Project title: Consulting Local Minds: A Community Engagement project on Mental Wellbeing
Local partners: Nilaari, a specialist community mental health charity delivering culturally-sensitive social care support, talking therapies and training to adults and young people across Bristol.
Project team and expertise:
NB : Senior researcher with expertise in ethnicity and health. Experience of community engagement and working with ethnic minority community mental health organisations.
Shelagh Hetreed (Nilaari): Business officer & Diversity Training Programme co-ordinator. Experience of BAME community engagement, tackling health inequalities and working towards inclusion through respect, changing hearts and minds and valuing and learning from lived experience.
People from ethnic minority groups are less likely to receive formal support from mainstream health services in the early stages of mental illness 1 2, and are overrepresented in compulsory hospitalisation for crisis treatment compared to the white British population in the UK 3-5. These inequalities have persisted for over thirty years, despite legal obligations on service providers to promote equality and reduce inequalities in healthcare 6 7, and targeted policy efforts to improve helpseeking pathways for ethnic minority groups 8-10. More research is needed to understand the factors generating and sustaining these inequities. There is a widely recognised need for more coproduced research and interventions that are informed by local specialist mental health organisations, communities and stakeholders 11. This project is an initial community engagement and feasibility exercise and learning will inform future public engagement activity and research at the University.
Aims: To engage with people from several ethnic minority groups in Bristol to explore how mental health, wellbeing and helpseeking is perceived, managed and negotiated.
Planned activities: We aim to run three workshops over three days in June and July 2019. People from all ethnic minority groups including service users, non-service users and carers will be invited to the consultation workshops (15 participants per day). The workshops will consist of several individual and group exercises designed to explore understandings and perceptions about the management of mental health, as well as the factors that help or hinder helpseeking behaviours. These exercises will help us understand how individuals from ethnic minority groups: plot and frame helpseeking pathways; build their resilience in difficult times; access and engage with mental health services; interpret notions of ‘care’ and ‘support’ from cultural perspectives; identify key transitional points during the helpseeking journey. The workshops will be facilitated by NB and Shelagh Hetreed.
1. Cooper C, Spiers N, Livingston G, et al. Ethnic inequalities in the use of health services for common mental disorders in England. Social psychiatry and psychiatric epidemiology 2013;48(5):685-92.
2. Prady SL, Pickett KE, Petherick ES, et al. Evaluation of ethnic disparities in detection of depression and anxiety in primary care during the maternal period: combined analysis of routine and cohort data. The British Journal of Psychiatry 2016;208(5):453-61.
3. Bhui K, Stansfeld S, Hull S, et al. Ethnic variations in pathways to and use of specialist mental health services in the UK: systematic review. The British Journal of Psychiatry 2003;182(2):105-16.
4. Bansal N, Bhopal R, Netto G, et al. Disparate patterns of hospitalisation reflect unmet needs and persistent ethnic inequalities in mental health care: the Scottish health and ethnicity linkage study. Ethnicity & health 2014;19(2):217-39.
5. Barnett P, Mackay E, Matthews H, et al. Ethnic variations in compulsory detention under the Mental Health Act: a systematic review and meta-analysis of international data. The Lancet Psychiatry 2019
6. Race Relations (Amendment) Act 2000. London: The Stationery Office.
7. Equality Act 2010. London: The Stationery Office.
8. Department of Health. Delivering race equality in mental health care: An action plan for reform inside and outside services. London, 2005.
9. Craig G, Walker R. ‘Race’on the welfare margins: the UK government's Delivering Race Equality mental health programme. Community Development Journal 2012;47(4):491-505.
10. Bhui K, Halvorsrud K, Nazroo J. Making a difference: ethnic inequality and severe mental illness. The British Journal of Psychiatry 2018;213(4):574-78.
11. Bhui KS, Owiti JA, Palinski A, et al. A cultural consultation service in East London: experiences and outcomes from implementation of an innovative service. International Review of Psychiatry 2015;27(1):11-22.
