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

and some minority groups have poorer quality housing. Poor wages, long working hours,overcrowding and bad housing all increase health risk and have an impact on children’spsychological development. 70 Research has shown that families living in poverty make less useof health services, particularly preventative services, and have poorer health and socialoutcomes. 71 The 2001 Census revealed that households headed by an ethnic minority personhad a lower disposable income than households headed by ‘White’ groups.Language barriersVarious studies have highlighted the potential problems posed by language. One study of casenotes held by a child psychiatry team found that although the clinical team was aware of thepotential for communicational difficulties, efforts to overcome such problems were not oftenmentioned in case notes. 72The qualitative part of the EMPIRIC study found that in GP consultations not conducted in thepatient’s first language, the level of participation by the patient was reduced, and that all theSouth Asian respondents who reported accessing counselling or therapeutic services were ableto speak English. 73RacismMany of the experiences of minority populations may be characterised by discrimination anddisadvantage that is likely to have a bearing on the mental health of these individuals. Racismis a factor that contributes to mental health difficulties in adults and children. A recent studyfrom the United Kingdom showed that victims of discrimination were more likely to haverespiratory illness, hypertension, anxiety, depression and psychosis. 74 People have spoken ofhow ‘tiring’ it is to cope with racism - in handling the situation itself and in coping with its‘internal’ (or personal) consequences and moving on. 75Racial stereotyping occurs on many levels and concerns about racism in Britain’s mental healthservices are not new. 76 For example, one study found that psychiatrists were more likely toask Black patients whether they had a social worker or had received learning support atschool, whereas they were more likely to ask White patients about problem drinking. 77However it is institutional racism that has a greater impact in generating inequalities in mentalhealth services, with the report Inside Outside 78 defining this as:“a feature of institutions where there are pervasive racist attitudes and practices, assumptionsbased on racial differences, practices and procedure which are discriminatory in outcome, ifnot in intent, and a tolerance or acceptance of such differences.”StigmaWhilst it has been suggested that there is no evidence that majority White groups find mentalillness and mental health support less stigmatising, a number of studies have highlighted thevariations in views towards stigma amongst different cultures. For example, based on somesmall local studies, some researchers have described Chinese societies as shame-orientated, 79liable to adapt their behaviour, particularly care-seeking behaviour, in order to ‘save face’.This may mean that Chinese are very reluctant to seek help outside the family and are fearfulof criticism and stigma and of ‘losing face’ in their society. There may also be conflict betweenthe service user and the family. 80Identification of mental health needsResearch in several inner-city GP surgeries shows that Black and minority ethnic patients areless likely to have psychological problems identified. It is well known that both Asian andCaribbean populations do not consult their GPs for mental disorders. Some researcherssuggest that this may be due to the nature of GP-patient interaction and poorcommunication. 81 Other reasons may include greater somatisation/presentation of physicalillness to GPs in patients from some Black and minority ethnic groups. 82 Inside Outsidementions fear of misdiagnosis and a lack of trust in services/professionals as possible reasonsfor some groups not consulting. 83 And some studies have drawn attention to the limited timeMinority Voices Research Report14