BME Communities Research Articles

'Reputation, reputation, reputation! Oh, I have lost my reputation!'; A literature review on alcohol addiction in the British Sikh and/or Punjabi community and the barriers to accessing support.

The literature review aimed to identify the barriers the Punjabi and/or Sikh community have in accessing support for alcohol addiction. A systematic review of the literature was undertaken of four scholarly databases, Google Scholar and grey literature on UK-based research conducted after 1980 into alcohol addiction in the Punjabi and/or Sikh community. Fourteen papers met the inclusion criteria outlined in the paper and were included in the review. Ten main barriers to accessing support were found; stigma, religion, lack of understanding of addiction, over reliance on a medical model of treatment and disregard of therapy, cultural implications of being a member of the Punjabi and/or Sikh community and the addiction community, gender and generational differences and a lack of government commitment to alcohol support for BME communities with a lack of culturally specific services. Despite the many barriers explored, the role of stigma remained a powerful theme throughout often underpinning other barriers. A key recommendation across many papers was the need for culturally sensitive support services. Several areas for future research were identified.

Community based prostate cancer risk assessment: Creation of a service for the BME community

Community based prostate cancer risk assessment: Creation of a service for the BME community

Innovative ways of engaging with BME communities

Migrant South Asian women living in the UK have a higher prevalence of depression, but access to and engagement with mental health services is poor. The lack of interventions for this client group led to the development of a psychoeducational and CBT-based intervention group in an IAPT setting. Results and its implication on health care services are discussed.

P235 An audit of the care of msm attending an outer london integrated sexual health service

IntroductionMen who have sex with men (MSM) remain a high risk group for HIV infection, increased rates of syphilis, LGV and gonorrhoea indicating high levels of risky sexual behaviour. The aim of this audit was to measure care against BASHH recommendations for testing for STIs in MSM (2014) and local guidelines to ensure high quality accessible services for MSM.MethodsData were collected retrospectively from electronic patient records of all MSM first attendances across all clinics between 1 January 2015 to 30 June 2015 (N=96) and data analysed using SPSS and Excel.Results79% (76/96) of MSM were from our local borough; age range was 16–65 with highest attendance in the 25–29 years age group; 43% were from BME communities. 100% were offered STI screening, 91% accepted (87/96) and 47% had a STI diagnosed. 80% of MSM had a comprehensive assessment undertaken while 65% had a record of vaccination status. PEPSE discussion was recorded for 76% of eligible patients. 100% of suitable patients were offered HIV testing (n=88/96), 90% (79/88) tested with a positivity rate of 2.5% (2/79).DiscussionThe service is highly accessible to local MSM, STI testing offer exceeded the BASHH recommendation of 97% and uptake of 91% exceeded the BASHH recommendation of 80%. Uptake of HIV testing met the BASHH recommendation of 90% but improvements are needed in PEPSE and PREP discussions and determining Hepatitis B status in all eligible clients. EPR has been revised and staff training undertaken to address and improve on this.

P062 Accessing the prep population: what is the best service model?

IntroductionPre-Exposure Prophylaxis (PrEP) is effective to prevent HIV infections. Optimal service models for delivering this intervention are as yet unclear. We looked at our dedicated PrEP clinic in East London to identify who was accessing our service.MethodsRetrospective case note review collected demographics, PrEP use, STI rates and ‘chem’ use from January to November 2016. Data was analysed with STATA.Results116 visits from 54 patients were returned with a median age 42 years (IQR 32 – 44.5). 90% were white. Of these 54 patients, only 27 started PrEP and engaged in care. For our population, there were lower than expected rates of STI’s (6% for CT and 9% for GC – any site) and a median of 4 partners in the preceding 90 days; much lower than encountered in the PROUD trial. 40% (21/54) had used ‘chems’ at some point, with 21% (4/21) of those ‘slamming’ (using intravenously) in the last 3 months. Routine urinalysis showed 30% abnormalities, but no subsequent abnormal uPCR.DiscussionAs the interest and use of PrEP grows, new service models may have to be developed to accommodate this population. We saw varying levels of engagement with patients who were predominantly white with low sexual risk. Young MSM were also underrepresented. Engagement with BME and MSM communities, along with drug services, may be needed to inform effective delivery of this intervention to those most at risk.

