Addressing the needs of Black and Minority Ethnic BME groups in Primary Care

1. Addressing the needs of Black and Minority Ethnic (BME) groups in Primary Care Dr Joanna Bennett Senior Research Fellow

2. Structure of the presentation Review evidence of BME groups experience of primary care mental health services Policy response � DRE Action Plan Progress - Pathways to care & treatment of common MH problems Conclusions

3. Primary care MH services Primary population - common mental health problems Assessment Treatment Referral to specialist services Severe mental health problems Physical health needs Referral to specialist services Community mental well-being

4. Prevalence MH problems : BME groups EMPIRIC Study (2002) Common mental health problems Pakistani 19.6% Irish 18.5% Indian 18.1% African Caribbean 17.3% White 15.8% Bangladeshi 12.6% Refugee community � approx two-thirds will suffer anxiety and depression Severe mental health problems African Caribbean�s twice that of White population (16 per 1000) EMPIRIC �Ethnic minority psychiatric illness rates in the communityEMPIRIC �Ethnic minority psychiatric illness rates in the community

5. BME groups� experience of primary care �Breaking the Circles of Fear� (2002) Difficulty accessing primary care services Inadequate knowledge and information of mental health services (content, structure) Service/GP response to help-seeking � often not taken seriously/delayed access

6. BCOF (cont..) Fear of services - the effects/side effects of medication, death Stigma/sense of shame within communities Result - Long delays � access via more formal routes / police involvement

7. BME groups� experience of primary care �Inside Outside� (2003) No major ethnic variation in registration with GPs and overall consultation rates Consultations rates for anxiety and depression reduced for BME groups ( particularly South Asians and Chinese)

8. GPs often do not recognise mental health problems in BME groups (African Caribbean�s & South Asians) When mental health problems detected BME groups are more likely to be referred to specialist services rather than managed in primary care (where appropriate) Compulsory admissions are strongly associated with absence of GP involvement ( Single, lack of supportive friend or relative)

9. Some BME groups more likely to seek help from alternative and traditional sources ( church, faith/spiritual/traditional healers etc.) Barriers to seeking help Language Discrepancy of user and Dr�s views on nature of the presenting problem Cultural barriers to assessment Lack of knowledge about statutory services

10. Delivering Race Equality: Action Plan Encourage earlier access to care Promote culturally capable, non-discriminatory services Build links with communities (faith organisations, support networks, service users and carers) Choice of location to see professionals

11. DRE Action Plan (cont�): Provide information on sources of support (BME voluntary and community organisations) Create new pathways to referral (community self-referral points & confidential help-lines) Users, Carers, advocates to be involved in care and recovery planning PCTs commission services that address needs of BME communities

12. DRE : Progress in Primary Care Range of activities � particularly community engagement/capacity building 160 of 500 CDWs recruited 340 more this year Community engagement projects Significant financial investment to improve services to BME groups in some local areas Many examples of good practice reported

13. Pathways to Care � referral to specialist care �Count me in� Census (2006) Rate of referral by GP was 40% - 70% lower than average for inpatients from �Black Caribbean�, �Black African� and other �Black� Groups inpatients Lower for Bangladeshi, White Irish and Other Asian groups Referrals by the police almost double the average for Africans & African Caribbean�s & higher than average for Indian and Other White groups Much effort given to community development. There needs to be more emphasis on key areas that impact on access and treatment such as pathways to care and treatment of common mental health problemsMuch effort given to community development. There needs to be more emphasis on key areas that impact on access and treatment such as pathways to care and treatment of common mental health problems

14. Pathways to Care Referrals by the courts almost double for African Caribbean�s Referrals by Social Services higher than average for African Caribbean�s and Bangladeshi groups. Suggests the need to: place more focus on developing access to GPs and new pathways to care ( community/voluntary agencies) Improve assessment, management and referral to specialist services

15. Treatment: Common mental health problems Medication (SSRIs) lack of evidence of efficacy (few BME groups involved in drug trials) Monitoring effects/side effects Evidence of ethnic differences in: Acceptability of drug treatment for depression Response to antidepressants

16. Treatment: Common mental health problems Psychological interventions Lack of evidence of effectiveness in BME population Some evidence of continued inequality in access and acceptance for therapy in primary care Counselling - 15% primary care, 40% voluntary sector (Lawson & Guite 2005) Referred but less likely to be accepted for therapy (Cahill et al 2006)

17. Conclusions Evidence of BME groups� experience of primary care mental health services � inconsistent and limited Further research needed to enable development of evidence-based approaches Much effort has been made by services with some good outcomes. However emphasis has mainly been given to community engagement and development

18. Conclusions Evidence indicate the need to place more focus on improving access, assessment, treatment and referrals to specialist services Improvement in treating common mental health problems including, access to psychological interventions (more therapist from BME communities) evaluation of effectiveness of interventions for BME groups PCTs take more responsibility for commissioning services appropriate to the needs of local BME populations