The National Health Service (NHS) Patient and Carer Race Equality Framework (PCREF) represents a landmark shift in mental health care across England.
What is PCREF and why it matters
Introduced as part of the recommendations from the Independent Review of the Mental Health Act, PCREF is the first anti-racism and accountability framework designed to tackle racial inequalities in access, experience and outcomes within mental health services. Its purpose is to make mental health care equitable, culturally competent and co-produced with the communities it serves.
Achieving this vision requires more than policy; it demands a deep understanding of culture and the ability to engage in cross-cultural communication. These elements are not optional – they are the foundation for building trust, improving patient experience and delivering care that truly meets diverse needs.
The role of culture in mental health care
The training we deliver on culture and cross-cultural communication helps staff understand how shared values, beliefs and practices shape how individuals perceive and interact with the world.
Culture shapes how individuals perceive mental health, express distress, and seek support. For example, in some communities, mental illness may carry significant stigma, leading to delayed help-seeking. Cultural beliefs can influence treatment preferences, such as reliance on faith-based healing or family involvement.
Language barriers and lack of culturally adapted interventions often result in poorer engagement and outcomes.
Therefore cultural understanding could influence patient engagement, trust and outcomes. These factors contribute to noticeable differences. Black adults in the UK are over four times more likely to be detained under the Mental Health Act compared to White adults, and more than ten times more likely to be placed under Community Treatment Orders. Restrictive interventions, such as restraint, are also disproportionately applied to Black patients. These statistics highlight systemic issues that PCREF seeks to address.
Cross-cultural communication in mental health
Cross-cultural communication is the ability to interact effectively with people from different cultural backgrounds.
In healthcare, this means active listening, cultural humility, language support and inclusive dialogue. When communication fails, trust erodes. On the other hand, when professionals demonstrate cultural competence, they foster confidence and collaboration which are key principles embedded in PCREF. PCREF encourages organisations to listen to diverse voices and adapt services to meet cultural needs.
The importance of delivering culture and cross-cultural communication training helps create cultural awareness of diverse communities which is important when collaborating with different stakeholders in designing services.
How PCREF drives change
PCREF is not just about reducing disparities it’s about transforming relationships between services and communities.
Cross-cultural communication underpins this transformation by enhancing patient engagement where patients feel heard and understood. They are more likely to participate in their treatment. Better communication can prevent crisis that lead to detention or restraint. When we tailor care to cultural needs, services can improve outcomes for all. Eventually, PCREF’s success depends on the ability of mental health professionals to communicate across cultures with empathy, respect, and openness.
The link between culture, communication and equity is unquestionable. PCREF provides the framework, but it is cross-cultural communication training that brings it to life. For Cygnet Health Care and Social Care services, this means embedding cultural competence into governance, training, and service delivery not as a tick-box exercise, but as a core value.
Towards an inclusive future
As an organisation, our challenge is to create mental health services where every patient and carer, regardless of race or culture, feels seen, heard and valued. That is the promise of PCREF, and it starts with how we communicate.