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

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2. INTRODUCTION“For decades the disparities and inequalities between Black and minority ethnic groups and themajority white population in the rates of mental ill health, service experience and service outcomehave been the focus of concern, debate and much research. However, there is little evidence thatsuch concerns have led to significant progress, either in terms of improvement in health status ora more benign service experience and positive outcome for Black and minority ethnic groups. Ifanything, the problems experienced by minority ethnic groups within our mental health servicesmay be getting worse.”Inside Outside, National Institute for Mental Health in England (NIMHE), 2003 7Background to the Minority Voices studyIn 2001, when YoungMinds started to plan the Minority Voices study, there were concernsabout the barriers facing many young people seeking help from mental health services.Research in progress around this time by the CAMHS Innovation Projects 8 and by YoungMinds 9was highlighting this as an area of ongoing serious concern and was also illustrating theimportance of seeking the views of young people themselves. Similarly, work by the King’sFund and the Social Exclusion Unit 10 11 was drawing attention to the fragmented nature ofmental health services and the particular problems facing Black and minority ethnic groups.Overall there were also worries about a significant increase in the prevalence of disordersamongst young people. 12At this time FOCUS, a Research Unit within the Royal College of Psychiatrists, was undertakinga survey looking at the extent to which specialist CAMHS were offering an appropriate serviceto young people from Black and minority ethnic communities, including the clinical aspects ofworking with such young people once they start to receive help. This survey involvedinterviewing commissioners and Tier 3 CAMHS managers about current planning and provisionof CAMHS for Black and minority ethnic groups. 13YoungMinds’ overarching aim was to build upon previous studies, including the FOCUS project,and to examine the issues relating to access which may prevent young people from Black andminority ethnic communities receiving appropriate and effective help.Study objectives• To give a ‘voice’ to young people aged between 12 and 25, drawn from a range of Blackand minority ethnic backgrounds, regarding their awareness and experience of, andwishes for, mental health services.• To review activity across Tier 1 CAMHS that promotes access for such young people.• To identify and analyse the barriers to effective access to appropriate services.• To identify examples of promising and innovative practice in this area.The specific aim of the study has been to make a contribution to the understanding of whymany young people from Black and minority ethnic groups do not use CAMHS - or onlyapproach them when they have reached crisis point - and to explore their views andsuggestions, alongside those of professionals working in this field, as to how service accessand acceptability may be improved.Minority Voices Research Report7
! Concerns about the provision of mental health services for Black andminority ethnic communitiesSince 2001 awareness of the particular difficulties facing Black and minority ethniccommunities has been considerably heightened through the publication of a number ofimportant reports and consultation documents, including:• Inside Outside published by NIMHE 14 (see initial quote above) which also states: “Atpresent, there is no national strategy or policy specifically intended to improve eitherthe mental health of minority ethnic groups or their care and treatment within mentalhealth services. Previous approaches taken to address these problems have been eitherfragmented or selective. As a result, the ‘ethnicity agenda’ within mental healthservices has tended to become either marginalised or ignored.”• Breaking the Circles of Fear by the Sainsbury Centre for Mental Health which highlightsthat “the care pathways of Black people are problematic and influence the nature andoutcome of treatment and the willingness of these communities to engage withmainstream services.” 15 This document also notes “the need for changes to mentalhealth care and treatment of Black people is widely recognised and long overdue. Thereis compelling research and statistical evidence which shows that Black and AfricanCaribbean people are over-represented in mental health services and experience pooreroutcomes than their White counterparts.”• The FOCUS report, which highlights the importance of recognising “the diversity ofindividual needs and cultures” if we are to truly understand and address the needs ofminority ethnic groups. 16 This work also draws attention to the complexities of definingethnicity, the limitations of census data, and the paucity of epidemiological research inthe field of ethnicity and mental health in children and adolescents.• Delivering Race Equality: a Framework for Action, which states in the foreword:“improving the provision of services to Black and minority ethnic communities, andensuring that those communities are not only informed, but also willing and able towork in partnership with services, are not merely matters of fulfilling statutoryobligations, important though those are. They are essential if we are to achieve ouroverall goals in modernising the health and social care system.” 17This report sets out the following - that people from Black and minority ethnic communities aremore likely to experience:• Problems in accessing services• Lower satisfaction with services• Cultural and language barriers in assessments• Lower GP involvement in care• Inadequate community-based crisis care• Lower involvement of service users, family and carers• Inadequate support for Black community initiatives• An aversive pathway into mental health services:- higher compulsory admission rates to hospital- greater involvement in legal system and forensic settings- higher rates of transfer to medium and high secure facilities• Higher voluntary admission rates to hospital• Lower satisfaction with hospital care• Lower effectiveness of hospital treatment• Longer stays in hospital• Less likelihood of having social care/psychological needs addressed within careplanning/treatment processes• More severe and coercive treatments• Lower access to talking treatments/therapiesMinority Voices Research Report8
Page 1 and 2: Minority VoicesResearch into the ac
Page 3 and 4: ACKNOWLEDGEMENTSThis eighteen-month
Page 5 and 6: factors that study participants ide
Page 7: Study recommendations• The lack o
Page 11 and 12: 3. CONTEXT OF THE STUDYVarious area
Page 13 and 14: • A measure of general psychiatri
Page 15 and 16: and some minority groups have poore
Page 17 and 18: 4. METHODOLOGYThe study methodThe p
Page 19 and 20: Staff: The interview schedules for
Page 21 and 22: 5. STUDY FINDINGS I: MAPPING OF ACT
Page 23 and 24: In a number of areas attempts to im
Page 25 and 26: 6. STUDY FINDINGS II: YOUNG PEOPLE
Page 27 and 28: ! Awareness of mental health and me
Page 29 and 30: “The therapist I was seeing was A
Page 31 and 32: Suggestions from young people for i
Page 33 and 34: 7. STUDY FINDINGS III: INFORMATION
Page 35 and 36: • High DNA (Did Not Attend) rates
Page 37 and 38: they felt sufficiently supported an
Page 39 and 40: Table 4: Areas of unmet need/defici
Page 41 and 42: • The breakdown of whether some B
Page 43 and 44: 8. CONCLUSIONS AND RECOMMENDATIONST
Page 45 and 46: The study recommendations are:• T
Page 47 and 48: Wide-ranging review of the issues c
Page 49 and 50: REFERENCES1 Silvera, M. & Kapasi, R
Page 51 and 52: 69 German, G. (2002). Antiracist st
Page 53 and 54: Minority VoicesA GUIDE TO GOODPRACT
Page 55 and 56: ContentsIntroduction04 The basis f
Page 57 and 58: Meeting NeedsThe level and typeof s
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Good practice example 1 - Sharing V
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Elements of good practiceThese thre
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Neville Street also offers provisio
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Tier 3 CAMHSIn providing for local
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Services targeted on 1) particular
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3) Particular mental health problem
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3.Good practice in service planning
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APPENDIX IIAs set out in Delivering
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This guide to good practice is base
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