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This paper aims to examine three recent papers on psychosis and social inclusion in relation to people of Black African and African Caribbean heritage in the UK and the USA.
Abstract
Purpose
This paper aims to examine three recent papers on psychosis and social inclusion in relation to people of Black African and African Caribbean heritage in the UK and the USA.
Design/methodology/approach
A search was carried out for recent papers on psychosis and social inclusion in relation to people of Black African and African Caribbean heritage in the UK and the USA. I selected three papers addressing this theme from different angles.
Findings
The first paper extends previous findings (that psychosis can follow traumatic events) to Black Americans and includes the contribution of societal inequalities and racism. The second paper illustrates Black men’s experiences of mental health services for psychosis in the UK. It finds, not surprisingly, that a lack of listening combined with coercive use of medication reduces trust in services. The third paper offers hope in reporting collaborative work with people of Black African Caribbean heritage in the UK to culturally adapt family intervention for psychosis. The first and third papers both place importance on valuing people’s spiritual beliefs.
Originality/value
All three papers highlight the on-going need for increased equity and social inclusion in mental health services for people of Black African and African Caribbean heritage, in terms of recognising the role of childhood trauma and later stresses, addressing the potential harm of over-reliance on medication, offering therapy that is collaborative and culturally adapted and respecting valued spiritual beliefs.
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Florence Gwendolyn Rose and Tony Leiba
Mental health is an underdeveloped service to the population generally and to African-Caribbean in particular. There is a need for more sensitive diagnosing, treatment and care…
Abstract
Mental health is an underdeveloped service to the population generally and to African-Caribbean in particular. There is a need for more sensitive diagnosing, treatment and care. African-Caribbean people are asking for a more culturally competent mental healthcare system.
This chapter aims to address the following issues: how African-Caribbean people reflect on mental health and mental ill health. Their reflections are drawn from interviews done with African-Caribbean people who are involved with Hagar, a mental health charity in Lewisham, London. Mental health and mental illnesses will be examined, followed by the Psychiatrists’ use of the diagnostic tools that do a disservice to Black people. The Trans-Atlantic slave trade and its contribution to the mental ill health of Black people will be addressed, thus providing a historical underpinning for much of Black people’s struggle with mental ill health. Racism and its contribution to mental health issues will be presented. The views of the Black Psychiatrist Franz Fanon will be argued as a way of understanding oppression, alienation and mental ill health in Black people, and going on to open up ways of providing treatment and care. Finally suggestions will be made about how to provide a culturally competent mental health service to African Heritage peoples.
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Dawn Edge, Amy Degnan and Sonya Rafiq
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…
Abstract
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.
John Wainwright, Mick McKeown and Malcolm Kinney
The purpose of this paper is to explore experiences of survivors of the mental health system regularly attending a mental health resource centre predominantly but not exclusively…
Abstract
Purpose
The purpose of this paper is to explore experiences of survivors of the mental health system regularly attending a mental health resource centre predominantly but not exclusively focussed on needs of the BAME community.
Design/methodology/approach
In total, 25 participants took part in a qualitative research study regarding their experiences of mental health and racism, alternative mental health support and struggles in the local black community.
Findings
Issues of race, place and space were central to the experiences of BAME mental health survivors. Participants emphasised the importance of place-based support in their everyday life, with the service provided engendering a sense of belonging conducive to coping with various struggles. Race and racism were also central to these daily struggles and the place of Liverpool 8 was at the core of notions of identity and belonging. The space within the centre provided a sanctuary from the combined discriminations and exclusions attendant on being BAME survivors of the mental health system.
Practical implications
Attention to matters of place and space appears crucial to the articulation of appropriate support.
Social implications
Place is salient to understanding the intersecting identities/experience of racism and mental health discrimination, constituting the basis for a concept of placism; associated with exclusions from feeling safe and included in everyday public places (including within the black community) with the exception of the welcoming and unconditionally accepting space of the centre.
Originality/value
This paper is the first to inquire into place-based experiences of alternative black mental health support. Placism is a novel construct that merits further inquiry and theoretical development.
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Mischa Gwaspari, Sanita Hochhauser and Matt Bruce
The main objective of the study is to investigate unmet needs of Black African and Caribbean Heritage (BAH) patients with and without a concurrent diagnosis of antisocial…
Abstract
Purpose
The main objective of the study is to investigate unmet needs of Black African and Caribbean Heritage (BAH) patients with and without a concurrent diagnosis of antisocial personality disorder (ASPD).