P203 HIV-testing African Service Users within a Newly Integrated Sexual Health Service - Our Experience

Background/introduction HIV testing is recommended for all sexual health clinic attendees, and in generic health services for high risk groups including BME communities, especially in areas of high HIV prevalence such as Leeds (2.51/1000). Aim(s)/objectives In July 2015 an integrated contraception and STI service, Leeds Sexual Health, began following commissioning by Leeds local Authority wherein the routine offer of HIV testing was extended to all attending service sites across the city, 4 out of 5 of which had previously seen patients for contraception and sexual health (CASH) services only. Methods We prospectively examined data in those of African ethnicity regarding offer and uptake of HIV testing in these new settings. Results Interim data indicates a much higher number of African patients accessing the integrated service but with a lower overall uptake of HIV testing, a significant disparity in HIV testing uptake between men and women, with significant numbers of patients choosing not to disclose their known HIV status at a community setting where they are accustomed to only sharing contraception information. Discussion/conclusion Staff used to achieving HIV testing rates of over 80% in a GUM clinic setting have found patients reluctant to test when they have come expecting the previous service. We are therefore trying to assess genuine missed opportunities for testing and considering reframing HIV testing as a positive and routine intervention e.g. along with postpartum contraception, when trying to embed HIV testing as part of a standard, integrated sexual health care offer.

An evaluation of opportunistic health checks at cricket matches: the Boundaries for Life initiative

In 2009, a population level health screening programme was established in the UK for people over the age of 40 years. The primary aim of the service was to identify and treat the leading causes of preventable disease and death, including cardiovascular disease and diabetes. Checks are offered every five years through scheduled appointments at primary care settings, and uptake of such checks has been relatively low to date with 12.7% of those eligible to have a NHS health check receiving one between 2009 and 2013. Non-clinical settings such as sports stadia have previously been used to offer health interventions and opportunistic health checks. Despite relatively modest results in football and rugby settings, professional cricket fixtures with high footfall may offer higher levels of uptake and participant satisfaction, and provide a novel setting for engaging BME communities. This paper describes the process and results from the Boundaries For Life initiative that delivered health checks at professional cricket matches over the 2014 and 2015 seasons. Uptake of the checks was significantly high in comparison to other sports settings, with very strong feedback from participants on the convenience of service.

BARRIERS AND FACILITATORS FOR PEOPLE IN BME GROUPS ACCESSING PRE-HOSPITAL CARE AND CAUSES AND CONSEQUENCES OF ANY DIFFERENCES IN DELIVERY: SYSTEMATIC REVIEW AND NARRATIVE SYNTHESIS

IntroductionResearch addressing inequalities has focused predominantly on primary and community care; few initiatives relate to the pre-hospital environment. We aimed to identify in the literature barriers or facilitators experienced by...

