Building cultural capability in mental health care
When Dr Ranti Lawumi (pictured right), a Highly Specialist Chartered Psychologist at our Trust, first began unpicking the impact of race and ethnicity in mental health care, it was clear that something was missing in the way support and treatment were being delivered.
She, like many others, found that the healthcare experiences of Global Majority racialised patients and communities were shaped by systemic racism and cultural misunderstandings embedded in the help they received.
Three decades later, including 25 years of service at our Trust, Ranti is now spearheading our Cultural Capability Training Programme, helping our workforce better understand the patients in front of them. Read on to hear her journey, what cultural capability is, and why this work is so critical to better serving our communities.
Looking back
“Early in my career, I worked in Primary Care, as well as in Drug and Alcohol services. I quickly saw that many patients were being traumatised not just by their conditions, but by the treatment itself. For example, Black patients (especially the men) were being labelled as threatening, while the female Black patients were almost always labelled as angry. Whatever the case may be, the feedback from staff to Black people expressing any kind of emotion seemed to revolve around ‘you are scary’ or ‘you are aggressive’, but this was not the case for white patients. This put Global Majority people off accessing care; it affected their experience of support with us, and we were not getting close to the good outcomes we were getting with white patients.
“The disparity I saw was not particular to our Trust, it was part of a wider trend in mental health care. In 2015, this culminated in our Trust Board at the time commissioning a report on equality in the service delivery and use of the Mental Health Act. We were able to look inward as a Trust and focus on the scale of the health inequalities facing our patients.
“We then joined forces with one of our local partners, then known as Wandsworth Community Empowerment Network, to help us establish a Forum made of local agencies, religious organisations (churches and mosques) and people in the area. These external partners became a very important critical friend to us, helping us ask the difficult questions we needed to ask ourselves: how do we use the Mental Health Act to deliver equitable care whilst taking into account the health inequalities faced by our racialised minority patients faced. This, in essence, laid the foundations for my previous post as the Health Inequalities Lead for the Trust.
“We also asked staff, patients and local communities how they felt we could improve our services and delivery of care, and what changes they wanted to see. From these discussions, the Healing Our Broken Village programme began, bringing together patients, carers, staff, faith groups, the voluntary sector and other healthcare services to really listen to what people were telling us, to identify what steps we could take to make a real, lasting difference.
"The result was the creation of the Ethnicity and Mental Health Improvement Programme (EMHIP). This programme developed specific key interventions, which included placing hubs in the community venues with embedded community workers, reducing coercive and restrictive practices on inpatient wards, and finally building a culturally capable workforce through a bespoke training programme."
Why Cultural Capability is important
“Cultural Capability is about helping our staff get a better understanding of our patients’ cultural, religious, socio-economic backgrounds and social networks. Most importantly, their perception of care, and their trust – or lack thereof – in traditional medical interventions by embedding active listening in the ways we work and reminding us all not to make assumptions about the people we care for.
“This is critical in south west London, where many of the people we serve are from global majority backgrounds, and might rely more on family, faith and community support. Alternatively, some people may prefer medication over something like Talking Therapies. It’s important that we don’t pathologise people’s cultural expressions but seek to understand them. If someone doesn’t want the support we’re offering, let’s unpick why, so we can build trust and work with the patient to identify the right support for them.
‘'Beyond this, cultural capability also involves identifying biases in mental health assessments; showing how lack of choice, advocacy, and support affects people’s mental health care; and examining where and why restrictive practices are unnecessarily used."
The Cultural Capability Programme
“This training programme was developed through extensive co-production with people with lived and living experience of mental health services. The programme aims to build a culturally capable workforce equipped to deliver anti-racist, trauma-informed care.
“We (the EDI Team) commissioned a bespoke training programme that was developed for our Trust by two external providers, Inclusivitti and Seventeen Seconds – split into e-learning and face-to-face experiential sessions. Developing the training was collaborative, involving clinicians, lived-experience members and patients. One powerful element included actors simulating patient interactions, helping staff practice active listening and empathy, in a safe and supportive environment.
“So far, we have trained 80 clinical staff members, over four pilot sessions. The ripple effect of this is already being felt. The idea is that even if two or three people in each team carry this knowledge forward, it helps to change our culture.
"My hope is that staff who have taken this training will now pause before deciding on someone’s care or treatment. To ask questions, listen without judgment, and really hear the answers. This work has meant so much to me, and I hope the team and I will leave an important legacy that will continue to improve care for patients for many years to come."
Racism stops here
At South West London and St George’s Mental Health NHS Trust, we are committed to being an actively anti-racist organisation which challenges racist behaviours and works against racial prejudice.
Our anti-racism values have been developed with staff across the organisation, alongside our Executive Advisory Group and our Evolve (Black, Asian and Minority Ethnic) staff network. They will help to build our Trust culture and will be used as part of our recruitment, development, and annual appraisals.
