African-Caribbean interactions with mental health services in the UK: experiences and expectations of exclusion as (re)productive of health inequalities

Abstract

In the context of current concerns about health inequalities among minority ethnic groups in the UK, this paper addresses perceptions of mental health services among members of an African-Caribbean community in a South England town. Efforts to reduce health inequalities must take account of the views of local community members on the sources of those inequalities and on local health services. The statistical existence of inequalities in diagnosis and treatment of African-Caribbeans in the UK is well-established, supported by sociological explanations of these inequalities which centre on social exclusion in a variety of forms: institutional, cultural and socio-economic. However, detailed studies of the perspectives of local communities on mental health issues and services have received less attention. In this case study of community perceptions of mental health services, we find that social exclusion comprises an explanatory framework which is repeatedly invoked by community members in describing their interaction with mental health services. Interviewees assert that experience and expectation of racist mis-treatment by mental health services are key factors discouraging early accessing of mental health services, and thereby perpetuating mental health inequalities. We conclude that participation and partnership are vital means by which to generate both the objective and subjective inclusion that are requirements for an accessible and appropriate health service.

Ethnicity, detention and early intervention: reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study

“…6 This deteriorating relationship trajectory between BME patients and mental health services, with decreasing engagement and increasing detention rates over time, has been consistently demonstrated. 6,[13][14][15][16] It is not clear, however, whether service-level intervention can reduce this detention rate and improve the engagement of BME patients. 3.…”

“…16,20,21 There is evidence that some BME communities, especially those from African Caribbean and Asian backgrounds, attach greater stigma to mental illness, may attribute unusual behaviour to the individual rather than to an illness and seek police rather than medical help when dealing with an ill relative. 10 It is as yet unclear how such factors influence the observed ethnic differences in care pathways during FEP.…”

“…Reducing Social Exclusion: The Social Exclusion Unit Report [15] highlights the importance of EI services in reducing barriers to employment. Social exclusion is the explanatory framework within which service users and BME communities most often describe their interaction with health services, perceiving fewer employment opportunities perceived as a major contributor to exclusion [16]. EI services can, and prioritise social recovery, particularly reintegration into mainstream education or employment.…”

“…6,13,16 A systematic review and meta-analysis 6 found that, compared with white patients, Asian patients are twice as likely and black patients are nearly four times as likely to be detained. The most commonly cited explanations for these differences are 'race related', with the excess attributed to discrimination, labelling and stereotypes of BME patients among psychiatrists.…”

The period of untreated psychosis before treatment initiation:

“…Pathways to care likely differ for various populations [9][10][11][12][13]. Given the importance of discovering determinants of DUP, some of which evolve during pathways to care, and in light of the fact that families commonly initiate evaluation and treatment, this study explored narrative accounts of family members who had been actively involved in initial treatment-seeking for their loved ones with first-episode psychosis.…”