Working through interpreters in old age psychiatry: a literature review

Purpose – The purpose of this paper is to systematically appraise the effect of use of interpreters for mental health problems in old age. The primary objective of the review is to assess the impact of a language barrier for assessment and management in relation to mental health problems in the old age. The secondary objectives are to assess the effect of the use of interpreters on patient satisfaction and quality of care, identify good practice and make recommendations for research and practice in the old age mental health. Design/methodology/approach – The following data sources were searched for publications between 1966 and 2011: PubMed, PsycINFO, CINAHL and Cochrane Library. The authors found in previous reviews that a substantial number of papers from developing and non-English speaking countries are published in journals not indexed in mainstream databases, and devised a search strategy using Google which identified a number of papers, which could not be found when the search was limited to scientific data bases only (Farooq et al., 2009). The strategy was considered especially important for this review which focuses on communication across many different languages. Thus, the authors conducted a search of the World Wide Web using Google Scholar, employing the search term Medical Interpreters and Mental Health. The search included literature in all languages. The authors also searched the reference lists of included and excluded studies for additional relevant papers. Bibliographies of systematic review articles published in the last five years were also examined to identify pertinent studies. Findings – Only four publications related specifically to “old age” and 33 addressed “interpreting” and “psychiatry” generally. Four articles presented original research (Parnes and Westfall, 2003; Hasset and George, 2002; Sadavoy et al., 2004; Van de Mieroop et al., 2012). One article (Shah, 1997) reports an “anecdotal descriptive account” of interviewing elderly people from ethnic backgrounds in a psychogeriatric service in Melbourne and does not report any data. Therefore, only four papers met the inclusion and exclusion criteria and present original research in the field of “old age”, “psychiatry” and “interpreting”. None of these papers present UK-based research. One is a quantitative study from Australia (Hasset and George, 2002), the second is a qualitative study from Canada (Sadavoy et al., 2004), in the third paper Van de Mieroop et al. (2012) describe community interpreting in a Belgian old home and the final paper is an American case study (Parnes and Westfall, 2003). Practical implications – Interviewing older patients for constructs like cognitive function and decision-making capacity through interpreters can pose significant clinical and legal problems. There is urgent need for training mental health professionals for developing skills to overcome the language barrier and for interpreters to be trained for work in psychogeriatrics. Social implications – The literature on working through interpreters is limited to a few empirical studies. This has serious consequences for service users such as lack of trust in services, clinical errors and neglect of human rights. Further studies are needed to understand the extent of problem and how effective interpreting and translating services can be provided in the routine clinical practice. It is also essential to develop a standard of translation services in mental health that can be measured for their quality and also efficiency. At present such a quality standard is not available in the UK, unlike Sweden (see www.regeringen.se/sb/d/3288/a/19564). This omission is disturbing – especially when decisions on human rights are being considered as part of the Mental Health Act. Such a standard can best be achieved by collaboration between medical profession and linguists’ professional associations (Cambridge et al., 2012). Originality/value – Whilst translation/interpretation has been addressed more generally in mental health: specific considerations related to old age psychiatry are almost absent. This needs urgent rectification given that a large proportion of older people from BME communities will require translation and interpretation services.

‘I don’t have a life to live’: deaths and UK detention

The Institute of Race Relations has over the last twenty-three years been monitoring the 508 deaths in custody in suspicious circumstances of individuals from BME, migrant and refugee communities, which rarely make the headlines and for which no person is ever convicted (to be published as the report Dying for Justice). Here, in an extract, the author examines the culture of racism and the impact of privatisation and sub-contracting in the detention and deportation of ‘failed’ asylum seekers. In case after case it exposes how the vulnerable, mentally- and physically-ill are neglected – leading to deaths by self-harm and inadequate treatment. The death during deportation of Joy Gardner, which involved disproportionate and reckless use of force, is examined in depth. The use of equipment of control for those who are clearly fearful of being forcibly returned, remains a vexed issue.

Investigated or ignored? An analysis of race-related deaths since the Macpherson Report

Since the publication of the Macpherson Report in February 1999, there have been at least ninety-three deaths with a known or suspected racial element in the UK. Of these, 97 per cent of the victims were from BME communities (including those from Gypsy or Traveller communities and European migrant workers). Particular groups of BME people are at risk – asylum seekers, new migrants, students and those working in the night-time economy. In only a quarter of the cases was the allegation of racism accepted and prosecuted as such, with racial motivation factored into sentencing. The over-strict interpretation of the legal provisions for racial motivation may be inhibiting the (racial) charging of perpetrators and in fact removing the racial context of a crime from the court room. It also appears that if authorities, including the police, had, on occasion, intervened earlier, against persistent harassment and low-level abuse, some deaths might have been prevented.

