Black & Ethnic Minority (BME)

Britain is a multicultural society. Nearly 6.4 million people in England belong to ethnic minority communities, representing about 1 in 8 of England’s population.

The ethnic minority communities in England share a number of features, namely disadvantage and discrimination in almost all walks of life, and this is particularly true in the area of health and health care. People from black and minority ethnic groups suffer from poorer health, have reduced life expectancy and have greater problems with access to health care than the majority white population.

The problems and challenges associated with ethnicity and mental health are complex and not amenable to either simple solutions or a single approach. Progress and change in this area is dependent on an inclusive process, involving politicians, policy makers, service providers from both statutory and voluntary sectors, service users and carers and most importantly, black and minority ethnic communities themselves.

The Fourth National Survey of Ethnic Minorities found that minorities were more likely than white people to report fair, poor or very poor health, limiting long-standing illnesses and a registered disability. Minority groups, relative to the white majority, report significantly higher scores of psychological distress, a high prevalence of diabetes, poor self assessed general health, and a severe lack of social support. Poor physical health amongst minority ethnic groups is also reflected in relatively higher mortality among migrants.

Despite the higher levels of ill health and disability amongst the minority ethnic groups they appear to have poorer access to health services. Whether this is due to variations in help-seeking behaviour, inaccessibility of health services or some other factors is not clear. There is also emerging evidence that within the health service, ethnic variations exist in access to particular types of medical interventions.

There does not appear to be a single area of mental health care in this country in which black and minority ethnic groups fare as well as, or better than, the majority white community. Both in terms of service experience and the outcome of service interventions, they fare much worse than people from the ethnic majority do. In addition, disease burden associated with mental disorder appears to fall disproportionately on minority ethnic populations.

Whilst there is little evidence to show that children and young people from minority ethnic groups are more likely than the indigenous white population to have mental health problems, the higher levels of poverty and unemployment in minority ethnic families suggests that, for some children, the risks will be greater.

Following the Race Relations (Amendment) Act (2000), all public authorities have an explicit duty to actively promote race equality. Their general duty is to:

• Eliminate unlawful racial discrimination
• Promote equality of opportunity
• Promote good race relations between people of different racial groups

This new public duty is not optional and statutory health and social care organisations have to meet it, irrespective of the size of the ethnic minority population they serve.

For the first time since the inception of the NHS, a national approach aimed at reducing and eliminating ethnic inequalities in health service experience and outcome is being advocated. The central principle that guides the NHS is that there should be high quality and uniform services available, and this should include tackling ethnic inequalities within mental health services.

The NIMHE BME Mental Health programme is the largest of the current NIMHE Programmes, reflecting the priority of BME issues within mental health services, and outside of those services. This programme is a dynamic and fast paced set of initiatives, with a commitment to ongoing dialogue with experts in the field: service users, carers, voluntary groups and others

More information can be found on the NIMHE web site : www.nimhe.org.uk/priorities/black.asp and NIMHE’s Knowledge Community www.kc.nimhe.org.uk

In summary the aims of the NIMHE BME programme are to:

• Enhance the quality of life, challenge exclusion through improved mental health services & health outcomes
• Develop appropriate training and support to staff to deliver culturally competent services, with confidence
• Enhance, or build capacity within black and minority communities and the voluntary sector to deal with mental health and mental ill health.
• To ensure compliance with Statutory obligations, [RR[A]Act 2000, Human Rights Act 1998

Summary of key policy documents relating to BME:

"Celebrating our Cultures: Guidelines for Mental Health Promotion with Black and Minority Ethnic Communities"

Published by NIMHE (developed by Mentality) in March 2004 this document provides information about specific mental health promotion needs relevant to a number of black and ethnic communities in England. It builds on "Inside Outside" published in 2003.

Professor Kamlesh Patel, Head of the Centre for Ethnicity and Health at the University of Central Lancashire oversees a key policy initiative on Race Equality within the Department of Health, including taking forward the programme of action arising from 'Delivering Race Equality'.

Delivering Race Equality: A Framework for Action - Mental Health Services Consultation Document Oct 2003

This draft framework sets out what those planning, delivering and monitoring local primary care and mental health services need to do to improve services for users experiencing mental illness and distress, and their relatives and carers, from Black and minority ethnic communities.

‘ Engaging and Changing’

This report is primarily designed to assist Chief Executives, Medical Directors and Directors of Nursing in StHAs, PCTs and Care Trusts in developing policies concerning the care and treatment of Black and minority ethnic detained patients. It focuses on ethnic monitoring, racial harassment, the use of interpreters and the provision of culturally appropriate care and staff training.

The context for this report includes visits on 11 May 1999 to 104 in-patient units in the NHS and independent sectors (National Visit 2) to examine aspects of the care and treatment of patients from Black and minority ethnic communities detained under the Mental Health Act and the implementation of the Race Relations (Amendment) Act 2000.

‘Inside Outside’

This policy document was published by NIMHE in March 2003 and sets out three key objectives and recommendations for change to improve the overall mental health of black and minority ethnic people living in England:

• To reduce and eliminate ethnic inequalities in mental health service experience and outcome.
• To develop the cultural capability of mental health services
• To engage the community and build capacity through community development workers.

Real Voices

Survey findings from a series of community consultation events involving Black and Minority Ethnic groups in England Sept 2003

'Breaking the Circles of Fear'

The Sainsbury Center for Mental Health’s major policy review of 2002, documents 'circles of fear' and the impediments to change which lead to poorer treatment and care of African and African Caribbean adults. Its groundbreaking recommendations chart a programme of reform aimed at breaking these circles of fear and delivering mental health services which meet their needs and aspirations.