Partnerships with imams are breaking down barriers between mental health workers and Sheffield's Pakistani community

Inequalities in the way people from some black and minority ethnic communities experience mental health services persist. In a bid to address this, in January 2005 the Department of Health published a five-year action plan, Delivering Race Equality in Mental Health Care. The plan aims to help services meet the needs of BME patients and to build stronger links with diverse communities.

Consultant nurse for acute care at Sheffield Care trust Rashna Hackett is spearheading an initiative to engage with the needs of the Pakistani community in Sheffield. Historically, members of this community have been reluctant to approach clinicians and too often have accessed mental health services only when there was a crisis.

Working to tackle this problem, Ms Hackett's Enhanced Pathways into Care Project won the Delivering Race Equality plan's "more appropriate and responsive service" award earlier this year. She was also commended for her work in mental health in the Nursing Times awards in 2007.

In the Pakistani community - the largest BME group in Sheffield - NHS workers have found a lack of awareness of mental health conditions. "There was a lot of stigma attached to mental health issues," explains Ms Hackett, "and we have also encountered language barriers that made it difficult to promote an understanding of the services that are available to help."

To address the situation, the community-based project was launched in 2005, led by the Sheffield crisis assessment and home treatment team.

Ms Hackett explains: "We looked to develop the services that were available within the community, to promote home treatment and to reduce the length of hospital admission times. We wanted people to be able to access statutory care via trusted community organisations so they felt secure."

Raising awareness

Partnerships with imams and the local Pakistani Muslim Centre have been put in place, and the chief executive of Sheffield Care trust meets community leaders regularly. The centre has played a key role in supporting patients who are undergoing home treatment and in raising awareness of mental health issues in a non-threatening setting. It has also begun to offer gym, cooking and exercise classes for patients and their carers.

"The whole community feels comfortable with the set-up," says Ms Hackett. "We don't have parents of young women worrying about them being at the centre, for example." The crisis assessment and home treatment team has also provided mental health awareness training to support all centre staff.

Local imams are playing a crucial role, forming a vital bridge between Sheffield's Pakistani community and the statutory sector. "The imams have been helping us with the delivery of home treatment," says Ms Hackett. "It's so important. Before, when a patient became ill, they might have believed that black magic was responsible and so would have been reluctant to go and see a clinician. But now, the imams are providing prayer, with advice on where to go for help simultaneously."

Over the course of the project so far, this community approach has been particularly beneficial for recipients of home treatment, with BME patients responding better than their white counterparts on both the Health of the Nation outcome scales and the Brief Psychiatric Rating scale.

Increased satisfaction

Inpatient length of stay has reduced for 12.5 per cent of Pakistani patients as community treatment options have been extended. There is greater satisfaction with services and numbers being referred for treatment have increased as an awareness of mental health conditions has been triggered in the community. Also, those suffering a relapse after leaving hospital are coming forward for treatment sooner - often via the Pakistani Muslim Centre.

An extension is planned with the development of EPIC2, which will focus on Sheffield's African Caribbean communities this year.

The project's community work has been built on in the ward environment, with cultural and race awareness training for nursing staff.

"We found that BME patients were over-represented in the intensive care unit," says Ms Hackett. "Nurses were referring many of them from the acute inpatient wards to the secure facility because they perceived them to be violent and aggressive. But when we saw them, they weren't displaying this behaviour."

So with DH funding via the five-year plan, training was introduced for 60 nurses working in two wards at the Longley Centre, an acute psychiatric unit in Sheffield, in 2007. "The training looked at how nurses might respond to issues relating to race in the contexts of assessments, care plans and treatment. We challenged their assumptions and asked them to think creatively about how to care for patients," she says.

"The response from nurses has been fantastic and we've been able to make them aware of [the five-year plan] and of the importance of being sensitive to race equality issues." So much so, in fact, that the cultural awareness training programme is being extended to the whole of the acute directorate in Sheffield.

Similar training for all health professionals has been introduced on a national scale by the plan's race equality and cultural capability programme - the first national training initiative to involve BME service users in its development and delivery.

Looking ahead, for Ms Hackett, the most important goal for the project is to ensure that members of BME communities can access services and care in a non-intimidating way. The project will shortly link up with a breast cancer nurse so that female patients can discuss mental health at the same time. "I want a one-stop shop so that if Mrs Khan comes in for her diabetes, she can also mention that she's been having problems sleeping," says Ms Hackett. "I want to mobilise health professionals to come together in a holistic, whole-system way."

Fore more on DRE's race equality and cultural capability programme, visit