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Several decades of mental health research in the UK repeatedly report that people of African-Caribbean origin are more likely than other ethnic minorities, including the White majority, to be diagnosed with schizophrenia and related psychoses. Race-based inequalities in mental healthcare persist despite numerous initiatives such as the UK’s ‘Delivering Race Equality’ policy, which sought to reduce the fear of mainstream services and promote more timely access to care. Community-level engagement with members of African-Caribbean communities highlighted the need to develop culturally relevant psychosocial treatments. Family Intervention (FI) is a ‘talking treatment’ with a strong evidence-base for clinical-effectiveness in the management of psychoses. Benefits of FI include improved self-care, problem-solving and coping for both service users and carers, reducing the risk of relapse and re-hospitalisation. Working collaboratively with African-Caribbeans as ‘experts-by-experience’ enabled co-production, implementation and evaluation of Culturally adapted Family Intervention (CaFI). Our findings suggests that a community frequently labelled ‘hard-to-reach’ can be highly motivated to engage in solutions-focussed research to improve engagement, experiences and outcomes in mental health. This underscores the UK’s Mental Health Task Force’s message that ‘new ways of working’ are required to reduce the inequalities faced by African-Caribbeans and other marginalised groups in accessing mental healthcare. Although conducted in the UK (a high-income multi-cultural country), co-production of more culturally appropriate psychosocial interventions may have wider implications in the global health context. Interventions like CaFI could, for example, contribute to reducing the 75% ‘mental health gap’ between High and Low-and-Middle-Income counties reported by the World Health Organization.

This chapter briefly summaries research over the past four decades (and prior) associated with black men and mental health in the UK. The chapter also examines some responses to the research. This is because we unfortunately remain in a situation where black men in Britain are 17 times more likely than white counterparts to be diagnosed with a psychotic illness. Research into the mental health needs of black men has been conducted repeatedly in the UK, with each new generation hopeful for change. By briefly exploring some policies that have emerged to address this inequality, this chapter highlights the barriers to change.

The practice of transracial adoption often triggers strong emotions, effecting views on its ethical validity, both from individuals who are pro transracial adoption and those who strongly resist transracial adoption. This chapter will consider transracial adoption of children of African-Caribbean origin and its psychological impact along a continuum of psychological wellbeing, psychological adjustment and aspects of mental health. The chapter will draw on literature from the USA and, where available, from the UK.

One of the earliest publications on transracial adoption by Grow and Shapiro (1974) explored the psychological adjustment of African-American children placed within white American families. This study along with later studies (Silverman & Feigelman, 1981) concluded that the children were adjusting well in placement. Further early research appeared to suggest that transracial placements have little negative impact on issues of self-esteem, racial or self-identity or intellectual development (Curtis, 1996; Hayes, 1993; Hollingsworth, 1997, 1998; McRoy, 1994; Simon, Altstein & Melli, 1994; Vrogeh, 1997).

The undermining impact on mental health for transracial adoptees appears to be an argument related to the disconnect between the child’s developing racial identity and lack of preparation for racism and the cultural and ethnic group social devaluation likely to be experienced in a white racist society. The impact of loss of ethnic identity is said to be a key issue in the research on transracial adoption. Ethnic identity is the connection or recognition that one is a member of a specific ethnic or racial group and coming to adopt those associated characteristics into the group associated cultural and historical connections into oneself identity (Rotheram & Phinney, 1987). The establishment of a secure and accurate racial identity is said to be a protective factor in psychological adjustment. This chapter will explore issues and narratives related to this argument.

Glaucoma is a blinding disease which disproportionately affects some communities, particularly African‐Caribbeans. The ‘ReGAE’ project: Research into Glaucoma and Ethnicity was set up in 1999 and is based at the Birmingham and Midland Eye Centre. Among its aims are to provide ethnically‐sensitive evidence‐based information to help inform the future commissioning and training of glaucoma care with ethnic groups and to develop a national programme of glaucoma education.

