it harder to get early mental health support.

  • Compared to White patients, more adults from marginalised ethnic backgrounds (except Mixed ethnicity) who are admitted to one of our hospitals have never accessed mental health support from our Trust before.
  • Far fewer children and young people from Black, Asian and Other ethnic backgrounds are referred to our services than we might expect.
  • Compared to White people, the police and A&E send more people from some marginalised ethnic backgrounds to our services.

We want to encourage people from marginalised backgrounds to get help for their mental health earlier. We will work with community groups, our staff, and partners to achieve this.

5. Tackling barriers to accessing community mental health support.

Our data shows that people from marginalised ethnic backgrounds do try to access mental health support from our community teams, they often struggle to attend their appointments:

  • Adults from marginalised ethnic backgrounds miss more appointments than White patients. For example, in 2023-24:
    • White patients missed 9.6% of appointments offered.
    • Mixed ethnicity patients and Black patients missed 15.8% of appointments offered.
    • Asian patients missed 12.4% of appointments offered.
    • Patients with an Other ethnicity missed 12.2% of appointments offered.
  • Black and Asian children miss more appointments than White children.

We will work with our patients, carers and communities to understand why more people from marginalised ethnic backgrounds struggle to come to their appointment. Then, we'll look at how to 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 backgrounds to improve our services. Longer-term, we aim to reduce the health inequalities they experience.

Together, we will make sure people from marginalised backgrounds can give feedback and participate in improving and developing services.

We already have systems in place for gathering feedback and getting patients and carers involved in our work. But with people from marginalised backgrounds, we will create or adapt culturally sensitive approaches. These will focus on understanding and meeting the needs of these communities.

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

We record patients' ethnicity and religion on our patient record system. But there are some gaps in the recording of this data. In 2024/25, 85% of our patients had their ethnicity noted in our records. 25.7% of patients had a religion recorded. 

Some patients have their ethnicity or religion marked as Not Known. This means they weren't asked. Others are noted as Not Stated, meaning they were asked but chose not to answer.

We will make a long-term plan to improve the quality and detail of the information we record about patients' identities. We will focus on ethnicity, faith, and culture in the first stage of this work.

8. Upskilling our workforce

We promote equality, diversity, and inclusion in our workforce. We will create a long-term plan to boost our staff's skills and confidence. This will help them challenge racist language and behaviour while providing 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. We will review our staff wellbeing support to make sure it is culturally appropriate.

Delivering our plan

Our Patient and Carer Race Equality Framework (PCREF) Steering Group will make sure we deliver against our priorities. The group is chaired by our Director of Community Services. 

It brings together staff from across the Trust who will deliver this work. Members of our local communities who have been involved in shaping our priorities are also included. 

We have a detailed action plan which we will use to track our progress against each priority area. 

We will keep meeting with more community leaders, patients, and carers from marginalised backgrounds. This will enable us to review our progress and give them a chance to influence this work as it grows.