practical guide to ethnic monitoring (print ready)

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A Practical Guide for Mental Health Services

Ethnic Monitoring

Ethnic Monitoring.indd 1 04/07/2007 23:44:58


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Ethnic Monitoring in Mental Health

This Guide to Ethnic Monitoring in Mental Healthaims to support front-line mental health staff andtheir managers to accurately record the ethnicityof the people using mental health services. Itprovides information and advice on:

What is Ethnic Monitoring?

The Duty to Promote Race EqualityWhat is Ethnicity?The 16 Standard Ethnic Group codesHow to Record EthnicityCommon Concerns

This guide is compiled from the followingdocuments:

Department of Health (2005) A PracticalGuide to Ethnic Monitoring in the NHS andSocial CareCommission for Racial Equality (2005) EthnicMonitoring: a guide for public authoritiesNational Institute for Mental Health in England(2002) Inside OutsideDepartment of Health (2005) Delivering raceequality in mental health care, an Action Planfor reform inside and outside servicesRace Relations (Amended) Act (2000)

What is Ethnic Monitoring?

Ethnic monitoring is the process we use to collect,store, and analyse data about peoples ethnicbackgrounds. We can use ethnic monitoring to:

highlight possible inequalities;investigate their underlying causes; andremove any unfairness or disadvantage.

We can then consider ways of reaching under-represented groups and making sure that servicesare relevant to their needs, and provided fairly.

Ethnic monitoring is only one part of an overallassessment of an individuals cultural, ethnic andreligious needs.

Ethnic monitoring can tell uswhich groups are using ourservices, and how satis ed theyare with them.



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The Race Relations (Amendment) Act 2000gives all public authorities a duty to promoterace equality and good race relations. The dutymeans that, in carrying out their functions, publicauthorities should aim to:

eliminate unlawful racial discrimination;

promote equal opportunities; andpromote good relations between people ofdifferent racial groups.

Mental health services, along with all publicbodies, must be able to demonstrate compliancewith the duty to promote race equality.

Where evidence from monitoring shows unequaloutcomes between different ethnic groups,services are required to take action to promotegreater equality and to prevent direct and indirectdiscrimination.

Without ethnic monitoring, we will never knowwhether the race equality scheme is working.There is a risk that people will just see the schemeas paying lip service to race equality.

If this happens, services could lose credibilityamongst staff, service users and the widercommunity. Through the use of good and robust

ethnic group data on patients and serviceusers, we will be in a better position to addresshealth inequalities, dif culties in access anddiscrimination experienced by some black andminority ethnic individuals and communities.

Information on a service users ethnicity cancontribute to the assessments of their needs.This ensures that service delivery can be aspersonalised and appropriate as possible.For example, insights into a persons ethnicbackground or the ethnic background of theirfamily may assist with diagnosis and planning.

In addition, ethnic monitoring is essential inorder to compare the uptake of services betweendifferent groups. This ensures that servicesare delivered fairly and according to individualneeds.

The Duty to Promote Race Equality

To have a race equality schemewithout ethnic monitoring islike aiming for good nancialmanagement without keeping

nancial records.



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Ethnicity is complex to de ne. Importantly,ethnicity is subjective: a person should self-assignhis or her own ethnic group. While other peoplemay view an individual as having a distinct ethnicidentity, the individuals own view takes priority.Features that help to de ne an ethnic group are:

a shared history or cultural tradition;a common geographical origin;descent from common ancestors;a common language or religion; andforming a distinct group within a largercommunity.

While an ethnic group is sometimes perceivedas a minority within a larger community, ethnicgroups cover people from all communities not

just those of African, Caribbean, Asian or Chinesebackgrounds.

For example, White British people are an ethnicgroup. Because they outnumber all other ethnic

groups in England, comprising 87% of thepopulation, they are the majority ethnic group atthe national level. White Irish people are a minorityethnic group because they only comprise 1.3% ofthe national population.

What is BME?

The term Black and minority ethnic (BME) is usedto refer to all people of minority ethnic status inEngland.

It does not only refer to skin colour but topeople of all ethnic groups who may experiencediscrimination and disadvantage, such as thoseof Irish origin, those of Mediterranean origin andEast European migrants.

What is Ethnicity?

Good Practice Points

Ethnic monitoring policies shouldinclude a clear statement fromBoard level about the importanceand signi cance of this exercise

Policies should includecommitment to analysingcollected data, disseminating

ndings and taking positive action

Joint data collection should beundertaken with local partners



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From April 2001, the Department of Health andLocal Authorities have used, as a National Stand-ard, a set of 16 codes to record the ethnic groupof services users (see below).