A response to a colleague defending my rationale for designing a short pilot study, working with new migrants in one small location to discover different ethnic and cultural variations in their responses to mental ill health June 19:
We will be working for 3 half days with up to 10 members of the community at each session.
We are consulting with members from different communities to specifically (and only) find out what their own cultural/ ethnic/ faith/ traditional concept of poor mental health is and how their community responds to someone who is unwell.
I am representing Nilaari in this small study with one of my colleagues joining us for 2 of the days. We are encouraging all the organisations that work in and around the local area, to publicise the pilot and encouraging their clients to engage. We specifically want to discover personal perceptions and reactions to mental ill health, from a range of perspectives, which may help MH services locally to become aware of the issues and hopefully, take steps to remove/ avoid some of the barriers in the future.
NB asked me to work with her after visiting our organisation recently. When she heard about my past and current work with BAME communities, she asked me to put together a proposal which she would lead and fund from the University. I am undertaking this work outside of my one day a week at Nilaari, to avoid impacting on other work.
This has been organised at short notice because NB has waited for me to have time and space to write up the 'Call To Action' conference report in May (to which she had been invited and at my request and took the role of one of our facilitators. These funds have to be spent by the end of July.
N B is a senior researcher at the University. She has formerly won awards for changing NHS practice in Edinburgh. I believe that she will be rigorous in her literature searches as she is experienced in conducting research and is applying for funds.
We aim to discover the concepts and perceptions of a residents of a single local, diverse location at one short period of time- a snap shot .
There was mention of this small study being 'repetition', of what has already been researched. This is ironic as it was me, at the ‘Call To Action’ conference in May that mentioned in my presentation that there had been a plethora of evidence available from studies over 20 or more years, on the inequalities in BAME Mental Health practice leading to poor access and engagement. I am aware of the past research papers but this is very specific and is new (as far as we can see). I don't believe that NB nor myself are naive enough to be repeating studies that that were already well documented. We believe that this will be new knowledge and would be delighted if you are aware of something similar and could let us know.
You asked about the motives of the university academics in conducting this work. I see no reason for uspicion, criticism or passing judgement on the work being done by academics. This could result in the work going elsewhere, without the involvement of the volunteer experts with the local expertise. NB will share the findings- I will be part of the process of collating them and I believe that this work will lead to positive outcome for communities. NB is passionate about the same issues as ourselves and has asked my oganisation to be the interface with the communities, which we are delighted to do. Any outcomes will be shared with the usual EDI groups, as I will always do- but this is not always the case with other colleagues around the table.
I see this as an opportunity rather than a threat which will build on and develop stronger relationships with the university and my organisation will be named as co producer in any future work that results. I hope that you can trust me, representing my organisations best interests best interests, to stay as transparent as we have always been, to wear our heart on our sleeve and to share any work that can bring equality of services to every community in Bristol. Without external funding, we would be unable to undertake any of this work and so consider it as a gift.
As far as my credentials (which I feel the need to share as your response may be interpreted as you feeling that this work was perhaps reckless and naive), I have a Masters degree and have belonged to a weekly academic PHD level research group in Bath for about 8 years. I worked in the Home Office for 12 years, 3 years seconded to London and working on diversity within drug services and through the CJ system then the last 2 as regional lead for preventing extremism. Since then, I have had 8 years of successful community engagement with BAME communities from being business partner with LF in ‘Pax Pontis’ (Bristol Somali/ British activist, working to support new emerging migrant community groups), presenting twice at the EU in Brussels on my work with these groups and (with Somali DG), my FGM related work with Somali teenage girls. Following this I had roles with Bristol CC and then LA, sustaining BAME elders groups. I have been at Nilaari for almost 5 years, working with the director to design and deliver ‘Usawa’ (our training day for practitioners) and to be the outfacing representative to promote and sustain Nilaari. I believe that I do have a grasp of research and can be trusted to steer this in a fruitful direction.
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