Karen Newbigging

Community conversation: addressing mental health stigma with ethnic minority communities.

IntroductionStigma associated with mental health problems is a significant public health issue. Patterns of stigma and discrimination vary between and within communities and are related to conceptualisations of, and beliefs about, mental health. Population approaches to addressing stigma rarely consider diverse cultural understandings of mental health.Methods257 members of the major black and minority ethnic communities in Scotland participated in 26 mental health awareness workshops that were designed and delivered by community organisations. Questionnaires measuring knowledge, attitudes and behavioural intent were completed before and after the intervention.ResultsCommunity led approaches that acknowledge cultural constructs of mental health were received positively by community groups. The study found significant reported stigma in relation to public protection, marriage, shame and contribution, but also high levels of recovery optimism. The workshops resulted in significant positive change in relation to knowledge, attitudes and behavioural intent amongst participants, with most aspects of stigma showing significant improvement, with the exception of dangerousness.DiscussionThe paper argues community approaches to tackling stigma are more valuable than top-down public education and could form the basis of national initiatives. Refinements to the evaluation framework are considered.

The role of advocacy and interpretation services in the delivery of quality healthcare to diverse minority communities in London, United Kingdom

Inequalities in access to appropriate and acceptable healthcare contributes to a pattern of poorer health status, reduced life expectancy and greater dissatisfaction with healthcare amongst people from Black and minority ethnic communities (BME). Language acts as a further barrier to access. The development of bilingual advocacy fuses two key functions--interpretation and advocacy--to ensure that people from BME communities are able to have their healthcare needs met appropriately. This paper explores the development of bilingual advocacy in East London, which has a highly diverse population speaking over 100 different languages. It considers the development of the bilingual advocacy services by an NHS University Hospital Trust, the local experience of these services and the factors that have influenced their development. We employed the Delphi method amongst the four authors to examine the advocate-, service- or client-related challenges that face advocacy services; and the threats of these challenges to Trust-based advocacy and their implications to the service, client and advocate. Advocate-related challenges included status, esteem and remuneration of bilingual advocates in relation to other health professionals, as well as skills development, career progression, gender, capacity building and potential research contributions. Service-related challenges included work load, case mix, administration, commissioning processes/arrangements; entrepreneurial aspects of advocacy services; and mechanisms/potentials for cost recovery. Client-related challenges included continuity of advocacy; language requirements and advocacy needs of clients; and ways in which mobile populations influence planning and delivery of advocacy services for inner city hospitals. The paper concludes with identifying the implications for future development of bilingual advocacy services and the implications for their workforce.

Mental health advocacy with black and minority ethnic communities: conceptual and ethical implications.

Purpose of review Recent policy and legislative developments confirm the right to advocacy for people experiencing mental health problems. Provision of mental health advocacy for black and minority ethnic communities is particularly identified as a key objective for Primary Care Trusts. This review considers the implications for commissioners and practitioners of ensuring access to appropriate advocacy for service users from black and minority ethnic community. Recent findings There is a dearth of literature on mental health advocacy with black and minority ethnic communities. The available research suggests that mainstream conceptualizations of advocacy are not meaningful to these communities and this adversely affects access. Advocacy provided by black community and voluntary sector organizations begins with understanding racism and social disadvantage. It is therefore concerned with addressing these inequalities and resonates strongly with current concepts of recovery. Summary People from black and minority ethnic communities are not well served by current provision of mental health advocacy, and there is a risk that this will be replicated in the development of independent mental health advocacy, under the amendments to the UK Mental Health Act of 1983. This largely reflects the conceptualization of advocacy and its purpose. The implications for both commissioning and provision of advocacy are explored.

Mental health advocacy and African and Caribbean men: good practice principles and organizational models for delivery

Background  Advocacy has a critical role to play in addressing concerns about access to appropriate mental health care and treatment for African and Caribbean men. Aim  To investigate good practice principles and organizational models for mental health advocacy provision for African and Caribbean men. Study design  The study consisted of: (i) A systematic literature review. Bibliographic and internet searching was undertaken from 1994 to 2006. The inclusion criteria related to mental health, advocacy provision for African and Caribbean men. (ii) Four focus groups with African and Caribbean men to explore needs for and experiences of mental health advocacy. (iii) An investigation into current advocacy provision through a survey of advocacy provision in England, Wales and Northern Ireland. (iv) Twenty-two qualitative stakeholder interviews to investigate the operation of mental health advocacy for this client group. The study was undertaken in partnership with two service user-led organizations and an African Caribbean mental health service. Results  Primary research in this area is scant. Mainstream mental health advocacy services are often poor at providing appropriate services. Services developed by the Black Community and voluntary sector are grounded in different conceptualizations of advocacy and sharper understanding of the needs of African and Caribbean men. The lack of sustainable funding for these organizations is a major barrier to the development of high-quality advocacy for this group, reflecting a lack of understanding about their distinctive role. Conclusions  The commissioning and provision of mental health advocacy needs to recognize the distinct experiences of African and Caribbean men and develop capacity in the range of organizations to ensure equitable access.Background  Advocacy has a critical role to play in addressing concerns about access to appropriate mental health care and treatment for African and Caribbean men.