Background: the increased incidence of psychosis in African‐Caribbeans in the UK compared to the white British population has been frequently reported. The cause for this is unclear; social factors are said to account for this increase and one factor that is often cited is discrimination.Aims and method: we have looked at two groups of psychotic patients, blacks of Caribbean origin and white British, and present a qualitative comparison of the individual's experience of unfair treatment and its perceived cause.Results: the African‐Caribbean patients did not describe more perceived discrimination than their white counterparts but were more likely to claim that their distress was due to racial discrimination perpetrated by the psychiatric services and society in general. The white patients were more likely to attribute perceived discrimination to their mental illness.Conclusion: this mismatch of explanatory models between black patients and their doctors may account for some inequalities in their treatment, their relative non‐engagement and adverse outcome.Declaration of interest: none.

Young men of African‐Caribbean origin are over‐represented in mental health services (MHSs), often entering these services by coercive routes, such as under the Mental Health Act or via the criminal justice system. This pilot study focused on patients' narratives of their journey from first contact with primary care services. Our principal aim was to describe and compare early experiences of help‐seeking for serious mental health problems among young men of white and black ethnicity.In‐depth interviews were conducted (using a topic guide) with black and white men aged 18‐30 years old and who were accessing secondary care mental health services for the first time for a psychotic illness. Participants were recruited from the early intervention services serving inner‐city Birmingham. Seven participants were interviewed, and 12 themes were identified from transcripts. Six of these individuals had consulted their GP prior to accessing the early intervention service. Only one attendee received medication at initial consultation, and none were referred to specialist mental health services. Participants described the manner in which family or friends interceded on their behalf to advocate for and secure specialist help ‐ either by accompanying them to see their GP, contacting mental health services directly or taking them to the local accident and emergency department. The latter route was accessed by black but not white participants. Three out of four black participants and one out of three white participants were subsequently admitted to hospital. None of the participants were particularly satisfied with their experience of primary care. Communication was less than ideal, and participants were able to reflect on their own failure to disclose critical information to their doctor. By contrast, all participants confided in family or in their trusted friends that they were becoming aware that they were experiencing mental distress.Our findings confirm the difficulties faced by GPs and those who consult them in the early stages of first onset psychotic episodes, and the importance of having family or friends who are able to advocate on other people's behalf at times of crisis. Despite the advent of universal early intervention services across the UK, those most in need may still not be receiving the help that they need in the timeliest manner.

Vitamin D deficiency is prevalent worldwide. This paper aims to investigate the vitamin D status and dietary intake in young university students.

Forty-one healthy students aged 18–29 years from Coventry University UK were recruited during January-February 2019, including white Caucasians (n = 18), African-Caribbeans (n = 14) and Asians (n = 9). Plasma 25(OH)D concentrations were measured and dietary vitamin D intake was determined. Chi-square and simple linear regression were used to analyse the data.

The plasma 25(OH)D concentrations were (36.0 ± 22.2) nmol/L in all subjects, (46.5 ± 25.3) nmol/L in white Caucasians, (22.6 ± 7.4) nmol/L in African-Caribbeans and (37.4 ± 21.7 nmol/L) in Asians. The majority (85.7%) of African-Caribbeans were vitamin D deficient compared with 22.2% of white Caucasians and 33.3% of Asians (p = 0.001). Overweight/obese subjects showed a significant higher proportion of vitamin D deficiency (65%) than normal weight subjects (28.6%) (p = 0.04). The average dietary vitamin D intake in all subjects was (4.6 ± 3.9) µg/day. Only 12.1% of the subjects met the recommended dietary vitamin D intake of 10 µg/day. Dietary vitamin D intake (p = 0.04) and ethnicity (p = 0.01) were significant predictors of 25(OH)D levels and accounted for 13% and 18.5% of 25(OH)D variance, respectively.