Community engagement and social exclusion: the BME experience

PurposeThe endless and recurrent nature of community regeneration is of massive concern to any government due to the financial and human resources requested. Past research has suggested that by involving members of the community in the process of these regeneration activities, past mistakes can be alleviated and so people will feel better appreciated. However, members of the BME groups which make up to 12 per cent of the UK population are not participating optimally. This paper aims to look into the reasons for this lack of participation and make suggestions accordingly.Design/methodology/approachThis research adopted the triangulation method of research where interviews, literature review and questionnaires sources of data were all used. However, this paper presents only the results of the quantitative method. A total of 250 questionnaires were distributed with 203 completed and returned using snowball method of distribution.FindingsWhat emerged from the analysis was that local councils and other regeneration service providers are better channelling more resources at the use of community representatives in areas where there is a dominance of ethnic minority groups.Social implicationsThis paper explores community regeneration and identifies the need for partnerships in the process of the delivery of regeneration to a community. It investigates the various levels of community engagement and participation, the cultural diversity of England and discusses the social exclusion situation of BMEs. The paper also discusses the results of a descriptive quantitative analysis of a questionnaire survey which studied BMEs and their experience of community regeneration, both in terms of their housing needs and also the challenges preventing them from effective community engagement.Originality/valuePractical suggestions are made to assist policy and decision makers in engaging members of the BME community more in regeneration.

Mental Health Inequalities Facing U.K. Minority Ethnic Populations

AbstractBlack and minority ethnic (BME) communities continue to experience inequalities within the U.K. mental health system despite major government policy initiatives. The authors examined the literature for causal factors for continued mental health inequalities facing BME groups and potential solutions. The authors selected 53 articles from 1991 to 2012 based on inclusion criteria encompassing all major policy initiatives and relevant literature detailing explanations of mental health inequalities. Although ethnic inequalities in mental health have been of concern for decades in the United Kingdom, a still‐significant gap exists between policies and methods of implementation. In comparison to White people, more BME people are diagnosed with mental health issues every year. BME communities are also facing barriers in terms of accessing culturally appropriate services, including lack of cultural understanding, communication issues, and where and how to seek help. Service providers need to work closely with people from BME communities prior to service design and delivery. Information should be made available in appropriate languages to support understanding about their illnesses and how they can seek help. Frequent reviews may further help assess BME communities' needs and make required changes and implementations.

Dismantling racial justice

According to this commentary, the UK coalition government’s 2012 proposals to restrict judicial review and to abolish measures which safeguard race equality amount to a further assault on migrants, asylum seekers and BME communities, in the guise of promoting economic growth. The arguments against judicial review – their number, their length, their cost – are contested here. The author argues that judicial review is a necessary protection for human rights, especially when legal aid is being withdrawn.

Shifting the Balance in Environmental Governance: Ethnicity, Environmental Citizenship and Discourses of Responsibility

This paper focuses on the notion of environmental citizenship in examining how black and minority ethnic groups (BME) in Britain talk about environmental rights alongside environmental responsibilities. This broader discursive context leads us to engage with two interpretations of sustainability promoting different policy and planning agendas— the environmental sustainability and just sustainability policy agendas—in understanding the multiple spaces of identity, power and agency in which BME communities respond to environmental issues in and daily life. We conducted ten semi-structured interviews with community key informants and ten focus groups with African-Caribbean or Indian communities. We identified four environmental responsibility discourses in the participants' talk, that were variously defined by issues of trust, social equity, off-loading of responsibility and government intervention and that served to shift environmental responsibility away from the individual onto institutional others. We conclude by suggesting policy implications for the environmental and sustainability policy and planning community.

