Pay attention

The latest survey of child and adolescent mental health problems
reported that one in 10 young people have a mental disorder,(1) but
the official statistics fail to highlight the needs of particularly
vulnerable groups.

Child and adolescent mental health services (Camhs) are undergoing
substantive changes in the way they are organised, staffed and
delivered following the 2004 National Service Framework for
Children. The government intends to increase the Camhs workforce by
2006 to create an improved comprehensive service after years of
neglect. But too little attention is being paid to the needs of
ethnic minorities, refugee and asylum-seeking children and young

Research has highlighted the inequitable, oppressive, and poor
quality services available for families from ethnic minorities.(2)
Inspection of social work services for black children and their
families in the UK shows that despite years of anti-racist and
anti-oppressive social work rhetoric, assessments and care planning
are still generally inadequate.(3) To try and improve matters
government guidance suggests:

  • Ethnic monitoring of services and staff to ensure they are
    provided equally.
  • Involving ethnic minorities in planning and reviewing
  • Training in anti-racist and anti-discriminatory practice.
  • Investigating and monitoring complaints of racial
    discrimination or harassment.
  • Explicit policies are in place for working with black

It is also important that the organisation and training of social
workers in Camhs is rooted in psychosocial and culturally competent
skills. The increasingly fluid patterns of migration, immigration,
asylum seeking and refugees crossing geographical and cultural
boundaries are disrupting traditional identities and subsequent
intra-familial stress requires attention.

Identity conflicts, developmental milestones, and transitions from
one phase of childhood to another are risk factors in the genesis
of mental health problems in young people. But when added to the
excessive strain experienced by children suddenly uprooted from one
country to another, they can magnify the effects of these factors.
In addition, recent research has identified the way that
globalisation and consequent social changes have proved unsettling
for established cultural identities.(4)

One of the central aims of culturally competent practice is to
exclude the risk of misinterpretation or underplaying significant
emotional and behavioural characteristics. An understanding of the
reluctance and resistance of parents to consider a mental health
explanation for their child’s behaviour or emotional state is
important when considering how to engage parents or carers from
diverse cultural backgrounds in the process of support.

It is equally important to make efforts to understand cultural
explanations and belief systems around disturbed behaviour as part
of risk assessment work.

For some young people it could be a relief to have an explanation
for feelings and behaviour that they find hard to make sense of,
whereas for others it could exacerbate feelings of blame, guilt and
self-loathing. The enduring social stigma of mental health
problems, combined with institutionally racist practices, provides
an overall context for these feelings to be repressed, displaced,
or acted out.

Respecting rather than challenging difference should be the
starting point for a partnership and collaborative social work
practice. The dilemma for social workers aspiring to practice in
culturally competent ways is in balancing this respect with
knowledge and evidence of the consequences of untreated emerging
mental health problems.

The Western psychiatric model of mental illness tends to ignore the
religious or spiritual aspects of the culture in which it is
based.(5) However, Eastern Asian, African and Native American
cultures tend to integrate them. Spirituality and religion do not
feature often in social work literature, yet they can be critical
components of a child and young person’s well-being, offering a
source of strength and hope in trying circumstances. Social workers
need to address this as part of the constellation of factors
affecting black children and adolescents, avoiding stereotyping,
and bearing in mind the positive, and sometimes negative, impact
spiritual or religious beliefs might have on their mental

The evidence suggests that an interplay between characteristics in
the child and their environment increases the risks of developing
mental health problems. Social workers ought to find that this
paradigm fits with a psychosocial framework for culturally
competent assessment and intervention in Camhs.

The risk factors include: 

  • Communication difficulty. 
  • Physical illness. 
  • Low self-esteem. 
  • Family breakdown. 
  • Death and loss. 
  • Socio-economic hardship. 
  • Disaster. 
  • Discrimination.
  • Homelessness.

There is very little evidence of what works with children from
ethnic minorities, or how models of practice should be adapted to
meet the needs of diverse, multi-cultural populations. The
literature on anti-racist and anti-discriminatory practice often
laments this knowledge gap. But there are identifiable areas for
social workers to focus their work.

Advocacy skills in which young people are encouraged to be
supported and represented by advocates of their choice with a
children’s rights perspective would help contribute to enhancing
future Camhs provision. A traditional psychosocial practice, that
links the internal and external world of the client, augmented with
culturally competent skills can help tackle the policy failure to
fully address the needs of black, other ethnic minority, and
refugee and asylum-seeking children and young people.

Social workers thus have the opportunity to make a major
contribution towards responding to the increased prevalence of
child and adolescent mental health problems. The insights offered
within reflective practice can fully engage troubled young people
and help identify those at risk of developing mental health

Steven Walker trained as a social worker at the
London School of Economics and is programme leader in child and
adolescent mental health at Anglia Polytechnic University.

Training and learning
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Child and adolescent mental health services are being
developed to try and cope with unprecedented demand. But too little
attention is being paid to the needs of ethnic minority, and
refugee and asylum-seeking families. Social workers have an
opportunity to meet their needs using psychosocial and culturally
competent skills.

(1) Office for National Statistics, Mental Health of
Children and Young People in Great Britain
, HMSO, 2005
(2) S Walker, Social Work and Child and Adolescent Mental
, Russell House, 2003
(3) Department of Health and Social Services Inspectorate,
Excellence not Excuses: Inspection of Services for Ethnic
Minority Children and Families
, HMSO, 2000
(4) S Fernando, Mental Health Race and Culture, Palgrave,
(5)S Walker, Culturally Competent Therapy, Palgrave,

Further information
K Dwivedi, Meeting the Needs of Ethnic Minority
, second edition, Jessica Kingsley, 2002
M Hodes, “Psychologically distressed refugee children in the United
Kingdom”, Child Psychology and Psychiatry Review, 5, 2:
pages 57-67, 2000

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