African-Caribbean people in the UK are twice as likely as white
people to be diagnosed with a mental health problem but are less
likely to access treatment and care. These bald facts raise
significant concerns. Are mainstream mental health organisations
failing to provide adequate care? Can black mental health
organisations fill the gap?
The Black Spaces project, funded by the Mental Health Foundation
(MHF), set out to discover how seven mental health agencies for
ethnic minorities try to provide a specialised service. The project
aimed to disseminate lessons learned to other black and mainstream
mental health services.1
Andrew McCulloch, chief executive of the MHF, says: “I have
personally observed many problems, including patronising and
paternalistic attitudes, over-representation in some parts of the
system and under-representation in others, poor involvement of
families, carers and communities, and possible covert
The agencies are based in Manchester, Wales, London and the
Midlands, including the African Caribbean Community Initiative in
Wolverhampton, which operates a day centre offering computer
classes, sports facilities and support groups. Another is the
Zindaagi project. It aims to develop and co-ordinate support
services for young Asian women who are vulnerable to suicide and
self-harm. In West London, the Forward Project aims to keep people
of African and African Caribbean descent out of psychiatric
hospital whenever possible.
Similar information was collated about each agency, for example:
location and suitability of the building, target population,
services on offer, number of staff and volunteers, number of
students involved, funding and a brief history of the organisation.
The report’s findings showed the importance of:
- Working in partnership with key organisations.
- Advocacy to secure black people’s rights.
- Empowering users.
- Cultural sensitivity to black service users.
- Not dancing to funders’ tunes.
- Involvement of families and the community in care.
The importance of partnership working is illustrated by some of
the organisations that have established valuable relationships with
housing associations, psychiatric units and benefits offices. For
example, African Caribbean Community Initiative in Wolverhampton
works with the local psychiatric hospital, negotiating care and
discharge packages as well as with the benefits office.
Advocacy work on behalf of clients in hospital settings has proved
vital, especially concerning diagnosis and treatment of black
people. Preventive work is also important to try to stop
unnecessary admissions to hospital. Black organisations have also
helped to ensure that people’s rights under the Mental Health Act
1983 are respected in hospital settings. For example, Awaaz, a
service for Asian people in Manchester, employs advocacy workers to
negotiate with health professionals on diagnosis and treatment for
people from the Asian community and ensure that interpreters are
appropriately versed in mental health issues to represent their
The labelling of the black agency itself can be important in terms
of accessibility, safety and cultural sensitivity. For example,
Awaaz chose not to have a name that identifies it with mental
illness because this carries a negative meaning for many within
Asian communities. It is also trying to provide a wider range of
services so it is not solely associated with mental illness.
Agencies that are directly aware of the impact of racism and the
issues surrounding mental health within some cultural settings are
invaluable. The researchers recognised the importance of black
organisations employing black staff who understand the social and
political experiences of black people’s lives in the UK.
It was felt that some projects were in danger of losing their focus
on mental health or black issues in the search for funding because
there have been problems attracting core funding. However, some
organisations found this has some advantage, in that they are not
dictated to in terms of service delivery.
Based on these findings, researchers including service users (see
panel, top right) compiled a set of suggestions for improving
mental health service provision. This starts with training
professionals, including GPs, nurses and social workers. Students
training for mental health work should be encouraged to take
placements within the black voluntary sector. This should be a part
of continuous professional development.
In terms of quality standards, the researchers suggest
self-assessment of the cultural and linguistic competences of staff
and annual reports on an organisation’s progress in relation to
ethnic issues. There should also be mechanisms to allow consumer
and community feedback to establish user-satisfaction with
Mental health organisations should respect cultural differences. At
Awaaz, for example, there are targeted gender services, which show
an understanding and respect of Asian culture, where men and women,
particularly if unmarried, often work or socialise separately.
Having staff who speak and understand local languages is very
important, especially if people are in mental distress. Activities
should be planned with an understanding of people’s religion,
allowing time and space for prayer. A culturally appropriate diet
is also important for some black and Asian people.
Service users should be encouraged to realise their potential, with
more focus on where people were before they had a psychological
problem. More attention should be paid to retraining people and
getting them into employment. For example, attending adult
education classes helps with integration in the local
The researchers also emphasised the importance of infrastructure
support for black voluntary sector organisations as they expand.
Different projects should be encouraged to link up so they can
develop new ideas and different ways of working.
A team of African-Caribbean, Asian and African service user
consultants should be developed to help with organisational
development within the black voluntary sector.
The 1999 National Service Framework for Mental Health emphasised
the poor sensitivity of existing services to African and Caribbean
people. And one of the key aims of the 2002 NHS Plan was to address
inequalities in health, especially for people from minority ethnic
communities. Yet the Department of Health issued a report in March
this year, Inside/Outside, acknowledging that neither of
these policy initiatives adequately address the particular needs of
However, McCulloch says: “I believe there is real hope of providing
better mental health services to black people through a combination
of more sensitive mainstream services and support for black-led
services, working in partnership with the statutory sector.”
About black spaces
The project forms part of the MHF’s focus on user-led research.
It is part of the Strategies for Living programme that encapsulates
a belief in learning from the experience of users as well as staff.
A small steering group of experts guided the project and a team of
consultants, including mental health service users, visited the
organisations. The lead consultant spent at least three days with
each agency, shadowing their work and acting as an observer and
student. A separate two-day visit was also organised for user
consultants to provide feedback.
Nicola Hill is editor of the Black Spaces project
1 Mental Health Foundation,
Black Spaces report, MHF 2003,
2 Department of Health,
Inside/Outside: Improving Mental Health Services for Black and
Minority Ethnic Communities in England, 2003