Minority voices: Research into the access and acceptability of ... - MMC

Help-seeking behaviour is determined by a variety of personal/individual and social/culturalfactors, including level of psychological distress, personal problem-solving skills andenvironmental factors. Some studies suggest that adolescents under-utilise professionalservices because of their negative attitudes towards mental health professionals and their ownpreferences for informal sources of help through friends and family members. Others havehighlighted that where appropriate services are set up, people will use them, a findingcertainly borne out in the Minority Voices study which shows that services that young peoplethought helpful were over-subscribed.It is also important to recognise that some studies in this area contradict each other. Forexample in a study of the degree to which religious coping strategies were perceived to beeffective in the face of depressive and schizophrenic symptoms, prayer was perceived asparticularly effective among African Caribbean Christian and Pakistani Muslim groups. 57However another study found that, relative to other kinds of help for depression, religiousactivity was not seen as particularly helpful, but that Muslims believed more strongly thanother groups in the efficacy of religious coping methods for depression. They were most likelyto say that they would use religious coping behaviour and least likely to say that they wouldseek social support or professional help. 58Engagement with mental health servicesIndian and Pakistani children make more use of general practitioners’ services for generalhealth problems (not specifically mental health) than other children, but Indian, Pakistani,Bangladeshi and Chinese children are less likely to be referred to outpatient clinics. 59 A caseanalysis of all the referrals to the Child and Family Consultation Service at the Royal LondonHospital in 1997 found that Bangladeshi families were less likely to attend the initialappointment, but once a family became engaged, service drop-out rates were unaffected byethnicity. This study found a difference in attendance rate depending on the source of thereferral and highlighted the importance of communication between the referrer, the family andthe service. 60 This study also found that nine out of ten Pakistani mothers would be more likelyto use a service if a therapist visited them in their own home or if they could see them withinthe local community, illustrating the importance of appropriate referral routes that match wellwith local needs.Even when levels of awareness of services are similar across different ethnic groups there maystill be differences in willingness to access a service. One study found that one in 40 WhiteBritish mothers were unwilling to utilise a child and adolescent mental health service,compared to one in four mothers of Pakistani origin. The latter tended only to considerreferrals for severe problems. 61 These disparities may be due to misunderstandings about thestructures of services. In one child psychiatry team it was found that South Asian familiesliving in close contact with their extended family did not invite them to the assessment,suggesting that they understood clinicians to expect only the nuclear family to attend. 62Routine treatment options, for example a weekly parenting skills and support group, were notenthusiastically embraced by South Asian parents. 63 A major concern of adolescents withmental health problems is the relationship with the doctor and the degree of approachability.An understanding and supportive relationship is valued. 64Research on risk factorsYoung people from ethnic minority groups disproportionately experience many of the knownrisk factors for developing mental health problems, including exclusion from school, 65 beinglooked after 66 and homelessness. 67A Commission for Racial Equality Investigation Report found that in Birmingham, AfricanCaribbean pupils were four times more likely to be excluded from school for fewer and lessserious offences than White children and were less likely to re-enter the mainstream. 68 Thelack of real progress in addressing the exclusion and achievement disparities has beenattributed to institutionalised racism, based on assumptions and unquestioned practice. 69Data from the Fourth National Survey show that minority ethnic groups have a lower incomethan white people in the same class. Unemployed individuals remain unemployed for longerMinority Voices Research Report13