Implementing the Patient Carer Race Equality Framework : Reducing the use of Restrictive Practice

Introduction

Individuals identified as belonging to racialised ethnicities in the UK (African, Caribbean and Asian) requiring access to mental health care, have long reported ethnic disparities in the access, experience and outcomes of mental health services (Bansal et al 2022). As populations characterised as ‘Black’, when they do access care, they are more likely to report negative experiences that often result in poorer outcomes.

The Patient Carer Race Equality Framework  (PCREF) is a new legislative, regulatory and accountability framework that now applies to all statutory mental health trusts in England.  With an expressed service-wide transformation objective targeting leadership, governance, organisational competence, culture and feedback of service offerings to racialised communities, it is driven by a co-produced, anti-racist and human rights mandate.  Spearheading the challenge against ethnic inequality within mental health services, it seeks to respond to the concerns of the local community and service users.  Sheffield’s PCREF delivery plan has therefore focused its sights on the reduction of the use of restrictive practice within in-patient care for racialised individuals, in particular for black and brown men.



Method

The research on which this presentation is based comprises five work packages; a stakeholder mapping,  development of an initial logic model describing the implementation resources, activities, outputs, outcomes and anticipated impact of PCREF; a process evaluation and completed logic model.

The third work package (presented today) comprises a  ‘nested’ process evaluation  using an implementation science approach.  Comprising four PCREF activities, a 5 month evaluation of (1) Enhanced monitoring of inpatient restrictive practice and post-incident reviews ; (2) Cultural advocacy on inpatient wards; (3) Improving access and pathways to mental health care in racialised communities; and (4) Improving protected characteristics data collection methods is undertaken.

With the support of senior researchers, recruited peer researchers will use the Stanford Lightning Report method, a pragmatic qualitative rapid assessment and reporting tool, to collect data reflecting a Plus, Delta and Insight synthesis of each PCREF activity.  Drawing on their inclusion, and supervision as part of the research team, and methodology training, the peer researchers will take the lead with this package of work. 



Results

From the results of the first work package, an emerging picture of the Trust  at the ‘foothills’ of race equity change emerges.  With a small implementation team, awareness of PCREF is gradually spreading throughout racialised communities.  Conversations regarding the reduction of restrictive practice are becoming more readily and easily broached, enabling the implementation landscape to reveal its ‘green shoots’ of epistemic justice as the beginnings of racial equity.



Conclusions

With the continual championing of lived experience and human rights practice for reducing the use of restrictive practice, and beyond, PCREF’s race equity ambitions become realised.