The codes are identical to those used in the2001 ONS census and are grouped under ve

headings : White; Mixed; Asian or Asian British;Black or Black British; and Chinese or other eth-nic group.

Ethnic group 16 codes

What is your ethnic group? Choose ONE sectionfrom A to E, then tick the appropriate box to indi-cate your ethnic group.

A : WhiteBritishIrishAny other White background (please write in)

B : MixedWhite and Black CaribbeanWhite and Black AfricanWhite and AsianAny other mixed background (please write in)

C : Asian or Asian BritishIndianPakistaniBangladeshiAny other Asian background (please write in)

D : Black or Black British

CaribbeanAfricanAny other Black background (please write in)

E : Chinese or other ethnic groupChineseAny other (please write in)

The 16 Standard Ethnic Codes


Ethnic monitoring applies toeveryone.Because everyone belongs to an

ethnic group, everyone should beasked to select their ethnic groupfrom the 16 codes.



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Assumptions should not be made aboutsomeones ethnicity based on their appearance,name or religion. For example, not all Muslims areof Asian origin and some people may appear tobe white British, but may be of European, Africanor mixed background.

Ethnic monitoring applies to all areas and is notthe sole preserve of services who have relativelylarge black and minority ethnic communities.

Who Decides a Persons Ethnicity?

As mentioned previously, a fundamental principle

is self-classi cation; that is, service users selecttheir own ethnic group from the codes on offer.In doing so, they should be aware of the differentcodes they may choose from. Occasions wherethird parties identify the ethnic group of serviceusers will be exceptional and should be handledwith care.

Self-classi cation is not a courtesy but arecognition of the fact that a persons ethnicgroup is an integral part of their identity. How anindividual sees her or himself may be differentfrom how that persons parents, other familymembers or third parties see them. Individuals

should not be assigned by a member of staff andcertainly not without explanation or discussion.

How Complete Should the Data Be?

Many analyses of monitoring data have been putin serious doubt because of the large numberof people recorded as being of unknown ethnicbackground. Often, this number is more than thetotal number of people recorded as being fromethnic minorities.

You should aim to get nearly 100% informationabout the ethnic backgrounds of your serviceusers.

Recording Ethnicity


All staff involved in recording,analysing and monitoring ethnicdata should be trained to do so.

Training should give frontline staffthe con dence to collect dataaccurately and sensitively.



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Recording Ethnicity

Ethnic monitoring still arouses suspicion for somepeople. Rather than see it as a force for good,they see it as a means of further discriminatingagainst them. The reasons and bene ts forethnic monitoring should, therefore, be carefullyexplained.

When providing information about themselves, it isnot advisable to give service users the opportunityto record Not stated on the forms they might beasked to complete. Likewise, we recommend thatyou do not say anything in your explanation to theethnic background question that might discouragepeople from answering it. For example, do not sayThis question is entirely voluntary.

An example of such an explanation could besomething like:

We want to make sure that everyone has a carepackage that is tailored around their needs. Werecognise that ethnicity is an important part ofhow people see themselves. If you can have alook at the different groups on this form and puta tick next to the one that most closely re ectsyourself, that will be a great help.

If someone wants to know more, then a moredetailed explanation may include:

Theres a lot of research that people fromdifferent ethnic groups have different experiencesof mental health services. Its important for us tomake sure that everyone receives the best qualityof care and we can only do that if we know who iscoming to us and using our services.

If asked, staff should make it clear that the question,as with all of the questions asked in assessment,is not compulsory. Ultimately, if someone refusesto answer, then this can be documented in theirnotes and revisited at a later date.

Consent and con dentiality should be respectedat all times. No-one should be forced into givingtheir ethnic group against their will.

Good Practice PointsInformation should be held atboth service and Trust level.

It should be used to informindividual patients care plans



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There are a number of concerns, issues andbarriers that may be encountered in recordingethnicity. This section provides some advice tohelp staff to overcome these concerns.

I dont like to ask in case I offend

Most people are proud of their ethnicity and seeit as an essential part of their identity. People areonly going to be suspicious or offended if they thinkthat the information is going to be used againstthem, or if it is just a meaningless paper exercise.

Explaining the reasons why we collect informationon ethnicity can help to overcome these concerns.See the previous section on Recording Ethnicityfor an example of the kind of explanation thatcould be offered.

I dont see why its important

People from minority ethnic communities are

among the most disadvantaged groups inour society, and are also among those leastsatis ed with the services they receive. There isoverwhelming evidence to show that:

Young Asian women are more than twice aslikely to commit suicide as young white women.Cultural con ict has been suggested as aprecipitating factor in suicide.

