The Race Ethnicity and Cultural Heritage team is a team of staff who have come together to address and support racism across Greater Manchester Mental Health Trust. This a Quality Improvement Project but it is so much more than that, it is a movement to finally take action against racism faced and move our trust towards being culturally competent and anti-racist. The project came out of two areas in the trust initially – Meadowbrook an inpatient unit in Salford, and Safire Ward at Park House in North Manchester.
Both areas were experiencing high incidents of racism in different ways. Meadowbrook had high incidents of racism from patients to staff across all wards but were noticing low levels of reporting and where staff did report an inconsistent approach to follow ups. To get a full understanding of what was happening and how staff were affected, the project lead spoke with our Adult Forensic Services who had previously run a survey to understand racism in their services, Meadowbrook tailored this and put it out to staff, it was completely anonymous which the team felt was crucially important for safety and had options to submit online or via paper and a private box. The results that came from this survey were hard to hear, staff were facing high levels of racist abuse and often felt unsupported by police, managers and colleagues. Many had been told that patients were too poorly to face repercussions, or had seen other initiatives not embedded in the service and had therefore lost confidence in reporting and raising concerns. At a similar time Park House admitted a patient (Patient X) who has acutely unwell and was racially abusing staff daily. Between December 2022 and December 2023, 641 crimes were reported across Park House. These included patient-on-patient, patient-on-staff and drug-related incidents. Of these, 57 around 9% were linked to Patient X, largely involving racist abuse. We know this figure underrepresents what was really happening, with incidents occurring daily, often several times a day, and many going unreported.
At the same time, staff turnover and sickness were increasing. In 2023, the ward started with a largely new team in place, but morale was low and teamwork was under pressure. The ward manager knew something had to be done to avoid turnover and properly support staff. Discharge not an immediate option for the patient, as is often the case on mental health inpatient wards, therefore the focus shifted to how we better support staff, while also recognising wider organisational and systemic gaps in how racism was reported, acknowledged and responded to. Park House reached out to the Equality, Diversity and Inclusion team for support and as they knew the work going on in Salford they connected the two teams and the REACH initiative was created.
In Salford the work focused on dealing with racist incidents, building connections with Greater Manchester Police and putting structured support in place. This came in the form of connecting with the local police liaison and head of security and sitting down with staff to ask what they really wanted to see. Tangible changes included: Sanction letters issued in person with police and head of security to patients who had capacity within 7 days of the incident, creating a flow chart so staff and managers know what support they can expect following an incident, creating a staff support package with flexible options so staff can select how they’d feel most supported following an incident – not prescribing the same support to all and creating a mutual expectations leaflet for patients to sign on admission so they are clear on what is expected from them to staff and vice versa. At Safire Ward, they had to start smaller to build a strong team before they could trial the change ideas above. The focus was on wellbeing, building a staff room (which they hadn’t previously had) so staff could leave the ward and have a break. Offering flexible shift options so rather than four days on, staff could work one day with a rest day in between to ensure the abuse was less constant, creating wellbeing activities and safe spaces for staff to share their feelings and how the abuse was effecting them.
Park House was later closed and all wards moved to a purpose built unit called North View, within this move it became apparent that all wards faced similiar problems, and therefore the whole unit joined the REACH Community of Practice, introducing psychological 1 to 1 sessions and monthly meetings for staff to properly de-brief and access support following incidents, trialling sanction letters and building police support and celebrating diversity through events and celebrations.
The REACH Community of Practice has now grown to 12 teams, including most inpatient units across GMMH and recently added community services, two external trusts have also joined – Sheffield NHS Foundation Trust and Pennine Care Foundation Trust.
