Why a Black and minority ethnic men and mental health project?

Last month David Robertson joined the Forum as coordinator of its BME Men and Mental Health Project. Here he explains why it is so important.

Mental illness is usually the result of multiple interacting factors - physical, biological, social, environmental and psychological.

People from BME communities face particular disadvantages as a result of racism and discrimination. These are reflected in poverty, in their housing, education and employment.

Evidence suggests that the distress arising from experiences of racism can bring BME people into contact with mental health services. It also suggests that their mental health needs are often not met as result of this contact. The inequality has been recognised by central Government and mental health services along with other public bodies have a legal obligation under the Race Relations Amendment Act (2000) to outlaw racial discrimination and promote equal opportunities by producing a Racial Equality Scheme, carrying out a Race Equality Impact Assessment on all new and monitoring outcomes by ethnic group.

Controversial

But ethnic differences in mental health are highly controversial. The heterogeneity in these communities is often overlooked with ethnicity is treated as a fixed trait despite many other factors - age, religion, nationality, birthplace, gender and sexuality - all having an impact on a person's identity.

Research studies of ethnicity and mental illness have tended to focus on treatment rates, mainly in clinical settings. These studies show that BME men are more likely to receive a diagnosis of mental illness than the White British counterparts. However, the patterns of ethnic inequality are diverse. For example, African-Caribbean men and, in particular, Black British born men are more likely to be given a diagnosis of schizophrenia than the general population. Men from Indian and Chinese ethnic groups, on the other hand, are less likely to be admitted to menatl health services.

Specifically, the evidence shows that individuals from BME communities are more likely to be subject to:

• over-diagnosis of schizophrenia and under-diagnosis of depression or affective disorder.
• compulsory admission under the Mental Health Act, 1983 (Mental Health Act Commission 1999)
• involvement of police in admission to hospital and the use of Section 136/137 of the Mental Health Act, 1983
• admission to medium- and high-secure facilities
• excessive admissions to hospital, especially via the courts.

The Mental Health Act Commission's Count Me In Census (2005) of mental health inpatient services showed that BME men are significantly overrepresented (in comparison to both White men and Irish men) in the mental health system, and very different pathways to care. Key findings of the Census in 2005 included:

• Ethnic communities which are over-represented in the system are White Irish, White Other, Black-Caribbean, Black African, Other Black, Mixed and Bangladeshi
• 33-44% higher than average rates of detention for Black men (different groups)
• Rates of seclusion were 50% higher in African-Caribbean males
• Control and restraint rates were 30% higher for African-Caribbean males

The results of the second annual 'Count Me In Census', carried out in March 2006, reaffirmed the findings from the initial census:

• Men from Indian and Chinese ethnic groups had lower admission rates than average by 21% and 46% respectively.
• Admission rates were highest in Black and White/Black Mixed groups (three or more times higher than average).
• Highest admission rates were among men from the Other Black group at 18 times higher than average (this category may include a number of 'second generation' Black British people).

True rates

The true rates of mental illness within BME communities are disputed. In 1999 the Ethnic Minority Psychiatric Illness Rates in the Community study (EMPIRIC), contradicted two key assertions that have been based on previous research: firstly, that there are apparently high rates of schizophrenia and other forms of psychosis among African Caribbean people; and secondly, there are low rates of mental illness among Asian people.

In fact, the EMPIRIC survey suggested that:

• The prevalence of common mental disorders (anxiety and depression) was very similar in all groups, with the exception of the Irish, for whom this rate was higher than in the White group.
• Rates of psychosis among Black Caribbean men were the same among White men after adjusting for age. The survey did not find any significant differences in rates of psychosis among other groups.

In short this survey on prevalence of mental illness in the community showed fewer ethnic differences.

As it stands there is are few studies that have focused on promoting positive mental health via health promotion and identifying best practice. Studies have been primarily epidemiological in the main. The MHF project will focus on the what are known as the DRE ethnic populations (after the government's Delivering Race Equality action plan). These which are African, African Caribbean, South Asian (Indo China), Irish and Mediterranean/Eastern European. The aims of the project are to:

• provide a better understanding of BME men's beliefs, attitudes and help-seeking behaviours and coping strategies in respect of mental health.
• to produce evaluated model resources for BME men on mental health issues which can be widely reproduced, and
• to publish examples of good practice in BME community, voluntary and statutory sector organisations which will hopefully lead to increased the awareness of how to work effectively with BME men and encouraging them to make greater use of appropriate mental health services.

If you've got any thoughts or comments, I'd be delighted to hear from you. Just use the feedback box below.