Design/methodology/approach
A total of 79 participants were recruited from ten psychiatric inpatient wards across two hospital sites in South London. Personality disorder was assessed using the SCID‐II for DSM‐IV, the prevalence of unmet needs was assessed by The Camberwell Assessment of Need Short Assessment Schedule and substance misuse problems measured using well validated drug and alcohol use disorder identification tools.
Findings
The presence of a concurrent ASPD was independently associated with a greater number of unmet needs. ASPD was associated with lower qualifications and a greater risk of homelessness and substance misuse. Unmet need was associated with lower qualifications and substance misuse. In a stepwise linear regression model alcohol dependence and drug misuse were the most significant predictors of unmet need.
Research limitations/implications
Further research is required to identify the reasons why these needs are not being met and establish reasons for these patients' high‐dropout rates from treatment.
Practical implications
The present findings suggest BAH psychiatric inpatients with ASPD are at greater risk of alcohol dependence and drug misuse and report a greater number of unmet needs thus requiring a greater volume of services; however, current services are not meeting these needs. Mental health teams should ensure thorough needs assessment procedures are incorporated into general psychiatric service practice ensuring effective treatment packages are tailored to these patients needs.
Originality/value
The research identifies a previously under‐researched sub‐group of psychiatric inpatients with a high proportion of unmet health and social needs and suggests further research to develop service improvements supporting their management.
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Addresses a number of issues concerning racial discrimination in UK public libraries. It examines Black librarianship in the UK in 2001; records the development of the Quality…
Abstract
Addresses a number of issues concerning racial discrimination in UK public libraries. It examines Black librarianship in the UK in 2001; records the development of the Quality Leaders Project which focuses on policy development, management and leadership issues in the context of Black workers and community needs; and discusses the potential contribution of this approach.
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Tamara Nadine Sancho and Michael Larkin
Undergraduates are highly susceptible to the development of mental health difficulties. Afro-Caribbean students are particularly vulnerable to the pressures of university yet are…
Abstract
Purpose
Undergraduates are highly susceptible to the development of mental health difficulties. Afro-Caribbean students are particularly vulnerable to the pressures of university yet are less likely than other ethnic groups to receive early intervention. This paper aims to understand the barriers and facilitators that Afro-Caribbean undergraduates perceive towards accessing mental health services in the UK.
Design/methodology/approach
Critical Incident Technique was used as the qualitative method because it explores the critical factors that contribute to or detract from a specific experience. Seventeen Afro-Caribbean undergraduates participated in five focus groups. This involved engaging in a novel psychosocial activity that incorporated vignettes to encourage the identification of barriers and facilitators to service access. The data were analysed thematically to generate categories of critical incidents and wish-list items.
Findings
Analysis revealed rich data from a sub-group rarely researched within UK literature. Fifteen barriers, eleven facilitators and five wish-list items were identified. The importance of mental health literacy, social networks, cultural sensitivity and concerns surrounding services underpinned many categories.
Originality/value
Findings provide a new perspective on barriers reported in previous literature. Novel facilitators were highlighted where, although psychological and sociocultural factors were deemed valuable, structural changes were most desired. Recommended changes illustrate innovative interventions that could make services accessible for young adult Afro-Caribbean populations. Future research should explore the barriers and facilitators identified by Afro-Caribbean undergraduates across various universities who have successfully accessed and engaged with services. This could provide a holistic perspective on viable facilitators enabling access despite the presence of barriers.
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Zhenreenah Muhxinga, Corrine Douglas, David Francis, Mark Laville, Sidney Millin, Juliana Pamfield, Peter Smith and Raymond Smith
A group of African and Caribbean people decided to tell mental health workers and others in east London about their struggles to achieve mental health. They wanted to show that…
Abstract
A group of African and Caribbean people decided to tell mental health workers and others in east London about their struggles to achieve mental health. They wanted to show that black people with mental health problems are individuals, with different histories and different talents. They wanted to show that it is possible for African and Caribbean service users to rebuild their lives after a mental health crisis and even after years in and out of hospital. In this article, Zhenreenah Muhxinga describes how they produced a book of stories to challenge the familiar assumption that recovery is not an option for black people.
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