With a lack of home treatment and voluntary sector options, members of the community had been reluctant to approach clinicians and too often accessed mental health services at points of crisis. Working to counter this situation, Hackett’s Enhanced Pathways Into Care (EPIC) project won DRE’s ‘More Appropriate and Responsive Service’ Award earlier this year. She was highly commended for her work in mental health in the Nursing Times Awards in 2007.

BME communities account for 20.7% of referrals to the five main acute care units in Sheffield hospitals but only make up 10.8% of the city’s population (2001 census).

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

A community-based initiative looked a potential way to address the situation and, under the leadership of the Sheffield Crisis Assessment and Home Treatment Team (CAHT), EPIC was launched in 2005. “We wanted to explore diverse routes to recovery for BME patients,” says Hackett, “so 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 that they felt secure.”

Partnerships with Imams and the local Pakistani Muslim Centre (PMC) have been put in place, with the Chief Executive of Sheffield Care Trust meeting with community leaders on a regular basis. As a centre for the whole community, the PMC, which has begun to offer gym, cooking and exercise classes for patients and their carers, has played a key role supporting patients undergoing home treatment and in raising awareness of mental health issues in a non-threatening setting.

“The whole community feels comfortable with the set-up,” says Hackett. “We don’t have parents of young women worrying about them being at the centre, for example.” CAHT has also provided mental health awareness training to support all centre staff.

And it is local Imams who are 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 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, EPIC’s community approach has been particularly beneficial for recipients of home treatment, with BME patients responding better than their white counterparts on both the HoNOS and BPRS scales. Inpatient length of stay has reduced for 12.5% 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. And 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.

EPIC’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 (ITS),” says 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 on ITS they weren’t displaying this behaviour.”

So with funding from the Department of Health via DRE, training was introduced for 60 nurses working in 2 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,” says Hackett.

“The response from nurses has been fantastic and we’ve been able to make them aware of DRE and of the importance of being sensitive to race equality issues in their work.” So much so that the training programme is now being extended for the whole of the acute directorate in Sheffield.

Similar training for all health professionals has been introduced on a national scale by DRE’s Race Equality and Cultural Capability Programme (RECC) – the first national training initiative to involve BME service users in its development and delivery. The programme can be downloaded for free from http://www.lincoln.ac.uk/ccawi/RECC.htm

Looking ahead, for Hackett, the most important objective for EPIC’s future is to ensure that members of BME communities can access services and care in a non-intimidating way. EPIC will shortly start work with a breast cancer nurse so that women with other health concerns are able to 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 Hackett. “I want to mobilise health professionals to come together in a holistic whole system way.”