On 24th September 2020, the Dialogue Society hosted an event on BAME women and mental health. As one of the panellists, I am writing to highlight the take-home messages from this live conversation. Mental health disparities exist among BAME and it is evidenced that immigrants and their descendants are at higher risk of developing mental health disorders than the majority ethnic group in a given setting¹. A main contributor to this disparity is “poor engagement with mental health services” in BAME population as they have lower rates of initiation, retention and drop out from services. Available literature suggests that poor engagement is linked to a number of factors, mainly: low literacy about mental health symptoms, high stigma and fear of being diagnosed with a mental health problem, perceived discrimination and prejudices from health care professionals and staff, unequal access to care, communication and language barriers, lack of familiarity with the available services as well as lack of knowledge of clinicians about cultural beliefs, stigmas, and the perceived illness causes in BAME.

Given this, BAME people mostly seek help from mental health services when in crisis and in need of hospitalisation. This is where the importance of developing culturally adjusted mental health services for BAME that are sensitive to the norms of BAME becomes more evident.

One of the main components of these targeted services should be training clinicians and staff to make sure BAME understand and seek help for mental health problems. Having a diverse staff and designing gender-specific services could also increase the trust of BAME in the health services, thus improving engagement and uptake of the services among BAME.

UK is a multi-ethnic country and since 1991, the minority ethnic population has been growing². Nevertheless, it is important to note that there are still many minority ethnic groups that are not recognised in the UK census data. Hence, developing culturally adjusted services for this diverse group living in the UK is of utmost importance. A scoping review³ on culturally adjusted mental health services designed for BAME in the UK reported that overall these services are very limited. However, they are feasible and can address the diverse needs of BAME easily and efficiently. Given the diverse population of ethnic minorities in the UK, there is still an enormous need to increase the quantity of these targeted services and also, to improve the quality of the existing services by integrating them into the health care system.

It must be added that there is a higher risk of developing mental health problems in women from BAME than white women⁴. This is largely attributed to cultural practices, educational background, racial harassment and discrimination as well as awareness about available services and domestic violence. In general, reports suggest that many women from Black and other minority ethnic groups only receive treatment and support when at crisis and therefore, there is a great need to have a better understanding of the underlying factors and to tackle these existing disparities by timely interventions, at local and national levels.

To conclude, the influence of culture on understanding and attitudes about mental health and help-seeking behaviours in BAME is huge and if not addressed, these influences can be carried on from one generation to the next. So what can we do to mitigate the influential role of culture within BAME and the future generations of BAME migrants in the UK? We can start with improving awareness and literacy about mental health. Community campaigns, specifically designed for BAME, can alleviate the huge stigma linked with mental health problems within these communities and reduce their feelings of isolation and alienation within the society.

In the meantime, we cannot ignore the fact that health systems play a big role in how BAME engage with the available services and thus, it is vital to improve the knowledge of staff in health care on culturally adjusted approaches when dealing with BAME.

References

1. Jongsma, H., Turner, C., Kirkbride, J.B. and Jones, P.B. (2019), “International incidence of psychotic disorders, 2002-17: a systematic review and meta-analysis”, The Lancet Public Health, Vol. 4 No. 5, pp. PE229-E244.
2. Office for National Statistics (2011), “Census analysis: ethnicity and religion of the non-UK born population in England and Wales: 2011”.
3. Vahdaninia M, et al. (2020). Mental health services designed for Black, Asian and Minority Ethnics (BAME) in the UK: a scoping review of case studies. mental Health and Social Inclusion, VOL. 24 NO. 2 2020, pp. 81-95.
4. Ethnic Diversity and Mental Health in London: Recent developments, by Frank Keating, David Robertson and Nutan Kotecha, is available from The King's Fund on 020 7307 2591.