DESIGN IN MENTAL HEALTH 2022 KEYNOTES
Sarah Hughes said that, currently, there existed a ‘triple barrier’ – as the Centre for Mental Health dubs it – to mental health quality equality.
inequality were education, unequal treatment, and ‘hidden inequalities’. The Centre believes, for instance, that school exclusions should be banned in the UK, since children excluded from school ‘often face a lifelong battle to re-enter society, and stay out of services’. Sarah Hughes said: “In school environments we see a kind of fragmentation around supporting children who might have vulnerable needs, because they’re coming from poverty, might have neurodiversity, or have maybe faced domestic violence in the family. None of these issues are really being thought about in education in the way I think you and I would probably hope.”
Media and popular culture Touching on the impact of media and popular culture, the speaker’s view was that there is ‘quite a global shift to a place of less support for vulnerable groups and individuals’. She said: “Currently we’re experiencing that cultural war that has a massive impact on people who are living unequal, vulnerable lives.” As to the labour market and ‘workplaces’, Sarah Hughes said we all know that not everybody pays a living wage in cities – with a huge rise in people experiencing mental health challenges due to the ‘gig economy’ and ‘zero hours’ contracts. She told delegates: “All these factors directly impact people’s way of life. Most mental health issues that we know get out of hand for certain age groups occur in the workplace, because of bullying and poor conditions etc.”
Policing and criminal justice As regards policing and the criminal justice system, the speaker said people from black and minority ethnic communities were ‘overrepresented in all these systems’. She elaborated: “We know health and care services also reinforce negative experiences and marginalisation because of ‘labelling’, poor access to treatments, lack of representation, lack of being able to meet cultural needs, and so on.” “On the subject of thresholds, access
THE NETWORK | AUGUST 2022
The Centre for Mental Health speaker said mental health inequalities were ‘social and economic inequalities’.
barriers, and associated battles,” Sarah Hughes continued, “if you have personality disorder, for example, your experience of accessing services will be harder, and those with psychosis will find it more difficult to access ‘usual’ health services. Often the support you will need to access those services won’t exist.” Acknowledging that the focus for much of the audience was ‘trying to adapt environments for the better’, Sarah Hughes remarked that, nevertheless, ‘genuinely, if you go into a UK psychiatric hospital today, we probably have some of the least modernised estates for our patients in Europe’. Referring next to ‘microaggressions
and negative experiences’, she said that in the case of the NHS particularly, and other big health systems, the impact was ‘quite huge; in fact, vast’. She said: “We’ve got to begin to understand that; to really ensure that we’re meeting the needs of our service-users – people with lived experience. We need to really understand that dynamic between those providing services and those receiving them.”
‘Unsafe and retraumatising’ environments Her next focus was ‘unsafe and retraumatising environments and practices’. The speaker said the Centre for Mental Health did ‘a huge amount on trauma-informed environments’. She elaborated: “We really think that’s very important, but it means different things in different places. What it doesn’t mean is a nice pot of flowers in the corner.” Here Sarah Hughes showed a slide of
the Centre for Mental Health’s ‘A system, designed for equality’, which touches on the respective impacts on equality of
public services, national policies, local systems, community, and civil society. She said: “We believe mental health is made in communities, and that providing opportunities for mutual aid, collective action, and positive identity, reinforces positive mental health; we indeed saw some of that during the early parts of the pandemic.” Voluntary sector organisations, however, relied on ‘scare, patchy, short- term, and unreliable’ funding, which often meant them offering services ‘on a shoestring’. In some cases this also serves to exclude those who need these services most. She said: “So, we want to see statutory bodies helping by becoming anchor institutions – by changing their funding and monitoring requirements. This can be done. I’m a newly appointed Non-Executive Director for my Integrated Care System in Cambridgeshire and Peterborough, and this is one of the things I am going to be very keen on implementing.”
Philanthropy’s importance Sarah Hughes said she believed philanthropy was ‘hugely important in taking away the barriers that really create inequality in our system, communities, and our homes’. She wondered though, ‘how much the mental health estates sector actually thinks about philanthropy as a way of moving on ideas about the environment’. Looking next at ‘local systems’, she
asked what ‘big providers’ and ‘big designers’ could do to demonstrate equality in mental health. Among the key measures, she believed, were having a living wage, and creating social value through procurement. She told attendees: “Everyone who has undertaken a tender
We believe mental health is made in communities, and that providing opportunities for mutual aid, collective action, and positive identity, reinforces positive mental health; we indeed saw some of that during the early parts of the pandemic
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