Maudsley Charity-sponsored panel highlights solutions to racial inequalities in mental health care

Maudsley Charity is proud to have sponsored a packed session at this year’s NHS Mental Health and Learning Disabilities Annual Conference 2026 in Birmingham.

Chaired by the charity’s CEO Sarah Holloway, the session featured insights from the implementation of the Patient and Carer Race Equality Framework (PCREF) and Advance Choice Documents (ACDs) in different settings around the country.  Maudsley Charity is funding both of these major racial equity initiatives at South London and Maudsley NHS Foundation Trust. The Advance Choice Documents project is in fact the largest implementation and study of ACDs in Europe.

Maudsley Charity is keen to support trusts across the country to implement ACDs and used the conference to launch sign-ups to a mailing list for ACD learning and a future implementation support programme.

If your Trust would like to be supported to implement ACDs please sign up here

Panelists

The panel of speakers were drawn from selected trusts across the country and featured the invaluable contribution of a leading expert by experience.

• Steve Gilbert OBE, Lived Experience Consultant and Chair of the Mental Health Advisory Group of the Race and Health Observatory
• Dr Lade Smith CBE, President of the Royal College of Psychiatrists and Consultant Psychiatrist, South London and Maudsley NHS Foundation Trust
• Jas Kaur, Associate Director of Equality, Diversity and Inclusion and Organisational Development, Birmingham and Solihull Mental Health NHS Foundation Trust
• Dr Emily Kaye, Consultant Rehabilitation Psychiatrist Clinical Lead for the Mental Health Rehabilitation Pathway,  Lancashire & South Cumbria NHS Foundation Trust

Additional contributors

• Professor Claire Henderson, Clinical Professor of Public Mental Health at the Institute of Psychiatry, Psychology & Neuroscience
• Mandy Mudholkar, ACD Clinical Supervisor, South London and Maudsley NHS Foundation Trust

Key takeaways

Advance Choice Documents

What they are and how they help

Steve Gilbert – Lived Experience Consultant and Co-Chair of the Mental Health Advisory Group of the NHS Race and Health Observatory

Steve Gilbert opened the session with a moving account of his personal experience with mental illness and detention. He emphasized the important role played by people with lived experience, family members, and carers in the review of the Mental Health Act which has led to the adoption of four key principles – choice and autonomy; least restriction; therapeutic benefit; and the person as an individual.

He reminded attendees that while the Mental Health Act doesn’t make its provisions specific to people from Black and racialized communities or people with autism or learning disabilities, they faced the most the adverse consequences of the detention system. He emphasized the importance of treating all patients with dignity and respect and urged every attendee to keep their experience at the heart of their efforts to adopt the reforms.

Dr Lade Smith – President of the Royal College of Psychiatrists and Consultant Psychiatrist, South London and Maudsley NHS Foundation Trust

Dr Smith and her colleagues on the Advance Choice Documents project at South London and Maudsley, explained what ACDs are and cleared up some common misperceptions about how they are used.

She clarified that ACDs do not allow people to refuse treatment but are about ensuring that professionals are aware of preferences like the adverse side effects of certain medications or the patient’s desire that a family member take care a beloved pet so they can focus on their treatment. The process of making one is collaborative and the ambition is for it to be accessed not just by mental health professionals, but potentially by police or emergency medical staff patients may come into contact with when unwell.

She explained that the higher rates of detention Black people under the MHA was an indication of them not engaging with services until they were at the point of crisis and that ACDs work particularly well for them because they create a better therapeutic relationship that encourages them to access services before they become seriously unwell.

She pointed to the fact that 50% of the national mental health budget is spent on the most unwell 2% of patients. The evidence base shows that ACDs can reduce detention rates by up to 25% – the only intervention currently known to reduce detention by these levels – and outlined the considerable cost savings to the NHS of implementing them.

Professor Claire Henderson – Clinical Professor of Public Mental Health at the Institute of Psychiatry, Psychology & Neuroscience

Professor Henderson, who leads research on the project pointed to evidence that the ACD meetings themselves are of therapeutic benefit. The shared decision-making and the equalization of the power dynamic that comes from patients telling an external and neutral facilitator what they want makes the patient an active participant in their own care, rather than a passive recipient of one size fits all advice.

Mandy Mudholkar – ACD Clinical Supervisor, South London and Maudsley NHS Foundation Trust

Mandy, an experienced and senior ACD facilitator, explained some of the practicalities of completing an ACD. She shared examples of what patients typically request, like headphones to help block out the noisy ward environment or opportunities to have fresh air – allowances that can practically be delivered and relatively easy to say yes to.

Patient and Carer Race Equality Framework

How PCREF has been implemented in Birmingham and Solihull 

Jas Kaur –  Associate Director of Equality, Diversity and Inclusion and Organisational Development, Birmingham and Solihull Mental Health NHS Foundation Trust

Jas Kaur emphasized the importance of strategic leadership and governance, and tying the Trust’s cultural transformation to improving patient experience as a key lever to address race disparities, differential treatment and experience.

She encouraged attendees to empower their workforce to use their lived experience to adapt what are essentially Eurocentric models of mental health. She gave the example of Muslim psychological professionals who adapted talking therapies to make them more Islamic, creating a new intervention that is appropriate for particular groups.

She spoke of the role of community engagement and the need for a narrative shift to effectively address racial disparities – that a focus on the most disproportionately affected is a way to make improvements for everyone.

She highlighted the need for proper data management, and the importance of using and trusting available data to make informed decisions and adapt service delivery.

Adapting racial equity interventions in areas of less visible diversity

Dr Emily Kaye – Consultant Rehabilitation Psychiatrist Clinical Lead for the Mental Health Rehabilitation Pathway,  Lancashire & South Cumbria NHS Foundation Trust

Lancashire and South Cumbria NHS Foundation Trust also leaned into the use of data to tackle less visible racial inequalities in a mainly rural trust with 1.8m people spread across over 2000 square miles. 11.6% of that population are from Black, Asian and minority ethnic backgrounds vs the national average of 14%.

Faced with the challenge of small datasets, the Trust combined ethnicity data with deprivation, age, service use and referral pathway to reveal a more complex picture. It has been a fundamental shift from simply counting people to delving into understanding experience, complexity and outcomes, using that analysis to treat health inequalities with the same rigour as patient safety.

The Trust has added board-level oversight and system-wide accountability so that responsibility is shared rather than existing in siloed plans. This led to a racial inequalities approach that is embedded in how the Trust leads, governs and makes decisions and to the introduction of a medical EDI charter – the first in the UK.

They’ve strengthened how they listen to communities, tapping into service user and carer councils, community groups, Recovery College, peer roles, and the Voluntary, Community, Faith, and Social Enterprise Alliance, which brings together over 200 organisations.