Older people from black and minority ethnic groups: mental wellbeing

1. Older people from black and minority ethnic groups: mental wellbeing Jill Manthorpe, Jo Moriarty, Martin Stevens, Nadira Sharif, Shereen Hussein King’s College London

2. Importance of looking at mental well being, ageing and ethnicity Demographic picture in the UK Evidence from primary research Own research and that of others Issues for the future Outline Older people from black and minority ethnic groups

3. Barriers to knowledge • Still neglected issue in mainstream research • Just eight per cent of articles in two old age psychiatry journals included people form a minority ethnic group (Shah et al., 2008, 20(5) 1041-5) • Complexities of separating out multiple factors • e.g. socio-economic status Older people from black and minority ethnic groups

4. International comparisons • UK only country to routinely collect ethnicity data (Finney and Simpson, 2009) • Important to consider impact of immigration policies, histories of colonialism, impact of EU • Small scale studies exist (e.g. Lorent et al., 2008) but often descriptive and practice free… Older people from black and minority ethnic groups

5. Difficulties in definitions… • Measurements confusing and contentious • Ethnicity – can’t be separated from (political) purposes for which information is collected (Finney and Simpson, 2009) • Longstanding debates about how it should be measured • Widespread differences between studies • Imprecise terms can cloud issues of causation and attribution (Bhopal et al., 1991) • Definitions of wellbeing (Opposite to ill-being? Everything? Aspiration? At end of life?) • Definitions of depression – clinical or commonplace Older people from black and minority ethnic groups

6. Why focus on mental wellbeing ? • Change practice, provision and advocacy • Affects physical wellbeing • Effect on quality of life • Effects on others (carers, wider social networks, communities) • Promote equalities • Cost • Dominance of dementia • Becoming more frequent as professional term and policy goal Picture from Westminster City Council Older people from black and minority ethnic groups

7. Changing demographic picture • By 2051 estimates of 7.4 million Black and minority ethnic older people aged 50+, living in England & Wales, with 3.8 million 65+. • Age distribution among different ethnic groups varies • Many but not all minority groups have younger age structures

8. But in future… • Anticipated increase in the proportion of (users and carers) older people among minority ethnic groups due to the ageing of people arriving in the 1970s • Differing age structures means that changes will not be uniform • Different localities will be affected differently • Large groups will be ‘White other’ Older people from black and minority ethnic groups

9. Impact of regional/local variations • Different localities have differing proportions of BME older people • Projections influenced by migration history & settlement • Currently: • 30 per cent people aged 65 and over in Brent • 20 per cent in Lambeth and Hackney • More areas are likely to have BME older people (movement inside the UK and longer life spans) (Lievesley, Centre for Policy & Ageing 2010) Older people from black and minority ethnic groups

10. SCIE practice enquiry • Targeted areas with low BME populations • Investigated accounts of practice in social care (including housing with care) in visits and interviews • Focus on promotion of mental wellbeing

11. Three themes in practice: (1) Language matters but not for all.. • Relationships with ‘link’ people and/interpreters • May be ambivalent (Chau, 2007) • Over reliance upon family members questioned • Good quality interpreting can raise quality of care to same levels as those proficient in English (Karliner et al, 2007) • Importance of recruiting bilingual workers • BUT services few and far between (and many languages) so practitioners manage: • Wish to use family among some older people • Alert to isolation of the minority…use of new media • Keep eyes open eg family visits falling off… • Potential of personalisation (if eligible) Older people from black and minority ethnic groups

12. (2) Managing relationships • Direct and indirect racism • Tensions, misunderstandings and lack of knowledge between older people and families • Little guidance and support for staff • Part of social care work • Zero tolerance to mediation… • Training often ‘food and faith’ based • Diversity of BME older groups being addressed in some social care provision

13. (3) Specialist or integrated? • Specialist along which lines? examples – Day care, Care Homes, Community groups…cost-effectiveness? • But also intergenerational and also by interest groups • Need for sensitivity & flexibility as groups/communities change and bills have to be paid • Potential of personalisation, housing wealth… Older people from black and minority ethnic groups

14. Barriers to knowledge • Studies of older people still have low numbers of older people from minority ethnic groups • e.g. English Longitudinal Study of Ageing • Different sampling strategies may be necessary (Manthorpe et al., 2009) Photograph from 3YO event

15. Discussion • Limited nature of much current research • Most evidence on clinical practice in health • Very little on social care • Tends to be deficit focused • Tends to look at easily identifiable groups • How comparable are concepts such as ‘successful ageing’, wellbeing, isolation, across different ethnic/migrant groups? • Differences within and between groups • Are the issues the same for carers? And paid care workers? Older people from black and minority ethnic groups

16. See… • Practice enquiry: Supporting black and minority ethnic older people’s mental wellbeing: accounts of social care practice • scie.org.uk