MENTAL ILLNESSES

Afro-Caribbean Community Perspectives of Mental Illnesses



Abstract

In the context of current concerns about health inequalities among minority ethnic groups in the UK, this paper addresses perceptions of mental health services among members of an African-Caribbean community in a South England town. Efforts to reduce health inequalities must take account of the views of local community members on the sources of those inequalities and on local health services. The statistical existence of inequalities in diagnosis and treatment of African-Caribbeans in the UK is well-established, supported by sociological explanations of these inequalities which centre on social exclusion in a variety of forms: institutional, cultural and socio-economic. However, detailed studies of the perspectives of local communities on mental health issues and services have received less attention. In this case study of community perceptions of mental health services, we find that social exclusion comprises an explanatory framework which is repeatedly invoked by community members in describing their interaction with mental health services. Interviewees assert that experience and expectation of racist mis-treatment by mental health services are key factors discouraging early accessing of mental health services, and thereby perpetuating mental health inequalities. We conclude that participation and partnership are vital means by which to generate both the objective and subjective inclusion that are requirements for an accessible and appropriate health service.

Table of Contents

Abstract2

Chapter 1: Introduction6

Study aims11

Chapter 2: Literature Review13

Access to the mental health system via the criminal justice system21

Cultural exclusion24

Institutional exclusion26

Socio-economic exclusion28

Community case studies30

Chapter 3: Methodology35

Interviews and focus groups36

Sample37

Chapter 4: Results and Findings39

Cultural exclusion40

Misinterpretation of African-Caribbean modes of selfexpression41

Culturally appropriate model of good practice44

Institutional exclusion45

Scepticism of council's commitment to inclusive and culturally appropriate change47

Socio-economic exclusion52

Exclusion at work52

Economic exclusion from non-drug therapies53

Chapter 5: Conclusion55

References59

Chapter 1: Introduction

The relationship between health inequalities and social exclusion is the conceptual ground of this paper. Since the publication of the Black Report in 1979 (Townsend & Davidson, 1982), health inequalities have been a key concern of UK health researchers. The existence of health inequalities among the various ethnic groups in the UK is well established (Smaje & Le Grand, 1997), with a range of physical and mental health outcomes appearing to vary according to ethnicity (NHS Executive Mental Health Task Force, 1992; Wilson, 1993; Nazroo, 1997). However, the precise mechanisms through which such inequalities are produced remain ill-understood. The specific health inequality which we address in this paper is the relatively poor mental health experienced by African-Caribbean communities in the UK (Department of Health, 1999).

Under-utilisation of support services appears to be an important contributor to the poor mental health outcomes seen in African-Caribbean communities (Bhui, Christie, & Bhugra, 1995). While a great variety of factors work to produce health inequalities, this paper focuses on the role of the interaction between local community and health service. The policy environment of the health services aims to eliminate any role that the health services may have in generating or perpetuating health inequalities. Equal opportunities legislation makes explicit inequality in treatment by practitioners a malpractice. Government policy strongly promotes partnerships with grassroots members of ...