Paper
Tackling inequalities: a partnership between mental health services and black faith communities
Published May 4, 2019 · Louisa Codjoe, S. Barber, G. Thornicroft
Journal of Mental Health
15
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Influential Citations
Abstract
In October 2017, the UK Prime Minister announced a review of the Mental Health Act in England. In the announcement, the fact that people from Black and minority ethnic groups (BAME) are four times more likely to be detained under the Act than White British groups (Care Quality Commission, 2018) was acknowledged. This has been described as the country’s “dirty secret” (Mulholland, 2017) and urgently needs addressing. The reasons for this disparity have been long debated. Some argue that it is a function of higher rates of serious mental illness in this group (Gajwani, Parsons, Birchwood, & Singh, 2016), which may be driven by social determinants of poor mental health and structural discrimination of minorities outside of the health system. However, determining the seriousness of mental illness involves a risk assessment, which may be coloured by prejudice and the notion of the Black person as “big, black and dangerous” (Mulholland, 2017). Others argue that detention rates are higher due to later presentation to health services. Whilst there is some evidence for this in the US (Sohler, Bromet, Lavelle, Craig, & Mojtabai, 2004), this finding has not been replicated in multiple UK cohort studies (Ghali et al., 2013; Morgan et al., 2006). What has been shown in the UK is that individuals from BAME groups are more likely to enter mental health services through the criminal justice system than through primary health care (Ghali et al., 2013). In addition, the longitudinal trajectory of psychosis in Black service users typically has longer periods of admission and compulsory re-admission (Ajnakina et al, 2017). There are other examples of mental health inequalities for the BAME group. People from ethnic minorities are less likely than their White British counterparts to have contacted their general practitioner (GP) about mental health concerns, to be prescribed antidepressants, or to be referred to specialist mental health services (Memon et al., 2016). Indeed, a recent report highlighted the underutilisation of services by BAME groups who are hard to reach due to linguistic and cultural barriers (NICE, 2017). Such failures by the professional health services plausibly leads to fear and mistrust in the community, perpetuating a cycle of poor access and increased requirement for coercion.
Mental health services and black faith communities can work together to address the disparity in mental health detention rates for Black and minority ethnic groups in the UK.
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