Evidence base for prevention

Approaches to tackle inequalities in mental health can be tackled at an upstream (national), midstream (community) and downstream (individual and group) level, as shown in the diagram below.

Figure 1: Approaches to tackling inequalities in mental health. Source: Mental Health Foundation (2020)

There are a range of reports and guidelines about how to address health inequalities.

Resources for understanding inequalities

• The NHS Core20PLUS5 model for adults and children and young people; and framework on inclusion health
• NICE guidance on health inequalities
• The King’s Fund article explaining what are health inequalities?
• The Health Foundation’s data, insights and analysis explore how the circumstances in which we live shape our health
• The Institute of Health Equity has produced a range of research into health inequalities

There are free e-learning modules in health inequalities produced by the Royal College of GPs and Royal College of Psychiatrists, as well as a Royal College of Psychiatrists module in equity versus equality. For NHS staff, there are also e-learning opportunities on: an overview of health inequalities; the Core20PLUS5 model of health inequalities; and the Health Equity Assessment Tool (HEAT).

Practical guides and strategies to reduce inequalities in health services

Alongside NICE guidelines around health inequalities and specific population groups, there are a range of toolkits and reports providing guidance about how to reduce inequalities in health services, aimed at different audiences.

Local authorities and national government

• 10 evidence-based actions that government could take to tackle health disparities

ICB and health systems

• Local work in Cambridgeshire and Peterborough ICS addressing health inequalities
• OHID’s Health Equity Assessment Tool (HEAT)
• NHS Confederation report on how to embed action on health inequalities into integrated care systems
• Mental Health Foundation’s report on Unlocking the potential of Integrated Care Systems to create a mentally healthy society
• Public Health England’s guide on reducing health inequalities in mental illness
• NHS England resources on healthcare inequalities, including a report on tackling inequalities in healthcare access, experience, and outcomes
• Guidance for commissioners and service providers on advancing mental health equality, which includes a detailed step by step guide to how to identifying health inequalities and delivering strategies for change
• The Health Equality Framework and Commissioning Guide, an outcomes tool based on the determinants of health inequalities
• A guide for NHS trust board members on reducing health inequalities

Service leaders and practitioners

• The Royal College of Psychiatrists practical steps to reduce inequalities in mental health services
• Building equitable primary care: A toolkit for practitioners and decision makers
• The national Health Equity Assessment Tool framework can be used to identify and tackle the causes of health inequalities
• British Medical Association’s toolkit for clinicians on reducing health inequalities
• Royal College of Paediatrics and Child Health’s toolkit for addressing child health inequalities and poverty

There are also a range of resources detailing how best to co-produce solutions to health inequalities.

References 

Full list of references is included at the end of this chapter.

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