Mental Health Inequalities in BME Communities

Introduction

There are considerable increases in diagnoses of mental health worldwide. Due to this rise mental health has garnered a lot of attention and has led Social Workers to find means through which they can effectively treat people with these issues. Adult Mental Health is vital and equally as important is access to mental health services. Whilst that is true not all people have equal access to mental health services (Memon et al. 2016). Some have better access based on their ethnicity, socioeconomic status, and a myriad of other factors. Inequalities abound in access to mental health services. In the U.K. Black and Minority Ethnic (BME) experience blatant biases within the U.K. mental health system (Memon et al. 2016). The government has striven to make access to mental healthcare as equal as possible through policy changes (NHS, 2017), but still, BME communities’ experience great inequalities in terms of accessing mental health services. The changes in government policy to improve access to mental health services is proof that mental healthcare services occupy a prominent position in modern society. However, whilst there is an increase in sensitivity there is still a vacuum in terms of culturally sensitive information. Lack of that information is a hindrance for BME communities since they do not have appropriate platforms from which they can discuss their mental health issues and the challenges that they experience when striving to access mental healthcare. The question not only permeates in everyday life but has had carryover effects into school and university life for BME students. This is relevant to social work because it calls the issue of cultural sensitivity in treating BME communities to the fore and how that sensitivity can be reinforced in social work practice.

AIM

This review will explore the inequalities that are faced by BME communities in adult mental health services in the UK and its implications to social worker practice. Another aim of this study is to explore the impacts of these inequalities on the mental health of the BME community and its implication to social worker practice. It will seek to identify the negative implications that the BME community experiences whilst under the mental health services and contributing factors such as race, culture judgements attitudes and stigma and its effects on BME service users experience within the mental health service. This is relevant to social work practice because social workers can serve as a bridge to mitigate the negative experiences that BME communities experience when they try to access mental health services.

Rationale

The topic was chosen because of its relevance to social work practice. It is the social worker who deals with disenfranchised communities thus they are the ones who are better placed to deal with the issues revolving around inequality in accessing mental healthcare. Furthermore, the government has asserted that every individual has a right to access proper healthcare and this review shows that at the grassroot level many people still do not have access to proper care. Moreover, this issue is important to practice because it identifies communities that are being affected by a lack of mental health services and notes their experiences and the barriers that they have faced and continue to meet. As such, the research questions will be, what are the negative experiences that BME communities face when striving to access mental healthcare? What policies can be set up that will improve the outcomes and access to mental healthcare for BME communities? How have current policies contributed to the inequality? What role does the social worker play in the whole scenario? The review will carry out a literature review on the matter and conclude by discussion how the reviewed information relates to the social worker and to social work practice.

Background

Before consideration of contributory factors for the inequalities that BME communities experience, it is crucial to understand the nature of the said inequalities and to understand the various terms used in the literature when describing the groups that have been affected. Much of the reviewed literature (Arday 2018; Parkin (2018; Memon et al. 2016) used the term Black and Minority Ethnic (BME) to refer to populations who are a racial and ethnic minority. The word(s) is diverse, and it does not only include black minorities but white minorities such as the Irish. Therefore, the term BME denotes an extensive group of people (Grey et al. 2013), and because the majority of the literature uses this term, then the name has been appropriated for use in the paper. People from BME communities are more likely to be detained under the mental health act. According to a document by the NHS (2017), titled “Detentions under the Mental Health Act, among the group referred to as the BME community, people in the Black ethnic group were the ones who were most likely to be detained under the Mental Health Act 1983 in 2016/17. At the same time, people from the white ethnic group were the ones who were least likely to be held under the Act. Amongst the minority ethnic groups Black Caribbean people were the ones with the highest detention rate. The information also showed that out of every 100,000 people the number of black people to be detained was 272. For the BME community in total, the figure was 757 per every 100,000. The relatively low values may be deceptive; they are very high in relation to the BME population. This figures are relevant for the study because they reinforce that individuals from BME communities receive inequal mental health services.

The prevalence rates are also seen in a school context. Arday (2018) notes that within the university context prevalence rates in relation to mental health issues are higher in regard to individuals from BME communities. Arday gives a comparison of South Asian women and white women and notes that prevalence rates of depression are higher in South Asian women at 63.5% while in white women the figure is 28.5% (Arday 2018). The numbers were also higher in Afro-Caribbean men at 3.1% as compared to 0.2% in white men. While the statistics are higher in people from BME communities they are less likely to be treated for their mental issues since they have lower access to mental health services. In relation to the aims of the paper, the above information by Arday (2018), shows that whilst prevalence rates are relatively higher in minority ethnic groups, their access is lower due to inequalities that will be expounded below. In a historical context, people from BME communities have always been severely underrepresented in healthcare (Grey et al. 2013). The root of that is racialized history which makes it hard for individuals from those communities to navigate the healthcare structure since policies were created with the white individual in mind (Grey et al. 2013). Moreover, there is a cultural paradigm through which mental health is viewed. Mehraby (2009) writes that there are two common paradigms through which mental health is observed in the BME communities. An individual is considered either to be possessed or crazy. She writes that historically mental health has been seen through the spiritual and religious contexts (Mehraby, 2009). Some say that mental illness occurs when an individual is possessed by evil spirits, Djinns or demons. Others say that an individual who has a mental illness is cursed or is being affected by works of Witchcraft. Others also say that a person with mental illness is experiencing a religious awakening or is receiving a divine message from God. The reason that mental illness is associated with spiritual and religious things is that it is associated with shame and stigma in many cultures. The differences in understanding the root cause of mental issues relates to the aims because it shows how a difference in culture contributes to the inequality experienced by minority ethnic communities. Due to the scandal that is associated with it, there are various reactions that people have when mental illness occurs. The first as stated above is that they ascribe it to spiritual power (Mehraby 2009). The second usually deals with sending the mentally ill person away and or locking them up. How to deal with the mentally ill individual will depend on the culture (Grey et al. 2013). Therefore, whilst prevalence rates are higher in BME communities they are not only guided by a Eurocentric view on mental healthcare, but there is a cultural context therein that must be understood. This is important because it shows that part of the root of the problem lies in how minority ethnic communities understand and treat mental health issues.