‘Mate crime’: ridicule, hostility and targeted attacks against disabled people

A common understanding of the term ‘hate crime’ involves opportunistic street crime and physical assault. The perpetrators do not usually have a relationship with their victims, although they may be known to live within the same neighbourhood. There are similarities between these types of targeted attacks against disabled people and people in other identity groups, such as BME communities, lesbians and gay men, transgender people. The term ‘mate crime’, is a play on the term ‘hate crime’, and refers to considered actions against disabled people at the hands of someone, or several people that the disabled person considers to be their friends, or they may be relatives. There does not seem to be a comparable set of hostile acts against the other identity groups who may be subjected to ‘hate crime’. Acts of ‘mate Crime’ are acts of cruelty, humiliation, servitude, exploitation and theft. The occurrences of cruelty and servitude indicate that what is currently being termed ‘mate crime’, has more in common with domestic violence than ‘hate crime’ which is perpetrated by people with whom there is no relationship beyond acquaintance.

Project grants for award winners set to benefit BME communities

Project grants for award winners set to benefit BME communities

The effectiveness of events to raise awareness of the Mental Capacity Act 2005 among representatives of ethnic minority communities

This article considers the effectiveness of two one‐day events designed to raise awareness of The Mental Capacity Act 2005 (MCA) in BME communities. The events were held using specially developed materials and were evaluated with the help of a 12‐item questionnaire. The results of the evaluation showed that there was an increase in the proportion of correct responses for 10 of the 12 questions after attending awareness‐raising events. The total score for all correct responses on the 12‐item questionnaire significantly increased after attending the awareness‐raising events. Collectively, the findings suggest that the awareness‐raising events were able to improve awareness of the MCA among representatives of BME communities. Such awareness‐raising events should be encouraged by health and social care providers

Developing Culturally Sensitive Cognitive Behaviour Therapy for Psychosis for Ethnic Minority Patients by Exploration and Incorporation of Service Users' and Health Professionals' Views and Opinions

Studies of cognitive behaviour therapy (CBT) for schizophrenia demonstrate that African-Caribbean and Black African patients have higher dropout rates and poor outcomes from treatment. The main aim of the study was to produce a culturally sensitive adaption of an existing CBT manual for therapists working with patients with psychosis from specified ethinic minority communities (African-Caribbean, Black-African/Black British, and South Asian Muslims). This will be based on gaining meaningful understanding of the way members (lay and service users) of these minority communities typically view psychosis, its origin and management including their cultural influences, values and attitudes. This two-centre (Hampshire and West London) qualitative study consisted of individual semi-structured interviews with patients with schizophrenia (n = 15); focus groups with lay members from selected ethnic communities (n = 52); focus groups or semi-structured interviews with CBT therapists (n = 22); and mental health practitioners who work with patients from the ethnic communities (n = 25). Data were analyzed thematically using evolving themes and content analysis. NVivo 8 was used to manage and explore data. There was consensus from the respondent groups that CBT would be an acceptable treatment if culturally adapted. This would incorporate culturally-based patient health beliefs, attributions concerning psychosis, attention to help seeking pathways, and technical adjustments. While individualization of therapy is generally accepted as a principle, in practice therapists require an understanding of patient-related factors that are culturally bound and influence the way the patient perceives or responds to therapy. The findings of this study have practical implications for therapists and mental health practitioners using CBT with people with psychosis from BME communities.

The EPIC project in Easington

Background: Improving pathways into care is an important part of government policy on delivering equitable care and treatment for the BME community. As part of EPIC Easington Mental Health services agreed to participate in the project to increase the level of self seeking behaviour at the point prior to accessing to our services for the Chinese community in order to reduce fear, increase satisfaction with services and ensure our workforce was capable of delivering appropriate and responsive care. Project Methodology: A literature search, community development approach and clinical pathway of care identified the key aims of the project. Four ‘work streams' were identified each with agreed overall aims and outcomes with the project group steering implementation. Outcomes: There was recognition at commencement that key outcomes would be difficult to quantify and the project would continue outside the parameters however we were able to demonstrate improvement as a result of the project and identify key learning points.