This small-scale study showed an alarmingly high prevalence of vitamin D deficiency among subjects from African-Caribbean origin during wintertime. Education programs and campaigns are urgently needed to fight the vitamin D deficiency in this population.

The targeted population were in a critical period of transition from adolescence toward adulthood involving in changes in behaviours and nutrition.

Research suggests that African-Caribbeans are less likely than their white British counterparts to ask for mental health support (Cooper et al., 2013). This is despite research identifying that minority groups as a whole, when compared to the white majority, report higher levels of psychological distress and a marked lack of social support (Erens, Primatesta, & Prior, 2001). Those who do request support are less likely to receive antidepressants (British Fourth National Survey of Ethnic Minorities, 1994; Cooper et al., 2010) even when controlling for mental health symptom severity, with African-Caribbeans less likely to make use of medication for depression even when prescribed (Bhui, Christie, & Bhugra, 1995; Cooper et al., 2013). Studies reporting on reasons for black people being less likely to attend for mental health consultation with their GP suggest a variety of explanations why this may be, focussing both on the suspicion of what services may offer (Karlsen, Mazroo, McKenzie, Bhui, & Weich, 2005) and the concern of black clients that they may experience a racialised service with stigma (Marwaha & Livingstone, 2002). Different understandings and models of mental illness may also exist (Marwaha & Livingstone, 2002). Different perspectives and models of mental health may deter black people from making use of antidepressants even when prescribed. Despite a random control trial showing that African-Caribbean people significantly benefit from targeted therapy services (Afuwape et al., 2010), the government, despite a report by the Department of Health in 2003 admitting there was no national strategy or policy specifically targeting mental health of black people or their care and treatment has not yet built on evidence-based success. One important aspect recognised by the Department of Health (2003), was that of the need to develop a mental health workforce capable of providing efficacious mental health services to a multicultural population. Although there were good strategic objectives little appeared to exist in how to meet this important objective, particularly in the context of research showing that such service provision could show real benefit. The Department of Health Guidelines (2003) focussed on the need to change what it termed as ‘conventional practice’, but was not specific in what this might be, or even how this could improve services to ethnic minorities. There was discussion of cultural competencies without defining what these were or referencing publications where these would be identified. There was a rather vague suggestion that recent work had begun to occur, but no indication that this had been evaluated and shown to have value (Royal College of Psychiatrists, 2001). Neither British Association for Counselling and Psychotherapy nor British Psychological Society makes mention of the need for cultural competencies in organisational service delivery to ethnic minority clients. This chapter will describe, explore and debate the need for individual and organisational cultural competencies in delivering counselling and psychotherapy services to African-Caribbean people to improve service delivery and efficacious outcomes.

The purpose of this paper is to discuss two recent studies on depression in members of ethnic minorities, one based in the UK with older people, and one in the USA. The aim was to examine what might lead to depression in these groups, and what might protect people from it.

The UK-based study examined depression and physical health in older members of the two largest ethnic minority groups in the UK: African Caribbean and South Asian. The US-based study examined whether a sense of belonging to the population group African Americans protected people from depression, as one social theory might predict, or whether racism prevented this protection, as predicted by another theory.

In London-based older South Asians, depression was explained by their poorer physical health compared to white Europeans. In older people of black Caribbean origin, depression was linked to their social disadvantage. The researchers did not measure people’s experience of discrimination, and other research suggests this can explain both physical illness and depression. The US-based study reported better well-being for people who identified with other African Americans, but not if they also felt negative about African Americans. However, these were weak links, so other things may affect well-being more, such as day-to-day relationships and a range of group memberships.

The London-based study was new in studying depression in older people belonging to the two largest ethnic minority groups in the UK and in white Europeans. The US study tested two competing social theories with different predictions about depression in relation to belonging to an ethnic minority. Both studies highlight the need for more research on discrimination and how to reduce it and its negative effects on both mental and physical health.