Men from black and minority ethnic backgrounds are over represented in the mental health service in Britain. But a large amount of evidence suggests that there is often a negative relationship between mental health services and the experiences of African and Caribbean men.
This group is under represented in professional advocacy services, despite the well-documented benefits these services can bring. The Social Care Institute for Excellence looked at evidence from research and practice to find out what barriers prevent African and Caribbean men from participating in mainstream advocacy services, and what models and principles support good practice in this area.
Research has identified that the under-use of mental health services is an important factor in poor outcomes for African and Caribbean communities. Some research suggests that this could be attributed to the experience and expectation of racist mis-treatment by mental health services.
Specialist mental health services often use frameworks and assumptions to design services that are unsuitable or inaccessible to minority ethnic community members. Concern about the welfare of African and Caribbean mental health service users has been heightened by the increased rates of admission and compulsory detention cited in the national census of inpatients in mental health services. Deaths of African and Caribbean men in mental health services also haven’t helped dispel fears.
The need for mental health advocacy with African and Caribbean men is clear. Advocacy may help to ensure all individuals are treated and supported under the least restrictive alternative, safeguarding their rights and enabling them to exercise choice. Advocacy has the potential to challenge inequality and discrimination, as well as secure access to appropriate treatment and support. It can also serve to influence the development and design of culturally acceptable and appropriate services and increase the awareness and understanding of African and Caribbean communities with mental health issues.
It is apparent from both service specifications and studies of African and Caribbean mental health services that advocacy is provided as part of a wider role. This interdependence with other aspects of provision is viewed as promoting greater opportunities for recovery and well-being. These services have typically developed in response to community needs because of concerns about the inaccessibility and inappropriateness of mainstream mental health services for African, Caribbean and black and minority ethnic groups.
However, the approach to advocacy of these organisations appears to be qualitatively different and consistent with notions of recovery and social inclusion. The lack of sustainable funding and a preference for a different conception of professional advocacy places such services in jeopardy. All studies drew attention to the importance of cultural sensitivity and shared heritage had a stronger emphasis in studies focused on black minority communities. The service descriptions of mental health advocacy services referred to cultural sensitivity but rarely elaborated on what this means. However, African and Caribbean services articulated this and made a strong argument for the provision of mental health advocacy by independent community organisations that understand this and the disadvantage faced by men from these backgrounds.
● Knowledge review 15: Mtetezi – Developing mental health advocacy with African and Caribbean men
● National Institute for Mental Health in England
This article appeared in the 9 August issue under the headline “Advocacy services for African-Caribbean men “