Conflict of roles: A conflict of ideas? The unsettled relations between care team staff and independent mental health advocates

Drawing on a national study of independent mental health advocacy, we explored the social relations of independent advocacy. The study was commissioned by the Department of Health (England), and involved a case study design covering eight different geographies and service configurations, and interviews or focus groups with a total of 289 stakeholders across two phases of inquiry. This paper focused on the analysis of qualitative data relevant to the relationship between mental health-care services and independent advocacy services, drawn from interviews with 214 participants in phase two of the study. Discussion of these particular findings affords insights into the working relations of independent advocacy within mental health services beset by reorganizational change and funding cuts, and increasing levels of legally-sanctioned compulsion and coercion. We offer a matrix, which accounts for the different types of working relationships that can arise, and how these are associated with various levels of understanding of independent advocacy and appreciation for the value of advocacy. The discussion is framed by the wider literature on advocacy and the claims by practitioners, such as nurses, for an advocacy role as part of their professional repertoire.

The early experience of consultant psychiatrists in application of the Mental Capacity Act: issues for black and minority individuals

The Mental Capacity Act 2005 (MCA) was fully implemented in October 2007 in England and Wales. This article reports on two similar, but separate, pilot questionnaire studies that examined the experience of consultants in old age psychiatry and consultants in other psychiatric specialities in the early implementation of the MCA pertaining to issues relevant to black and minority ethnic (BME) groups. Fifty‐two (27%) of the 196 consultants in old age psychiatry and 113 (12%) of the 955 consultants in other psychiatric specialities returned useable questionnaires. Eighty per cent or more of the consultants in old age psychiatry and consultants in other psychiatric specialities gave consideration to religion and culture and ethnicity in the assessment of decision‐making capacity (DMC). Almost 50% of the consultants in old age psychiatry reported that half or more of the patients lacking fluency in English or where English was not their first language received an assessment of DMC with the aid of an interpreter and 40% of the consultants in other psychiatric specialities reported that no such patients received an assessment of DMC with the aid of an interpreter.The low rate of using interpreters is of concern. The nature of the consideration and implementation of factors relevant to culture, ethnicity and religion in the application of the MCA and the precise reasons for the low rate of using interpreters in patients lacking fluency in English or English not being their first language require clarification in further studies.

Reimagining mental health in primary care: a blueprint for STPs

Recently a man called David told me his story. Desperately low, and at his wit’s end having lived in a homeless hostel for 8 years, without family contact or a job, his GP put him in touch with the MIND Esteem Team — designed to help people with complex lives. A year later he has his own place and a new life as a peer support worker. He said it only took one person to help him find his way, but that one person needs the support of a system working well together. Our understanding of primary care mental health is continually evolving. Shaped by changing societal and medical perceptions, we strive to bring equity, effectiveness, access, and efficiency to our care pathways amid the chaos of human distress. The tug between the biological and psychosocial, symbolised by the apparently polarising questions ‘What is wrong?’ and ‘What has happened?’ illustrates the dichotomy that lies at the heart of caring for humans in distress, and troubles a medical profession still wrestling with mind–body dualism. The GP Five Year Forward View and the introduction of sustainable transformation plans, now partnerships (STPs), provide a clear opportunity for primary care to embark on a journey of reimagining mental health; making mental wellbeing everyone’s business, in response to people’s distress and illness, which are often undifferentiated and complex, not neatly fitting diagnostic categories, but representing responses to the challenges of everyday living and the impact of adverse childhood experiences, profoundly influencing future health and success in life. It also requires an integrated system-wide response in which primary care is at the forefront of access and engagement, and, thus, prevention, early intervention, and recovery. However, at a time when the NHS and its primary care workforce are experiencing unprecedented pressures, with expectation and demand rising in …

Contribution of the voluntary sector to mental health crisis care in England: protocol for a multimethod study

Introduction Timely access to the right kind of support for people experiencing a mental health crisis can be problematic. The voluntary sector (VS) plays a key role in providing support and enabling access, but there is a knowledge gap concerning its contribution and interface with public services in mental health crisis care. This study aims to address this. Methods and analysis The study has three empirical elements: (1) a national survey of voluntary sector organisations (VSOs) in England and national stakeholder interviews to develop a typology of organisations and interventions provided by VSOs; (2) detailed mapping of VS services in two regions through interviews and extending the national survey; (3) four case studies, identified from the regional mapping, of VS mental health crisis services and their interface with National Health Service (NHS) and local authority services, at both a system and individual level. Data collection will involve interviews with commissioners; VSO and NHS or local authority providers; and focus groups with people who have experience of VSO crisis support, both service users and carers; and mapping the crisis trajectory of 10 service users in each study site through narrative interviews with service users and informal carers to understand the experience of VSO crisis care and its impact. Ethics and dissemination The University of Birmingham Humanities and Social Sciences Ethical Review Committee granted ethical approval (reference ERN_16–1183) for the national and regional elements of the study. Ethical review by the Health Research Authority will be required for the case study research once the sites have been identified from the first two elements of the study. A range of methods including a policy seminar, publication in academic journals and a tool kit for commissioners and practitioners will be produced to maximise the impact of the findings on policy and practice.