Westminster PCT ... Consulting for long term improvement
"There is a sense of shame about being a mental patient and that manifests itself in inequality." Amjad Taha, Manager of Westminster PCT's Black and Minority Ethnic Health Forum
A public meeting to discuss mental health, organised by Westminster PCT and held in March this year.
Westminster Primary Care Trust is taking a grassroots approach to transforming its mental health services. The Trust has long worked in partnership with the local Black and Minority Ethnic Health Forum to ensure that people from ethnic minorities are involved in the planning, design and delivery of health services.
Now the Forum has created a new way for the Trust to listen to the experiences of local black and ethnic minority people when it comes to mental health. "Our approach is different because we are working with community groups on an equal basis," explains Amjad Taha, Manager of the Forum. "They have been involved in the whole process: the planning, the execution and producing the results."
Mental health is a big issue for ethnic minority communities for a number of reasons. Black people, for example, are six times more likely to be sectioned under the Mental Health Act, while women from East Africa and India have a forty per cent higher suicide rate than the national average.
Going local
The Forum realised that its track record of work and links with more than 300 community groups and voluntary agencies in the local area could be used to tap into the views of ethnic minority people and try to identify some of the problems they faced in trying to access services. But rather than adopt a top-down approach or use old-fashioned techniques such as sending out questionnaires which might not hear those voices essential to change mental health services in a meaningful way, the Forum decided to support local groups to carry out consultations themselves, in the best way for their communities.
"We wanted to empower the community groups to conduct their own consultation in their own way, in their own environment, rather than telling them what to do," says Amjad. "Too often consultations are planned by an organisation and the community is not consulted until a much later stage. This approach worked because people felt at ease. Things were not imposed on them." Not only were people from local groups offered a two-day training session with a professional trainer, but support at the consultation meetings was also offered in the form of interpreters and note-takers as well as meeting rooms and refreshments.
Taboo
"We provided the guidance and equipment," says Amjad. "All they needed to do was arrange a date and time with their members." Groups were encouraged to ask about people's experiences of mental health services, their attitudes to mental wellbeing and their access to information which were then fed back to the Forum.
The comments received so far reiterate previous findings that mental ill health is a taboo for many people of ethnic minority backgrounds, making them less likely to seek help from counsellors and therapists.
"There is a sense of shame about being a mental patient and that manifests itself in inequality," says Amjad. "People leave things until they get out of hand because they don't want to be seen as mentally unwell. "There is a widespread attitude amongst refugees and asylum seekers, for example, that depression and sadness are just part of the refugee experience. They don't feel they need help, so they leave it until it's too late and they have to be taken by the police to hospital."
Inequality
The Black and Minority Ethnic Health Forum is an arms-length advisory group which aims to influence both Westminster and Kensington and Chelsea Primary Care Trusts through regular meetings with local groups and the two boroughs' primary care trusts, hospitals, mental health trusts and social services departments.
Brian Colman, Equality and Diversity Manager at Westminster Primary Care Trust, argues that the Forum's inclusive approach to consultation is important if lasting change is to be made.
"This work is essential because of the glaring inequality and discrimination which has been ethnic minorities' - and particularly the black community's - experience of the mental health system," he says. "We need to listen better to what the community is telling us and then act on what we hear. My hope is that this project will result in concrete changes and real outcomes which clearly improve the experience of users. This is central to our commitment to Race for Health."
The Forum aims to present its completed findings to both the primary and acute trusts at the end of November (2004). Among its recommendations will be work on both changing the perception of mental health within black and minority ethnic communities and improving their experiences once they make contact with services.
Amjad says community-based mental health workers, more appropriate patient advocates, the wider use of interpreters and improved continuity of treatment once people are discharged would all be steps in the right direction. "I understand the difficulties and the lack of resources in the NHS, but we are talking about changing culture and attitudes," he says. "It is easy to produce a leaflet but this is much harder. It will take time. But I think the commitment is there and there is some drive from the top to carry this agenda forward. We just have to carry on trying."