Young black men are more likely than theirwhite contemporaries to be sectioned under theMental Health Act for compulsory treatment.

Older women of Indian, Pakistani andBangladeshi origin are more likely to visit a GPfor a nervous or mental health condition.Re-admission rates are higher in black andminority ethnic groups. They spend, on average,longer periods of time within hospitals.People from BME communities are less likelyto have their cultural, social and psychologicalneeds addressed within care planning and inthe treatment that they receive.Minority ethnic groups report greater levels ofsatisfaction in relation to Home Treatment/Crisis Resolution services.

We need to ensure that personalised and effectiveservices are delivered to service users from thesecommunities. The only way we can do this is if weknow who is accessing and using our services.

Common Concerns



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I treat everyone the same, theirethnicity is irrelevant.

Ethnic monitoring is not just about an individualpractitioner and the people on their caseload. Theduty to record ethnicity applies to everyone workingin services.

That said, ensuring equality is not always aboutproviding the same services to everyone. It is aboutproviding unique services to everyone, based ontheir own individual needs.

It can be just as discriminatory to treat people thesame when, in many respects, they are differentas it would be to treat people differently when theyare, in many respects, similar.

Whilst a persons ethnicity may not be a key factorto a practitioner, we can be con dent that it isimportant to the individual service user. Ethnicity,culture and religion are essential components of

a persons identity and have an important role inhow they perceive their own health and in theirrecovery and wellbeing.

What if someone is unable to statetheir ethnicity?

Close relatives or advocates may speak onbehalf of individuals who are unable to speak forthemselves or are not able to understand what isbeing asked of them or give an accurate reply. Thiscould be because of physical illness or disability,learning disability, cognitive impairment or mentalill-health.

However, such information should be treated withcaution. An individual may have a very differentperception of their ethnicity to their carers oradvocates. They should therefore be given theopportunity to verify such information as soon asthey are able.

Past records, re ecting a time when the individualcould respond for themselves, which include aprevious self-assessment of ethnic group, may beas good a source as any in these circumstances.

However, a persons perception of their ethnicitymay change over time and so information shouldbe routinely revisited.

Common Concerns



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Common Concerns

What if I feel that asking aboutethnicity would be inappropriate incertain circumstances?

Of course, in some situations, such as in anemergency, the individual may be in no t state

at the time to talk lucidly about themselves letalone give their ethnic group.

Likewise, you may deem that asking aboutethnicity may, in a particular case, causeadditional tension and suspicion and be counter-productive. In these instances, staff should lookto completing the information at a later date.

What if someones ethnicity doesntt with one of the 16 codes?

Some people have complex ethnic backgrounds,resulting from migration, mixed parentage andmultiple nationality. The other groups giveservice users the opportunity to de ne exactlywhat they perceive their ethnicity to be.

Staff should alert managers to genuine codingdif culties, as Trusts and councils should keeptheir coding lists under review to ensure thatthey remain comprehensive and representativeof local demographics and issues.

What about con dentiality?

When it comes to seeking, collecting, storingand using personal information about serviceusers, we all need to pay attention to the DataProtection Act 1998 and the Human Rights Act1998. Service users should expect their personalinformation to be held securely and access to itonly given to people on a need-to-know basis.

As with all patient details, individuals should beasked to give their consent for their personaldata, including ethnic group, to be recorded oncomputer and other systems.

They should also be told who might have access

to this information and be given the chance to saywhether or not they are content for the namedagencies and individuals to have access to theirpersonal information.



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Further Information

More detailed information about ethnic monitoringcan be found in the following documents:

Department of Health (2005) A PracticalGuide to Ethnic Monitoring in the NHS andSocial Care

Commission for Racial Equality (2005) EthnicMonitoring: a guide for public authorities

National Institute for Mental Health in England(2002) Inside Outside

Department of Health (2005) Delivering raceequality in mental health care, an Action Planfor reform inside and outside services

National Institute for Mental Health in England(2003) Engaging and Changing

Race Relations (Amended) Act (2000)

All of these documents can be downloaded fromthe Publications section of the Colour mindwebsite.

Additionally, you can contact the CentralLancashire Mental Health and Race EqualityTeam for advice and training.

Mental Health Race Equality TeamOxford Annex, FoundationsOxford StreetAvenham,PrestonPR1 3SG

01772 558925

www.colourmind.co.uk

Document Information

Title : Ethnic Monitoring, A Practical Guide forMental Health Services

Date : July 2007

Authors : Tony Roberts, Zainab Dhukai, PearlyGupta, Tyrone King, Hajra Sardar

Audience : Staff and Managers in Mental HealthServices



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