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Race Equality Training in Mental Health Services in England Does One Size Fit All?

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Race Equality Training in Mental Health Services in England Does One Size Fit All? Race Equality Training in Mental Health Services in England Does One Size Fit All? Joanna Bennett, Jayasree Kalathil and Frank Keating © The Sainsbury Centre for Mental Health 2007 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying or otherwise without the prior permission of the publisher. ISBN13: 978 1 870480 73 4 Published by The Sainsbury Centre for Mental Health 134-138 Borough High Street London SE1 1LB Tel: 020 7827 8300 Fax: 020 7827 8369 www.scmh.org.uk The Sainsbury Centre for Mental Health is a charity that works to improve the quality of life for people with severe mental health problems. The Sainsbury Centre was founded in 1985 by the Gatsby Charitable Foundation, one of the Sainsbury Family Charitable Trusts, from which it receives core funding. A charitable company limited by guarantee registered in England and Wales no. 4373019 Charity registration no. 1091156 Design: Intertype Printing: Ashford Press, UK Contents Acknowledgements 4 Foreword 5 Executive summary 6 1 Introduction 9 2 The history of race equality training 12 3 Delivering race equality training 24 4 Training providers 33 5 Evaluation of training 38 6 Discussion & conclusions 40 7 Recommendations 44 Appendix 1 Methodology 46 Appendix 2 Membership of steering and advisory groups 50 References 52 Race equality tR aining in mental health seRvices in england Acknowledgements We would like to thank: The National Institute for Mental Health in England (NIMHE) (part of the Care Services Improvement Partnership [CSIP]) for jointly funding the study. The Steering and Advisory Groups which were chaired by Chinyere Inyama (see Appendix 2 for a list of members). The administrators, Gwen Murray, Caspar Below and Polly Tidyman, who supported the research team at various stages of the project. Members of the Breaking the Circles of Fear team at the Sainsbury Centre for Mental Health, Errol Francis, Yvonne Christie, David Robertson, Paul Grey and Eileen Phillips, who supported the development of the project. Special thanks to all the organisations and individuals who participated in the study. 4 Foreword The need to improve training in cultural competency as a method of addressing racism was shown in Breaking the Circles of Fear (Sainsbury Centre, 2002), Inside Outside (NIMHE, 2003) and the Delivering Race Equality action plan (DH, 2005). The importance of this training was highlighted by the findings of theDavid Bennett Inquiry (NSCSHA, 2003) and the results of the Count Me In censuses (Healthcare Commission, 2005 & 2006). This report shows that the delivery of race related training in mental health is often patchy and does not always form part of an overall strategy to achieve race equality. Race related training is often the main strategy for achieving race equality but it is seldom subjected to rigorous evaluation. This means that there is no clear evidence of the extent to which race equality training is making an impact on improving services for Black and minority ethnic (BME) communities. The findings of this report are important. They show that a ‘one size fits all’ approach to race equality training for all personnel in an organisation does not adequately address specific issues related to individual practice or organisational needs. Training for race equality needs to be seen as just one element within the wider framework of race equality. There should be more focus on racial discrimination and everyday practice, and rather less on cultural differences. With that in mind, perhaps the most important finding of the report is that even where there has been some success in improving cultural knowledge within existing race equality training, there is little evidence that this type of training has had an impact on the experience of service users or on equality outcomes. This report should be read by all commissioners and providers of race equality training and anyone who has an interest in race related training. Chinyere Inyama Chair of Steering Group 5 Race equality tR aining in mental health seRvices in england Executive summary Introduction This report presents both a historical analysis of the development of race related training and the findings of a survey of race equality training in mental health services in England. This is the first national study of race related training in mental health services. The study was jointly funded by the Sainsbury Centre for Mental Health and the National Institute for Mental Health in England (NIMHE) (a part of the Care Services Improvement Partnership [CSIP]). The main purpose of the work was to make recommendations that would inform the development of an effective programme of race equality training. The historical review showed that: ❖ Race related training originated in an era when racism was overt and instituted in law. Racism was viewed as the major cause of race inequalities. As the focus on ‘race’ became unpopular politically, the concept of diversity was introduced as an explanation for all forms of inequality. ❖ Approaches to race related training have been influenced by the changing politics of race relations. The concepts of race and racism have been replaced by culturalism as an explanation for all inequalities experienced by Black and minority ethnic (BME) groups and this has become the central framework for race equality training. Through a postal survey we elicited responses from 47 training commissioners, 461 employees and 35 training providers. The findings indicate that while the majority of mental health services are providing training for their staff, there is fragmentation and a lack of robust evaluation that demonstrate effectiveness in terms of improving outcomes for Black and minority ethnic communities. The findings suggest there is a need for a more strategic approach and for national standards that address both the nature of training and the selection of training providers. Training provision 91% of organisations reported that race equality training was provided for employees; 86% said this was for all staff. Training was compulsory in 53% and strongly encouraged in another 28%. 67% of employees said they had attended race equality training in the last three years. Of the many models of training that are used, the most widely provided were in diversity (86%), cultural awareness (51%) and cultural sensitivity (44%). The key reasons for providing training were the Race Relations (Amendment) Act and government policies such as Delivering Race Equality. 6 executive summaRy Training objectives and content 84% of employees and 91% of providers said one of the main aims of training was to improve awareness of race and cultural issues. 80% of training providers but only 33% of staff thought changing behaviour was among the key aims. The content of training varied widely. It was influenced most by the trainer’s own perspectives and the commissioning organisation’s requirements. The most common reported contents were policy and legal issues (88%) and understanding difference (82%). Less common contents included skills for non-discriminatory practice (60%) and strategies for resolving conflict (39%). One quarter of participants reported that service users were involved in delivering the training. Training providers There is no professional body that sets standards for the qualifications and practice of race related training providers. 60% of training providers in our survey had received training in race equality, 54% in mental health care and 40% in training skills. 45% of trainers were independent or freelance providers. 34% reported that they use or have used mental health services. Evaluation of training 35% of statutory and half of independent sector organisations had evaluated the training their staff received. The main methods of evaluation were attendance at training events (76%) and post-training reaction (71%). One-third of commissioners said training had had a positive impact. 77% of training participants in our survey reported some positive impact on their work or themselves, but only 48% reported a positive impact on the organisation or service delivery. Conclusions and recommendations This report concludes that: ❖ Current approaches to race equality training are inappropriate and inadequate in addressing racial inequality in mental health services. ❖ Essentially ‘training for race equality’ should focus specifically on the areas of inequality people experience in mental health services, such as diagnosis, compulsory detention, reducing fear etc., rather than a generic focus on cultural difference or diversity. ❖ Emphasis in race related training must be on the improvement of professional practice and not merely the acquisition of knowledge on the cultures of those categorised as the ‘other’. 7 Race equality tR aining in mental health seRvices in england ❖ Training for race equality should form part of a wider framework for reducing race inequality, embedded within the organisation’s clinical governance systems. It should address the needs of the organisation and its staff and form part of a wider framework of reducing race inequality. Key recommendations include: ❖ Fundamental changes are needed in the way that race equality training is delivered. ❖ The Department of Health should commission and co-ordinate a programme of work which develops a template and sets national standards for appropriate race equality training, including guidance on the qualification
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