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

Meeting NeedsThe level and typeof services requiredto meet needsIn order to meet the mental health needs of anypopulation of children and adolescents - in a district,living within the boundary of a local authority etc. –services are required that cover the promotion ofmental health, prevention and the identification ofproblems, assessment, early and timely intervention,treatment and longer term management. The kinds ofservices that are likely to benefit children with differentkinds of needs have been set out in a four-tieredconceptual framework: essentially, at Tier 1, are allservices that work with children that are not mentalhealth specialist services and that may serve topromote child and adolescent mental health, toprevent problems from arising and/or from becomingentrenched, and offer interventions for mild anduncomplicated problems. Child and adolescentspecialist mental health services at Tiers 2, 3 and 4provide for progressively more severe,complex and/or rare problems and disorders. 3What is effective?A range of preventative and treatment interventionshas been shown to be effective in improving outcomesfor individual (and groups of) children, adolescents,and their families. 4 And some recent studies haveprovided evidence for good practice in serviceprovision in meeting the mental health needs of youngpeople in general (see Appendix I). 5 Young peoplefrom Black and minority ethnic communities may havespecifically different needs and it is known that theseare poorly understood (see Appendix II). 6Issues for young people fromBME communitiesIn common with the evidence obtained from youngpeople in general, in the Minority Voices study thosefrom Black and minority ethnic groups reported: A large number of preoccupying concerns relatedto education and employment; physical health; familyrelationships; past traumatic experiences and moneyand finances. Their particular concerns includedexperience of discrimination and racism;inclusion in the local community; the uncertainnature of any help they may have found, forexample, the danger that a voluntary agencymight have to close for lack of funds; and forrefugees and asylum seekers, legal status andhow long they might stay in the UK. A lack of awareness among parents – as well asyoung people themselves - of what constitutes mentalhealth and significant problems, and what kinds ofhelping services are available. As a result, appropriatehelp is often obtained late and in response to a crisis. Worries about the stigma of using a mental healthservice and the possible lack of a confidential service.A particular worry for BME young people isthat if they seek help, they may be viewed as‘going outside the family’. Long wait times for appointments; having to travelsome distance to get to a service; services only beingavailable at times that were difficult for them, forexample, clashing with college or school timetables; asense of being ‘passed around’ between workers andagencies, with no explanation as to why they werebeing referred on; having to tell their story severaltimes to different professionals; a lack of informationabout medication, especially on what happens whenthis is discontinued; and a lack of continuing supportwhen discharged from CAMHS.A particular concern was when no interpreterwas available and having to return at a laterdate if they required this support. Poor appreciation by staff in all services of mentalhealth needs related to the experience of youngpeople from BME communities, especially refugees andasylum seekers. Along with this, there was greatappreciation by young people when they foundthemselves in a specialist service that they felt ‘finallyunderstood’ them. A lack of choice in the gender and culturalbackground of key members of staff.A particular concern was that some youngpeople want someone from their own cultureand others do not, for fear of someone fromtheir own community hearing of theirproblems.A lack of younger staff from BMEgroups probably deters some young people,who do not feel able to talk about theirdifficulties with older members of their owncommunities. Young people’s experience is strongly influencedby their parents’ views and those of theircommunities, as well as those of their peer group.A particular concern was that often staffdo not fully appreciate this or knowhow to work with it in the best interestsof the young person. For young people aged 16 and over,uncomfortable and disturbing experience of adultmental health services.05