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It has been acknowledged that the disparities and inequalities for black and minority ethnic (BME) communities in mental health in the United Kingdom (UK) has reached such proportions that it is considered a public health issue. This paper reviews training as one of the strategies that have been employed to address these inequalities and draws on a historical review and a scoping exercise in England which mapped approaches to race equality training in mental health services. The historical review showed that the concept of race and racism has been replaced by culturalism as an explanation for all racial inequalities and is the central framework for race equality training. Whilst the survey showed that the majority of mental health services were providing training for their staff, there is much fragmentation and a lack of robust evaluation demonstrating effectiveness. While education and training have a key role to play in developing knowledge and skills to address racial inequality, current approaches are fundamentally flawed.

The national policy Delivering Race Equality in Mental Health (Department of Health, 2005) is in its fifth and final year. Evidence suggests that the changes that were hoped for have not been achieved. This has raised the question as to whether the objectives were unattainable or whether the implementation is yet to see the leadership that is required to bring change in a field fraught with emotion and soured optimism. Drawing on engaging leadership theories and the concept of organisational incompetence this paper highlights key requirements for change, including giving a focus on what has gone well, for example through using appreciative inquiry, and on pursuing possibilities beyond those prescribed through performance management.

This article summarises what the Department of Health's (2005) Delivering Race Equality (DRE) agenda in mental health services set out to achieve and the background to this. The article then provides commentary on the Central and North West London NHS Foundation Trust's experiences while acting as one of the 18 focused implementation sites (FIS) created as part of the Department of Health's five‐year Delivering Race Equality Action Plan and highlights the recommendations that developed out of this work and have national application.

Social policy in the UK has subsumed race inequality into a wider framework of inequalities, managing diversity and social exclusion. However, the David Bennett Inquiry and the Race Relations Amendment Act (2000) have placed ‘race’ firmly back onto the policy agenda, particularly within mental health services. In response to the Inquiry and as part of a wider strategy, the Department of Health has set out proposals to improve mental health services to black and minority ethnic (BME) communities. Although there is a long history of race equality training to address race inequality in public services in the UK, the definition and effectiveness of race equality training remains unclear.This paper presents an overview of approaches to training in the UK, the evidence of effectiveness and explores whether cultural competency is an appropriate and adequate framework to address race inequality.

It is again suggested that people from black and minority ethnic (BME) communities comprise a disproportionately high percentage of mental health inpatients. Furthermore, the Commission for Racial Equality (CRE) concluded the Department of Health (DH) did not have ‘due regard’ to the Race Equality Duty, retaining major concerns regarding the ability of the DH to ensure future compliance (CRE, 2007). In light of these ongoing problems the DH published a five‐year action plan, Delivering Race Equality (DRE) in Mental Health Care to develop race equality and cultural competence training for mental health practitioners (DH, 2005).A focused review of literature was undertaken, structured around three questions.1. How is cultural competence in mental health care defined?2. How is cultural competence in mental health care delivered?3. How is the delivery of cultural competence in mental health care evaluated?Consensus is lacking on definition of cultural competence and on the sequence of when the components should be acquired, some terms being used interchangeably. It is unclear how cultural competence in mental health care can be delivered. No attempts have been adequately evaluated, particularly by service users (Bhui et al, 2007). More innovative research is needed to develop a consensual definition of cultural competence and to facilitate the delivery and evaluation of such, in ways acceptable to service users and service providers.

Mental health care in England has been subject to a great deal of scrutiny in recent years for its equality of access, experience and outcome. Five years of the Delivering Race Equality programme produced momentum, learning and improvements. It is clear, though, that efforts need to consider a continuous quality improvement approach and consciously use all new initiatives to further drive more equal services. A current initiative in England is the care clusters model for mental health, along with associated moves to commission services on a payment by results basis. This paper examines these developments and the possible implications for supporting greater equality in mental health care.

Since the demise of Delivering Race Equality strategy in 2010 under the last Labour government and with the Coalition (2010–2015), and now the Conservative government at times have adopted a “color blind” approach to race and health. This raises the fundamental question why is race equality off the political agenda and how black mental health issues can be part of a future strategy. The 2015 Care Quality Commission (CQC) annual monitoring report of the Mental Health Act (MHA; which has also incorporated the learning since the inception of the Act in 1985) further highlighted the overrepresentation of African and Caribbean men and women who are sectioned in secure wards or on Community Treatment Order (CTO) in the psychiatric system over the last 30 years. The CQC have revised the code of practice which recognizes issues around race equality as part of wider perspectives and principles of human rights.

In October 2017, the government established an independent review of the 2007 MHA as a way of providing more safeguards for patients and service users. The review, under the leadership of Sir Simon Wessely which is reported in 2018, provided an opportunity for an informed public debate on the historical and contemporary roles of psychiatry and the experiences of mental health in Britain’s African and Caribbean communities. The review did examine community anxieties about the proportionally larger numbers of black ethnic minorities receiving inpatient care and CTOs, or in the criminal justice system. However, after 30 years of Black History Month in the UK, we still need to ask the question: Are those of African descent overrepresented in these systems? If so, is serious mental illness over diagnosed among these groups due to the persistence of stereotypes rooted in the experiences of slavery, or do they in fact experience distinctive patterns of mental health and illness, perhaps due to the wider fallout of historical enslavem

More than six years have elapsed since the much‐heralded Race Relations (Amendment) Act 2000 (hereafter also referred to as the “Act”) came into force. The Act had been prompted by concern at the lack of progress made in the sphere of racial equality despite the existence of the 1976 Race Relations Act. There were accusations that the 1976 Act was outdated and lacked the political teeth to be effective. The new Act imposed for the first time specific requirements on public sector institutions to be more proactive in promoting race equality. The duties would apply to public bodies that were previously exempt such as the Police and the National Health Service. This paper aims to focus on Scottish local councils and to examine the progress made by these public sector organisations in the field of race equality since the new Act came into force.

The researchers carried out a postal survey of Scotland's 32 local authorities in order to assess the progress made in the area of race equality. Questions focused on examining the scale of progress in relation to both employment and service delivery.

The results revealed a mixed picture. On the positive side, most councils had initiated race awareness training programmes. The majority had also incorporated aspects of race equality into their equal opportunities policies and most had instituted measures to engage with ethnic minority communities. However, there are still areas where performance is unsatisfactory, including inadequacies in the ethnic monitoring of staff, failure to reflect the size of the ethnic minority community in the workforce, and the absence of a clear and distinctive policy on racial harassment in the workplace.

This research will be of great value to anyone who is interested in assessing whether the legislative duties imposed by the Act have been satisfied by Scotland's local authorities. It is the first study of its kind in Scotland and is likely to appeal to both practitioners in the public sector and to academics.