Current Context

Public health, health promotion, prevention and early intervention are now creeping to the top of the policy agenda. The current policy debate has shifted to finding preventive measures in the context of public health.

The Cultural Consultation Service (CCS) is focused on making health interventions at a population level. We think about culture broadly, as part of the fabric of our society, such as the creative arts, cultural biographies and group histories which are helping to create a modern narrative.

Despite these positives, we are facing a policy focus ‘away’ from looking at health inequalities and solutions for them, as well as a negation of whole bodies of research evidence about institutional factors such as racism, discrimination and stigma as relevant factors for mental health care and public health.

In the wake of the 10 year Delivering Race Equality programme and the Count Me In Census, progressive solutions are still necessary and can only be effective through research, policy and practice that is authentically grounded in the lived experience of service users and people suffering with poor health.

Why is poor science now being tolerated for BME people experiencing mental illness? And why is the government pushing to diminish debate and actions around the role of institutional racism in mental health amid damning statistics, instead of finding solutions?

Tackling inequalities

Cultural complexities and concerns over inequalities tend to be overshadowed by a focus on risk alongside different perceptions of illness. This can lead to conflict between service users and providers, complaints, poor service user experiences and outcomes, and a lack of engagement in any form of shared decision making.

Mental health policies, commissioners and service providers have made significant strides to tackle inequalities, discrimination and stigma in the wider population – and in mental health services. The new NHS England mental health strategy focuses on public mental health, employer responsibility, reducing and remedying inequalities, and promoting resilience in the population. This, of course, includes NHS staff and patients.

Health promotion is about self responsibility, which means that everyone is responsible for their own health and wellbeing. And we will equip them to do that. There is no question that as a population we have to take more responsibility for our health. The emphasis is on looking after ourselves more and preventing illnesses and reducing the risk factors.

It is also about early intervention when there are signs that something is wrong, rather than getting very ill. It is also about services, organisations and staff working together.

Within all of this, the role of culture is important. It has multiple meanings, yet often it is equated with race and ethnicity, but we all have culture. That doesn’t mean we lose sight of the inequalities that exist and take place.

Creative arts has an important role to play and often comments on the problems in society through provocation that sustains thoughtful engagement; for example, the Arts can be used to better understand and inform the public about the politics of health inequalities and how we can improve health promotion by engaging better with the public, using different methodologies.

Progressive approaches can capture real cultural biographies, and raise awareness of the intergenerational transmission of inequality and risk; this approach is essential for effective prevention. Many different social and identity groups that are excluded have each will have very different trajectories, but within a contemporary context, we have to look at the bigger picture to see how these inequalities have been generated and can be prevented in the future for all groups.

Although the Mental Health Act and other relevant legislation are important, we haven’t really made any progress on mental health law and inequalities. It is slipping off the national agenda. There are services which are trying to improve the situation, but as we no longer have any routing data, and less is being done about mental health admissions and detention, we don’t know, from an evidence base, how to make those improvements happen and be sustainable.

Moving forward

In the face of relative silence from commissioners and health regulators and providers, the public concerns about health inequalities and justice in health care warrant championing.

The culture of care, commissioning and critique must be more constructive and active at identifying and remedying blind spots and omissions. This can only be done with high quality research and educational provision for professionals, active policy and practice engagement and communities of practice that are supported and empowered to realise their aspirations for better public health and health care provision.

At the same time, the global economy is in recession and many low income countries are trying to find solutions to inequalities, albeit in different economic and cultural contexts.

Our ambition is to enable public health and cultural psychiatry research, teaching and practice to improve health inequalities globally and locally. This means we must consider sustainability and preventive interventions, for example, targeting conflict and violence, and new ways of creating cultures of care and concern.

To discuss these or any other questions, contact us.

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