6 - Mental illness in Black and Asian ethnic minorities: care pathways and outcomes

Summary

Summary This chapter summarises the research literature on care pathways for Black and minority ethnic groups, based on a series of papers and reviews from 1999 onwards. The work contributed to the King's Fund report on London's mental health and set the foundations for important systematic reviews of the evidence and empirical studies of care pathways. Despite those initiatives, there is not much evidence that the picture is dramatically different from when the review was undertaken. Although much work is now underway on this issue, unlike when we first wrote on it for Advances in Psychiatric Treatment in 2002, much more service development and focused research is necessary. The chapter ends with an update on the Enhancing Pathways into Care (EPIC) project that was part of actions in the Delivering Race Equality policy, and reflections on the public health vision in mental health policy.

A substantial body of research indicates that, for people from Black and Asian ethnic minorities, access to, use of and treatments prescribed by mental health services differ from those for White people (Lloyd & Moodley, 1992; for a review see Bhui, 1997). Pathways to mental healthcare are important, and the widely varying pathways taken in various societies may reflect many factors: the attractiveness and cultural appropriateness of services; attitudes towards services; previous experiences; and culturally defined lay referral systems (Goldberg, 1999). Contact with mental health services may be imposed on the individual, but people who choose to engage with services usually do so only if they think that their changed state of functioning is health-related and potentially remediable through them. In such cases, they will contact whoever they perceive to be the most appropriate carer, and these individuals are often not part of a national healthcare network.

The care pathway approach focuses on the point of access to care and the integration of care by culturally diverse carers. For example, if for African– Caribbean men in crisis the most common point of access to mental health services is through the police and the criminal justice system rather than through their general practitioner (GP), then the challenge is to explore the reasons for this at the interface of these agencies. Carers include the popular and folk sectors of healthcare provision as well as standard primary and secondary care services and the voluntary sector.