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Delivering race equality for our patients
Race equality in mental healthcare: is routine data collection adequate?
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marlene m kelbrick, SHO Hampshire Partnership NHS Trust
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kelbrickm{at}aol.com marlene m kelbrick
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I read with interest the article by Aspinall (March 2006) discussing race equality in mental healthcare and data collection. Delivering race equality has in recent times been a hot topic for the government as well as within psychiatric circles. Our aim as doctors and psychiatrists is to deliver good quality health care to all our patients, whatever race, background or appearance. It is however recognised that people from ethnic minorities may experience discrimination when it comes to receiving healthcare. The CRE (Commission for Racial Equality) is an independent body initially set up under the 1976 Race Relations Act. It receives a grant from the Home Office (although working independently of the government), and looks at ways to promote equality and encourage good relationships within ethnic groups, and also recommends ways to modify racial inequalities. Data from their quoted surveys (1999 Health Survey for England and the EMPIRIC survey) showed that some ethnic minority groups have increased rates of physical problems such as diabetes and cardiovascular disease, as well as mental health problems. Pakistani and Indian women appear to have higher rates of common mental disorders such as anxiety and depression, and the black Carribean population is more likely to be admitted to psychiatric units and more likely to be locked in wards or detained under the Mental Health Act. Barriers to accessing health services reported include user ignorance, difficulties with literacy and language, cultural differences and location of service delivery. One area covered by the government’s Delivering Race Equality’s 5 year action plan as mentioned by the author, is that of the patient’s experience and satisfaction with services being used as one of the criteria when assessing the success of the plan by 2010. In my unit we are currently undertaking such a survey to assess the satisfaction with services of inpatients as well as their carers. We are also taking part in the data collection for the national annual Count Me In Census which is designed to collect data of the ethnicity of inpatients in order to make sure that the services we provide are meeting the different needs of people from different ethnic groups. We hope that this will bring us one step closer to identifying areas in which to improve our care and deliver equal care to patients from all ethnic backgrounds. The NHS is in a current climate of huge change and I hope that part of that change will be delivering race equality in mental healthcare. |
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Veena S Raleigh, epidemiologist Healthcare Commission, University of Surrey
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veena.raleigh{at}healthcarecommission.org.uk Veena S Raleigh
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Dear Sir Race equality in mental healthcare: is routine data collection adequate? Peter Aspinall’s article (Aspinall, 2006) provides an excellent review of the current status of information relating to race and mental health. It is difficult to see how healthcare organisations, and those with responsibility for data prioritisation, definition, collection and dissemination, can be fully compliant with the Race Relations Amendment Act 2000, or deliver on the Department of Health’s policies relating to mental health and reduced health inequalities, in the absence of data to support basic functions relating to race equality eg health needs assessments, monitoring access to services and treatments, and outcomes. In February 2007 the Commission for Race Equality announced an investigation into whether the Department of Health was meeting its race equality duties (CRE, 2007), and a subsequent cross-government equalities review by the Cabinet Office noted the lack of equality dimensions (other than age and gender) in health data for equality monitoring (Cabinet Office, 2007). Some specific points: 1. Aspinall notes that ethnicity recording for inpatients became mandatory in 1995. Currently, not only is it not mandatory for patients treated out of hospital, there is a Data Set Change Notice (DSCN) in place that bars healthcare organisations from transferring information about the ethnicity of these patients (NHS Information Standards Board, 2005). This probably reflects a cautious interpretation of the Data Protection Act. The Healthcare Commission has drawn the attention of the Information Centre (IC) and Department of Health to this historical anomaly, and we have formally sponsored to the IC that ethnicity coding is made mandatory in all commissioning data sets (CDS) ie outpatients, A&E patients, and MHMDS (for all patients, not just inpatients). This is now going through the approval process, but will take the customary time to implement. 2. In order to drive improvements in ethnicity coding in national data sets (those where ethnicity coding is mandated), the Healthcare Commission, and its predecessor the Commission for Health Improvement, have included indicators on ethnicity coding levels in their annual performance assessments of NHS organisations since 2003. We believe this has contributed significantly to the steady improvement in coding over recent years eg valid coding in HES has increased from 64% in 2002/03 to almost 80% in 2004/05. 3. Aspinall, rightly, notes incomplete recording of ethnicity in HES and MHMDS, and the urgent need for this to improve. It is important though to add some qualifiers: (a) there will always be some patients who do not wish to give their ethnicity, and (b) in the MHMDS, ethnicity coding is over 90% for inpatients; for other patients it is tailing at about 60%, attributable probably to 1 above. The fact that mental health trusts are recording and transmitting this information at all for patients not admitted to hospital is to be commended, given that it is contrary to the official guidance currently in place. 4. The Healthcare Commission is the regulator for all healthcare In England – NHS and the independent sector (IS). We have noted to both the Department of Health and the Information Centre that data sets applicable to the NHS need to extend to IS providers of care to NHS patients, to support compliance with equality legislation (among other reasons that make this information important). The Commission is working with these agencies to support developments in this direction, although the contractual, IT and resource issues may make this a slower process than we would want. 5. The lack of primary care data by ethnicity is a notable gap in information about mental health service users. Hopefully this will be addressed in due course via the Connecting for Health initiative. Yours Dr Veena S Raleigh Lead, Methods and Research, Informatics, Healthcare Commission, Finsbury Tower, 103-105 Bunhill Row, London EC1Y 8TG Reader, Postgraduate Medical School, University of Surrey Declaration of interest: None Aspinall, P.J. (2006) Informing progress towards race equality in mental healthcare: is routine data collection adequate? Advances in Psychiatric Treatment, 12, 141-151. http://apt.rcpsych.org/cgi/content/full/12/2/141 NHS Information Standards Board. (2005) Data Set Control Change Procedure No. 32/2004 http://www.connectingforhealth.nhs.uk/dscn/dscn2004/322004.pdf Commission for Race Equality. (2007) http://www.cre.gov.uk/Default.aspx.LocID-0hgnew0qf.RefLocID- 0hg00900c002.Lang-EN.htm Cabinet Office. (2007) The Equalities Review: Fairness and Freedom, the Final Report of the Equalities Review. London. |
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