Search results

This chapter aims to give an overview of key mental health policy and service provision, highlighting the need for specific attention to Black and minority ethnic children and young people. The focus is on mental health provision in the UK provided through the statutory sector and the voluntary and community sector, the issues raised are likely to have resonance across wider geographic locations. The themes examined include: the relevance of terminology regarding race and ethnicity and related impact on the planning and provision of services; the extent to which policy and commissioning of services give due focus and attention to the mental health of Black and minority ethnic children and young people; views young people themselves have contributed on the issue; and a case study illustrating work being undertaken to redress some of the imbalances encountered by young people in accessing appropriate support. The chapter argues that the supply chain to young people receiving support that is relevant and appropriate to their needs is a long and complex one. It is fundamental to take a holistic approach and consider how the components of this chain impact specifically on the mental health of children and young people from Black and minority ethnic communities.

Child and adolescent mental health services (CAMHS) – This term refers to all services that work with children and young people to address their behavioural and emotional wellbeing needs. The services may be provided by the National Health Service (NHS), local authority, school, private sector or charitable organisation and span early intervention support through to specialist treatment.

Care Quality Commission – The independent regulator of health and social care services in England.

Commissioning – The process by which health services are procured and should be based on an up-to-date assessment and understanding of needs of the target population.

Co-production – A process for planning and delivery of health and social care services that involves partnership working and power sharing between those responsible for the planning and provision of services, service users, their family members, carers and other citizens.

National Service Framework – Ten year programmes that, until the health and social care reforms started in 2010, defined standards of care in the NHS including measurable goals within set timeframes.

Population Needs Assessments – The collection and study of relevant data to understand and estimate current and future needs of a population in order to inform the planning of services that meet identified needs.

Voluntary and Community Sector – Also referred to as the Third Sector and encompassing a diverse range of organisations, services and groups that are seen as distinct from the public (also referred to as statutory) and private sectors.

Youth Information, Advice and Counselling Services (YIACS) – Most YIACS have charitable status and provide services to young people on a range of issues, a key feature associated with YIACS is the provision of holistic, young person centred support provided under one roof.

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.

Since the demise of Delivering Race Equality strategy in 2010 under the last Labour government and with the Coalition (2010–2015), and now the Conservative government at times have adopted a “color blind” approach to race and health. This raises the fundamental question why is race equality off the political agenda and how black mental health issues can be part of a future strategy. The 2015 Care Quality Commission (CQC) annual monitoring report of the Mental Health Act (MHA; which has also incorporated the learning since the inception of the Act in 1985) further highlighted the overrepresentation of African and Caribbean men and women who are sectioned in secure wards or on Community Treatment Order (CTO) in the psychiatric system over the last 30 years. The CQC have revised the code of practice which recognizes issues around race equality as part of wider perspectives and principles of human rights.

In October 2017, the government established an independent review of the 2007 MHA as a way of providing more safeguards for patients and service users. The review, under the leadership of Sir Simon Wessely which is reported in 2018, provided an opportunity for an informed public debate on the historical and contemporary roles of psychiatry and the experiences of mental health in Britain’s African and Caribbean communities. The review did examine community anxieties about the proportionally larger numbers of black ethnic minorities receiving inpatient care and CTOs, or in the criminal justice system. However, after 30 years of Black History Month in the UK, we still need to ask the question: Are those of African descent overrepresented in these systems? If so, is serious mental illness over diagnosed among these groups due to the persistence of stereotypes rooted in the experiences of slavery, or do they in fact experience distinctive patterns of mental health and illness, perhaps due to the wider fallout of historical enslavem

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.

Given the backdrop of a global influx of refugees and high numbers of youth under the age of 18 among counts of forcibly displaced persons, this chapter examines the literature on educational experiences among resettled refugees in Western countries. Young refugees typically face a complex set of unique challenges and adversities including disruptions in their schooling, displacement, exposure to potentially traumatic events, and resettlement stressors. Youth and parent interactions with schools are influenced by linguistic and cultural differences, which can make it difficult to communicate and advocate for young refugees' educational needs. The chapter provides a review of educational literature on resettled refugee youth. We use a socioecological framework and offer a protective and promotive lens, including psychosocial issues, to consider for school-based prevention and intervention programs. The chapter builds upon Pastoor (2015), who advocated a holistic approach with refugee students in school-based settings.

Workplace voice is well-established and encompasses behaviors such as prosocial voice, informal complaints, grievance filing, and whistleblowing, and it focuses on interactions between the employee and supervisor or the employee and the organizational collective. In contrast, our chapter focuses on employee prosocial advocacy voice (PAV), which the authors define as prosocial voice behaviors aimed at preventing harm or promoting constructive changes by advocating on behalf of others. In the context of a healthcare organization, low quality and unsafe patient care are salient and objectionable states in which voice can motivate actions on behalf of the patient to improve information exchanges, governance, and outreach activities for safer outcomes. The authors draw from the theory and research on responsibility to intersect with theories on information processing, accountability, and stakeholders that operate through voice between the employee-patient, employee-coworker, and employee-profession, respectively, to propose a model of PAV in patient-centered healthcare. The authors complete the model by suggesting intervening influences and barriers to PAV that may affect patient-centered outcomes.