How to reach and engage with young people from black and minority ethnic groups who may require help from mental health services

What needs to happen to aid the development of effective service provision for young people from black and minority ethnic groups.

Minority ethnic population of the UK: 4.5 million (7.6%)

Indians Pakistanis Black Caribbeans Black Africans Mixed ethnic backgrounds

Black Caribbean Pakistani Indian Bangladeshi Chinese Travellers

Iraqis Somalis Yemenis Iranians Kurds Bosnians Algerians Tamils Vietnamese

Ethnicity is…

A process by which people create and maintain a sense of identity

Something that we all have

Barriers to access

Determined by a variety of factors: Level of psychological distress Personal problem-solving skills Environmental factors Negative attitudes towards mental health

professionals Preferences for informal sources of help

(friends, family members) Religious coping strategies

Use of GP services Referrals for severe problems

Misunderstandings about the structures of services

Exclusion from school Being looked after Homelessness Institutionalised racism Lower income Unemployed Overcrowding Bad housing Poverty

Communicational difficulties GP consultations not conducted Level of participation by the patient

reduced

Discrimination

Racial stereotyping

Shame-orientated Liable to adapt their behaviour to

‘save face’ Reluctant to seek help outside the

family Fearful of criticism and losing face in

society Conflict between the service user and

the family

Psychological problems not identified Nature of GP-patient interaction Poor communication Greater somatisation/presentation of

physical illness to GPs Lack of trusts in services/professionals

Issues raised by young people in black and minority ethnic

groups

Diversity of needs Education and employment Physical health Discrimination and racism Family relationships Inclusion in local community Money and finances

Past traumatic experiences Worries about legal status How long they might stay in UK Losses and grief

Fears of stigma and general reluctance to talk

Difficulties in finding out where to go Long waiting times Having to travel some distance No interpreter Sense of being ‘passed around’ Having to re-tell their story Service times not convenient

Stigma of being in contact with services

Worried that friends and family would find out

Concerns those in close-knit community would find out

Lack of knowledge of local area

Lack of knowledge of transport system

Not being able to self-refer

Not able to get help promptly

Information sharing Trusting relationships Staff changes Constantly referred on Unfamiliar with how UK health system

works

Having some choice in own care Choice of gender of staff

member Cultural background of staff

member Staff interested and aware of

differences

Care through adult mental health services

Inpatient care on adult wards

Failure of inpatient CAMHS to meet dietary requirements

Day-to-day social interaction

Different dynamics and roles within families

Different attitudes towards being asked questions

Worried about views of parents

Professionals making assumptions on basis of ethnic group

Responding to questions about ethnicity

Appreciate the diversity of needs and situations

Why the question about ethnicity is being asked

What information is actually required

Develop an understanding

Take account of needs

Suggestions for improving access to and the delivery of services for the mental health of young people from black and minority ethnic groups

Greater range of settings including drop-in resources

More flexible hours of operation Support from referring professional Services in other settings Choice about ethnicity of professional User involvement

Outreach work Work in schools Non-traditional routes

More awareness-raising Promotion through frontline

professionals Use of audio-visual materials Changing referral structures Information for parents, family

and community ‘Open days’

Interpreters to receive training about mental health

Services to work with same interpreters to facilitate continuity

Simultaneous translations and interpreting

Identified training needs:• Cross-cultural communication

of distress• Engagement skills• Challenging personal views and

attitudes• Information on adapting models

and approaches • Information about client

contexts• Information about local services

Having a diverse staff group able to communicate in a range of languages

Neutral décor or reflecting local community through signs, posters and displays in different languages

Interpreter support Reception staff from black and minority ethnic

groups Celebrating religious and other cultural events Space to accommodate extended family

members Translated materials in different languages

(and ideally ansaphone not only available in English)

Need for different agencies to work in partnership

Forge effective working links Services that can meet diverse needs

Frontline access Informal venues Support across different areas or

social activities Less obviously mental health focused.