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Written by Aileen Jackson, Head of Mental Health at the Health Innovation Network.

Working in innovation in mental health can be exciting, and it is easy to get swept along with the thrill of implementing new ways of working through service design and technology. Between digital solutions that  can for example support the diagnosis of attention deficit hyperactivity disorder (ADHD) and service transformations that improve access to treatment , it can feel like we’re contributing to solving  many issues. And we are. But sadly, the harsh reality of the inequalities of our world can also mean we’re creating new ones too.  

According to the Kings Fund inequality is unfair and avoidable, yet 52 per cent of the LGTBQ+ population have experienced depression compared with 20 per cent of the general population, and three per cent of black men have experienced a psychotic disorder compared with less than one per cent of white men.  

This year’s theme of World Mental Health Day demands us to stop and ask, how do we make mental health services better in an unequal world? And on a personal level I ask, how do we ensure that innovation is a driving force in improving healthcare that meets the need of everyone, as per our founding NHS principles, and not exacerbating inequalities?

At the Health Innovation Network, we have a strong emphasis on both conducting an Equalities Impact Assessment and on addressing inequalities . Here are some of my recommendations on how we can all work together to put this into practice.

Be data informed

Eating Disorders is a prime example of where this can help. One of our national projects is Early Intervention in Eating Disorders. Our research revealed that historically, eating disorders have been perceived as disorders that affect only white women and that people of colour  are significantly less likely to receive help for their eating issues. Black teenagers are 50 per cent more likely than white teenagers to exhibit bulimic behaviour, such as binging and purging (Goeree, Sovinsky, & Iorio, 2011).Dig a bit deeper and this issue becomes more complex. People of colour with self-acknowledged eating and weight concerns are significantly less likely than white participants to have been asked by a doctor about eating disorder symptoms, despite similar rates of eating disorder symptoms across ethnic groups. (Becker, 2003).

Listen

Our approach to addressing the issue of inequalities in eating disorders recognition and treatment includes, services collecting demographic data on referrals and treatment outcomes, engaging directly with young black and Asian people to listen to their experiences, collating these experiences into a resource and sharing  with health care professionals. We are also creating a video to attract more diverse clinicians into this area of mental health .

Listening to staff and service users is even more important since the Covid-19 pandemic caused dramatic changes to the way we all interacted. In mental health, for example, there was a rapid shift from face-to-face consultations to remote consultations.

Offer Patients Choice

Together with our south London partners we have  gathering evidence on the impact of remote consultations in mental health. We have learned from academic reviews, staff and patient surveys and service evaluations of the inequalities that have arisen from this shift in service delivery .

We have discovered that patient choice is paramount, and that there are large gaps in evidence on digital exclusion. There are definitely some benefits for patients and staff, such as less travel, convenience, and more opportunity for family involvement, but there is also concern about private space to engage on digital platform for a consultation. Our evidence is showing us that a face-to-face appointment is preferred by many for a first appointment and that video consultations are emerging as more acceptable than a phone call. Remember always to put the person at the heart of making this choice, a phone call to an older person may be better received, where as an online chat will suit others. A letter to invite comments can still be viewed as a gift.

Challenge yourself

And challenge the innovators of digital technology and service redesign. Ask them how can the latest mental health app/innovation support more equitable access to treatment and recovery? Work with them to help them understand the barriers marginalised groups face so they can help you to find solutions.

Share your findings

A large part of our work at the Health Innovation Network is to spread and adopt innovation. We have made it our mission to share our learning from our work in remote consultations nationally so we can influence decision makers.  to date we have engaged with close to 2000 mental health stakeholders  through our learning webinars.  Join us at our next webinar on 27 October to hear directly from people with lived experience how together  we are promoting the patient voice  to influence the future of remote consultations in mental health, register to attend here