Addressing Barriers to Personalised Mental Health Care for Black, Asian, and Minority Ethnic Communities

People from Black, Asian, and Minority Ethnic communities facing mental illness or distress encounter barriers in accessing personalised mental health care, including Personal Health Budgets (PHBs), essential for their safety and recovery. A report by the Association of Mental Health Providers, NHS England, and the Race Equality Foundation provides solutions to these disparities and offers key learnings to change this troubling reality.

The challenge is particularly pronounced concerning PHBs, which utilise NHS funding to develop individually tailored care plans, providing individuals with greater choice and flexibility in meeting their health and wellbeing needs.

This revelation provides an insight into how the ambitious targets outlined in the NHS Long Term Plan, aiming to have 200,000 individuals benefiting from PHBs by 2023/24, a goal underscored in the Government’s Integration White Paper, are struggling to be met and reach everyone. However, data from NHS England suggests that by the end of Quarter 3 2023-24 (December 2023) only 161,054 people had received Personal Health Budgets in England.

Previous research from the Race Equality Foundation’s briefing on PHBs for Black, Asian and Minority Ethnic individuals in City and Hackney in 2020, ‘Tackling Inequalities Faced by Minority Groups in Mental Health through the Personalised Care Programme‘, provides crucial insights into the development and deployment of PHBs for individuals with mental health problems. For instance, it revealed that both medical and non-medical interventions are effective in supporting people with severe and enduring mental illness. Participants with lived experience noted that PHBs work best when offered alongside medication, as many rely on both to manage their mental health effectively. The issue is that the transformative nature of PHBs is not being met for Black, Asian and Minority Ethnic individuals.

Expanding on this research, the Tackling Inequalities in Mental Health through Personalised Care Development Programme, a partnership between the Association of Mental Health Providers and the Race Equality Foundation, has worked for nearly three years to enhance access to personalised care for Black, Asian and Minority Ethnic communities in the Northwest and the Northeast and Yorkshire. By focusing on tangible actions for local health and care systems to facilitate continuous improvement, this programme showcases the potential of personalised care in addressing mental health inequalities, with insights applicable nationwide.

Key lessons from this initiative include restructuring the relationship between lead commissioners and operations, promoting collaboration among commissioners and senior leaders, and addressing tensions in PHB implementation.

Engaging with both those in need of support and those providing the services is crucial for addressing inequalities. While local organisations possess deep insights into community dynamics and personalised care, smaller voluntary and community groups often lack familiarity with PHBs and the necessary infrastructure for participation. Therefore, integrating trusted smaller organisations into PHBs requires consideration of their developmental needs, facilitated through collaboration with larger Voluntary, Community and Social Enterprise (VCSE) entities.

Kathy Roberts, Chief Executive of The Association, states:

“The findings of this programme provide local health and care systems with a clear set of actions to ensure that people from Black, Asian, and minoritised ethnic communities who experience poor mental health can access the personalised care and support, including PHBs, that they are entitled to. The programme has also confirmed the need for local systems and their statutory leadership arrangements (i.e. Integrated Care Boards and local authorities) to engage meaningfully at a strategic level with the VCSE mental health sector in identifying the mental health needs of people from Black, Asian, and minoritised ethnic Communities and in the provision of services for them. The Association is committed in working with national and local health and care system leaders and other partners to support the adoption of the recommendations of this programme.”

Jabeer Butt, Chief Executive of the Race Equality Foundation, states:

“The programme has amplified the existing evidence base that demonstrates the importance of PHBs and personalised care in facilitating better mental health outcomes for some of the most marginalised and excluded people and communities. In identifying actions required to mainstream the accessibility of both, the Association and the Race Equality Foundation hope the learning from this Programme will be adopted by all local mental health systems and Integrated Care Boards.”

Ultimately, this report aims to promote a culture of continuous improvement in delivering personalised care and PHBs, particularly for marginalised communities. The findings will guide Integrated Care Systems and their Boards in addressing racial inequalities in mental health access, support, and outcomes, aligning with government policy objectives such as those in the Advancing Mental Health Equalities Strategy.