Perceived treatment barriers and experiences in the use of services for obsessive–compulsive disorder across different ethnic groups: a thematic analysis

Abstract

Background Patients from ethnic minority backgrounds are underrepresented in clinical settings. Factors like cost of treatment, poor knowledge of the health system, geographic availability of services, lack of mental health literacy, differences in health beliefs, and social barriers have been identified as reasons for these inequalities. The aim of this study was to identify and compare barriers that parents from different ethnic groups face when accessing specialist services for obsessive–compulsive disorder (OCD) for their children. Method Ten parents from White backgrounds and 10 from ethnic minority backgrounds were recruited from the National and Specialist OCD, BDD, and Related Disorders Clinic for Young People, London, United Kingdom. They were interviewed about their opinions and experiences when accessing treatment. Results Using thematic analysis, several common barriers for both groups were identified. These included a lack of knowledge of OCD, lack of resources within the health system, previous negative experiences, lack of trust in the mental health system, lack of time and financial issues, no support out of hours, bullying, and inconvenient location of services. In addition, there were several barriers that were endorsed by ethnic minority groups but not by the parents from White backgrounds, namely stigma and discrimination from within their communities, shame and denial, a general lack of trust in the health system by their cultural group, different beliefs about mental health issues, and discrimination from within the system. Conclusions Policy‐makers and clinicians should be aware of the additional barriers minority patients may face in accessing treatment and should support interventions designed to overcome them.

Cultural competency in the treatment of obsessive-compulsive disorder: practitioner guidelines

“…Stigma can be related to cultural concerns of bringing the family shame, being perceived as 'crazy' and being hospitalized, confirming false racial stereotypes, accessing mental healthcare that is viewed negatively in the cultural community, and beliefs that having a mental illness or accessing mental health care are signs of weakness (Turner et al, 2016). Compared with White parents of children with OCD, a study conducted in the UK showed that minoritized parents were more likely to fear stigma and discrimination from within their families and cultural groups (Kolvenbach et al, 2018). Shame and denial of mental health symptoms also emerged as salient barriers for patients of colour.…”

“…Seeking treatment may evoke feelings of shame, fear or stigma for having mental health issues at all, and reveal a lack of trust towards the mental health system and therapists (Williams et al, 2017d). Parents also report concerns of systematic discrimination when seeking help for their children of colour (Kolvenbach et al, 2018). In comparison with White British parents, Black African parents were more likely to agree that they would dislike judgement or discrimination of their cultural or ethnic background from a doctor (Fernández de la Cruz et al, 2016).…”

“…Clinicians must actively consider their own biases towards minoritized clients to prevent under-serving individuals from these communities (Kugelmass, 2016;Williams et al, 2012b). As cultural mistrust of mental health care is also a barrier to seeking services (Kolvenbach et al, 2018;Williams et al, 2017c), clinicians should endeavour to practise transparency when communicating goals and expectations for treatment (Williams et al, 2012b). Use of the term 'counselling' instead of 'therapy' may reduce concerns and stigma (Thompson et al, 2004).…”

Improving awareness and help seeking for Obsessive Compulsive Disorder in ethnic minority youth

“…We attempted to approach religious centres in person to overcome these challenges and they were often cautious of the support being offered. However, research suggests that ethnic minorities often seek treatment from religious and traditional healers as this is perceived as less stigmatizing, and thus collaborating with religious leaders may be necessary to increase acceptability of mental health interventions [26,54]. For instance, churchbased health promotion where religious leaders were consulted has been found to improve some health positive behaviours [39][40].…”

“…Existing literature in this area suggests unique barriers for those from ethnic minority backgrounds in accessing rather than receiving support. Studies on OCD report different beliefs about mental health, insu cient mental health literacy, not knowing where to nd help, fears of stigma and discrimination, lack of integration with religious and community groups and inaccessibility as barriers to accessing support [24][25][26]. Some of these barriers are also reported by ethnic minority parents when they were asked about their help-seeking attitudes if their child was struggling with OCD.…”