A flagship scheme to improve the lot of ethnic minorities in the mental health system is struggling. Anabel Unity Sale investigates
The grand aim of the Department of Health’s initiative to improve the experiences of ethnic minorities in the mental health system appears to have underestimated one vital factor: recruiting the staff to put the idea into action.
The five-year programme, Delivering Race Equality in Mental Health, set out to appoint 500 community development workers. But three years later, only about 170 are in post.
So disappointed with the response was health minister Rosie Winterton that last month she wrote to all the strategic health authorities expressing her concern. As a result the target deadline date has been delayed a year until December 2007.
Lord Kamlesh Patel, chair of the Mental Health Act Commission and national director of the Department of Health’s ethnic minority mental health programme, is also concerned at the slow pace of recruitment. His disquiet is exacerbated by the fact that each primary care trust was given a specific budget – depending on local need – to fund community development workers.
Patel blames economics: “The financial problems in the NHS mean the funding has been diverted elsewhere within the PCTs.”
Marcel Vige, co-chair of the National Black and Minority Ethnic Mental Health Network and manager of Mind’s diverse minds unit, adds another reason: “There are lots of expectations over what the community development worker will deliver and that they will act as a bridge between the community and services. This requires a wide range of skills – a lot for any one worker to have.”
He argues that, because the posts are new, there should be a comprehensive training system in place to support them, and the commissioners of mental health services must provide detailed guidance.
Jon Beech, community development coordinator for Touchstone, a mental health charity in Leeds, has direct experience of
recruiting community development workers.
In September he hired eight from a variety of ethnic backgrounds. His staff, who are undergoing comprehensive training, aim to support the mental health needs of the city’s communities. “We are starting with the communities themselves setting the agenda to see what is important to them.”
But this isn’t happening everywhere. Moira Fraser, head of policy at the Mental Health Foundation, says the reality for some mental health practitioners from ethnic minorities is that they are part of a system steeped in traditional ways of working.
If mental health services are not wellregarded by an ethnic community a worker from the same background may feel they
are letting down members of that community if they cannot emphasise its positive aspects, she adds. “If a service is seen
as coercive then a practitioner may find it difficult to work in that context.”
Vige says ethnic minority practitioners should balance their role as an employee of an organisation with their ethnic identity. “As a practitioner you are in a system where black people are discriminated against and there is the idea that you will address this but you have to reconcile these two different motivations as a black employee.”
The background to this need for specific community development workers lies in the first census of the ethnicity of people using in-patient mental health services, which in itself was spawned by the Delivering Race Equality action plan.(1) A second census is expected soon and will include people with learning difficulties for the first time.
The Count Me In census was carried out jointly by the Mental Health Act Commission, the Healthcare Commission and the National Institute for Mental Health in England. Published at the end of last year, the census revealed that African-
Caribbean people are three times more likely to be admitted to hospital and up to 44 per cent more likely to be sectioned
under mental health legislation.
This disparity spurred the government on to build bridges between the statutory sector and the voluntary and community
sector by recruiting specific community development workers.
So what can be done to improve the experience of mental health professionals from ethnic minorities and ultimately improve mental health services?
Beech urges employers to be committed to achieving workforce diversity, rather than assuming it is a level playing field for
all practitioners. He says: “Think about what your organisation can do to encourage people from ethnic minorities to work for you.
At Touchstone we have a commitment to reflect the community it services.” If mental health providers want to improve service delivery they need to broaden what they consider to be appropriate behaviour by their staff, says Vige. He urges professionals in psychiatry and psychology to look at different cultural understandings of mental health as a means to attract more staff from ethnic minorities.
Powell says more should be done to retain ethnic minority staff: “There needs to be recognition that the needs of black
staff are different and support should be stepped up – mentors from similar communities could offer guidance.”
Patel says organisations need to make their mental health services more appealing through their leadership, noting that,
although there are people from ethnic minorities in front-line roles it is not the case in senior management posts.
He adds: “They need to implement Delivering Race Equality in full; it will not only help recruit ethnic minority staff but it
will improve services for all people.”
ABLE TO CONNECT
Even if Jennifer Powell won the lottery this weekend, the passion she feels for her work is such that she enthuses: “I’d still do this job in some capacity.” For the past three years she has been a community development worker for Sharing Voices, a Bradford based voluntary mental health organisation for ethnic minorities.
Powell is one of the 500 community development workers the government in 2003 pledged to recruit as part of its five-year
Delivering Race Equality in Mental Health programme. Sharing Voices sees several hundred clients a year – either through self-referral or other professionals – through seminars, one-to-one sessions and informal social gatherings.
Although Powell and her colleagues work closely with local communities on improving mental health, they avoid using a medical
approach with clients. “In south Asian communities there is no word for depression so we talk to people about their lives and their experiences, about how they are feeling.”
This approach has made it easier for Powell to make connections with local communities, although it took time to gain their trust and respect. She now works in a way at Sharing Voices that she and her clients find comfortable. “I love working with ethnic minority communities because I’m working with my own communities. It is diversity in its truest sense because we work cross-culturally with different sexualities and abilities.”
However, this wasn’t the case during her time in mainstream mental health services. Powell says: “Sometimes black staff
felt we couldn’t work in our true manner because it wasn’t understood or deemed appropriate; it’s like we had to leave our blackness at the door when we came to work.”
Contact the author
Anabel Unity Sale
This article appeared in the 9 November issue under the headline “A Late Delivery”