“I have a passion for mental health. It started from my first day as a student nurse,” says Dr Ann Mitchell, chair of the newly established ethnic minority subgroup of the RCN’s Mental Health Forum.
Dr Ann, who has been an RCN member since 1988, was born in Guyana and came to England in the 70s to pursue a nursing career. She has contributed extensively to mental health nursing as a practitioner, educationalist and in more recent years as a researcher, making her well placed to lead the subgroup.
In January 2021, Dr Ann joined the RCN Mental Health Forum Committee. She wanted “to give something back to mental health” and says she has “a lot of knowledge and skills to help progress the aims of the forum”.
Shaping the RCN’s response to the government’s consultation on Reforming the Mental Health Act (MHA) was one of the forum’s main projects in 2021, in part informed by the independent review of the MHA in 2018. The final report of that review highlighted how ethnic minority groups are at a greater risk of compulsory detention than white majority groups. Black people in particular are four times more likely to be detained under the MHA.
There needs to be a shift in addressing inequality and health outcomes
However, the government’s 2021 follow-up consultation on reforming the MHA in England did not ask specific questions about the impact of the proposed changes on people from minority ethnic communities, Dr Ann explains.
“It was a huge report to look at, but one of the things that stood out to me that hadn’t been addressed was mentions of cultural diversity and the mental health issues facing ethnic minority groups,” she says.
The RCN, in its consultation response, highlights the need to focus on racial inequalities in MHA reforms.
The ethnic minority subgroup was born out of multiple drivers, including the Mental Health Forum’s MHA reform consultation work. “This played a core part in officially setting up the subgroup, as it showed the need for a shift in addressing inequality and health outcomes,” she says.
Another driving force came from RCN members, who have raised their concerns around the equal opportunities for training and leadership skills for ethnic minority mental health nurses over the past few years.
Launching the new subgroup
The subgroup has been in the making for many years behind the scenes, but came to fruition in October 2021 at an RCN event with actor David Harewood. He spoke about his experience in the mental health system and attendees also heard from black health care professionals about their experiences. There was also a discussion around what needs to be done to impact change in the system.
This was the biggest RCN library event to date in terms of attendance, showing the appetite for the topic and issues raised.
Dr Ann describes hearing about Mr Harewood’s journey as “earth shattering” and says: “I couldn’t believe what I was hearing, the lack of empathy and understanding he experienced was truly shocking.”
She believes that the subgroup is a space for like-minded ethnic minority individuals to come together to force change. “We needed a group to look specifically at the care and issues ethnic minority people face in mental health care,” she says. “The change isn’t going to happen overnight, though”.
Aims of the group
“Firstly, we want to achieve membership in the group across the four countries of the UK. It’s got to be UK-wide and ethnically diverse,” she says. “Secondly, the focus is on hosting biannual events to highlight mental health issues within the ethnic minority community.”
The next event the subgroup is organising is a panel discussion on developing resilience and mental wellbeing among ethnic minority groups in preparation for later life. This is a collaboration with the Centre for Ageing and Biographical Studies, which is part of the Open University, and will take place on 14 March.
“This group will also raise the profile of mental health nursing as a career and promote good mental health care in the nursing profession. That is so important. We need more mental health nurses,” Ann says. “We will also support the Mental Health Forum committee to develop, lead and disseminate related projects.”
Bridging the gap
One project might be influencing the training given to nursing staff to help them bridge the gaps in mental health outcomes for people from ethnic minority backgrounds. “Training must incorporate how to identify and tackle all forms of bias and the impact this has on service delivery,” she says.
“Training should also develop cultural knowledge. The RCN has some wonderful resources and programmes on this already that should be referred to.” For example, the RCN CPD module Understanding attitudes and their effects on nursing practice and the RCN Cultural Ambassador Programme.
Culturally sensitive and tailored care is vital when treating people from diverse backgrounds, having a range of traditions, languages, faiths, and cultural norms around mental wellness and ill health that differ from the majority perception. “We cannot have a one-size-fits-all approach to care,” Ann says.
Nursing staff have great communication skills and this can help them find out more about the person they’re caring for
Dr Ann understands that this is not a quick win and that nursing staff can’t know everything about other cultures, but they should be making an effort to do so. “Nursing staff have great communication skills and this can help them find out more about the person they’re caring for.”
She also believes that there should be a programme of study on caring for people from different cultures, starting in pre-registration nurse training.
“There should be explicit reference to intersectionality in training,” Ann explains. This is the view that an individual can face multiple causes of discrimination and disadvantage when their protected characteristics and other identities, such as race, disability, gender, sexual orientation or gender identity, overlap.
“This is central to developing transcultural and culturally sensitive care. The MHA reform would be significantly strengthened too if the act was more explicit in how it intended to identify mechanisms to tackle this.”