A Cultural Consultation Service in East London: Experiences and Outcomes from Implementation of an Innovative Service
Palinski A., Owiti J., Ascoli M., de Jongh B., Archer J., Ahmed N., Ajaz A., Bhui K.
Executive Summary1. In the context of the increasing challenges facing mental health services and in line with existing equalities guidance (including the NHS Tower Hamlets Mental Health Promotion Strategy 2008-2011), the Cultural Consultation Service (CCS) was commissioned by Tower Hamlets NHS with support from the National Mental Health Development Unit to provide cultural consultation in East London. The CCS was designed to work at multiple levels of service delivery and commissioning with an additional focus to promote recovery and facilitate high quality clinical learning.2. The broad aims of the service were to: improve clinical outcomes, service user outcomes, and the experience of mentalhealthcare for patients from black and ethnic minorities. improve the cultural capability of mental health professionals. work at a strategic level with commissioners to inform the process of development and improvement of services.3. The CCS was launched in 2010. During the course of the first year to 18 months, the CCS aimed to develop and pilot the service specification whilst embedding itself within the local commissioning and health care systems. 4. Over 900 clinically related contacts were provided. The CCS received a total of 99 referrals for in-depth consultation over a period of 18 months. Qualitative findings were collected from 46 cases which had in-depth consultations. Quantitative outcome measures were available for 36 of these in-depth consultations both at baseline and follow-up at least 3 months following a clinical cultural consultation.5. Overall, service users referred to CCS had high levels of clinical needs. The Health of the Nation Outcomes Scale (HoNOS) was particularly high with an average score of 15.9.6. After the cultural consultation contact, clinicians rated service users as having significantly higher overall functioning. Although no significant changes were found in service users’ perception of their overall health, levels of depression and anxiety, objective scores did indicate some improvement.7. The level of service receipt (and by implication associated costs) significantly reduced after CCS intervention, with a significant reduction in use of A&E services, psychiatrists and CPNs/case managers. Overall, GAF scores improved, indicating better functioning levels. Cost analysis indicates that savings amounted to £497 per patient, taking account of service use costs (which go down after intervention) and costs of CCS provision to this group. Therefore, CCS intervention costs NO MORE than usual care, and was shown to actually reduce spend per patient over a three month follow-up.8. Clinicians found CCS helpful as it provided a richer clinical perspective and allowed service users to share issues about life and illness experiences that were not previously known tostaff. More specifically, clinicians had felt the cultural consultation service had helped to provide: changes to treatment plan (71%); improved engagement (50%); increasedmedication compliance (21%); and earlier discharge (7%). Forty-five per cent of those clinicians who responded wanted to have a cultural consultant permanently based withintheir team and cited lack of resources as the main obstacle to implementing the recommendations of the CCS.9. Training sessions were delivered to five community mental health teams within Tower Hamlets, the Voluntary Sector Network, and there was a one day training on the BartsExplanatory Model Interview. In addition, there were monthly Cultural Consultation Club meetings where case presentations took place to a wider audience. Overall there was positive feedback, as clinicians reported that they had gained new knowledge with regards to ways of working with culture and in engaging with patients’ often complex narratives. This was objectively supported by significant improvements in cultural competency as reported from a validated self-evaluation quantitative questionnaire completed by clinicians which indicates that workforce cultural competence as an aggregate measure improved over time.10. The CCS provided six organisational consultations through a series of workshops on culturally competent commissioning focusing on increased awareness of the context of local services and identifying priorities for future direction.11. Having a tertiary service of cultural consultation may offer a privileged point of observation of teams’ cultures, functions and dysfunctions. It may clarify where the problemslie, rather than to offer simple solutions. Cultural consultation can therefore be conceptualised as both an effective and direct clinical intervention which improves functioning, met need, cultural competency, and it reduces costs per patient. It can also be used as a tool to analyse the scale of a clinical or organisational dilemma and what the solutions might be.