The theoretical perspective that best defines the issue of accessing mental healthcare for the BME community is the Systems Theory. Simmons University (2018) notes that systems theory explains human behaviour as an amalgam of many influences from multiple related systems. The method looks at individuals through the prism of their issues, their families, organizations, and society as a whole. Each system is considered to be a contributory factor to the overall problem. In this scenario, the overall problem is the lack of access to proper mental health care for the BME community. One would be tempted to view the issue through one-dimension by stating that it is governmental policies that have led to the birth of the issue. However, that would not and should not be the case. Lack of quality mental healthcare is spearheaded by culture, government policies, racialized institutions, racial history and Eurocentrism and many other factors. The systems theory enables the social worker to think about how the dynamics are always changing and evolving and how changing one element may have ripple effects throughout the whole system. It is up to the social worker to battle their preoccupation with only one factor in the system and pay attention to every factor. However, it is a given that some elements will carry more weight than other factors, but they should not be evaluated at the expense of other factors if the social worker wants to understand the whole system in a more holistic manner.

Policy and Legislative Framework

There are a number of current legislation that inform the issue. The Mental Health Act of 1983 is about being detained on the ground of mental issues. One can be detained if the medical social worker believes that they are a danger to themselves and others. The information by the NHS on detention rates showed that it is more likely that an individual from BME communities will be detained as compared to a white individual (NHS, 2017). The Mental Capacity Act of 2005 is also another law that influences the issue. The law protects an individual when they are unable to make decisions on their own due to mental illness. In 2014 the Depart of Health launched the “Positive and Safe” programme. Parkin (2018) notes that the plan was started with the aim of reducing the number of restrictions across all health and adult social care. There are also NICE guidelines that advocate for staff training to aid in the reduction of restrictive interventions. In 2017, the cabinet office published a report on policing, and mental health and the report showed that individuals from BME communities experienced less quality mental health care (Parkin 2018). Current policies aim at reducing the number of disparities that individuals from BME communities experience when trying to access mental health care. The austerity of existing laws and policies are biased against people from BME communities. As said above, it is more likely that an individual from BME communities will experience greater restrictive force under the Mental Health Act of 1983. Furthermore, given the state of current laws and policies outcomes are less than optimum. It is still a great challenge for them to access mental healthcare and when they do, they may experience higher degrees of restrictive interventions. Additionally, many factors such as cultural sensitivity and predisposition towards particular mental health issues are not taken into account when coming up will laws and policies and that is part of the reason why the outcomes are not ideal. Therefore, BME communities still experience inequalities when they try to access proper mental healthcare.

Methodology

Secondary research was undertaken to get the materials that would be used under the literature review section. This method was conducted since there is a lot of information on the inequalities that BME communities face when trying to access mental healthcare services and all that is needed is a synthesis of the current literature. Secondary research meets my particular aims since it aided in conducting an exploratory review of the inequalities that individuals from BME experience and how that has affected their mental health.

Search Strategy

The library search engine was used as the primary database from which relevant literature was retrieved. Google scholar was also utilized as a secondary search engine. The set time for the search was starting from January 2013 to March 2019. That search period was selected because the research would be old enough to have received an endorsement from various peers and new enough to maintain current relevance. The more recent the publication, the higher the probability that it would be selected since recent publications consider contemporary nuances and changes in policies and laws. The two search engines were searched using a combination of terms and keywords. The words selected were selected based on current research on the topic. The names used were: (i) social work, social support, voluntary workers, social care services, community care; (ii), Ethnic Minorities, Black and Minority Ethnic, Minority groups, groups with African ancestry, ethnic community, ethnic population, African Caribbean, black Caribbean, Asian, Pakistani, Indian, British race; (iii), Inequalities, discrimination, disparities; (iv), mental health services; (v), implication for social worker practice. After the relevant literature was selected, their reference pages were evaluated to determine whether there were other articles that fitted the inclusion criteria.

Inclusion and Exclusion Criteria

In relation to the inclusion criteria the following studies were included: investigations on the inequalities that ethnic minorities experience when trying to access standard healthcare and mental healthcare services; predisposition of BME to particular mental issues; barriers that prevent BME from accessing mental healthcare services; current and previous mental health policies in England; ways of dealing with obstacles that BME face when trying to access mental health services; quantitative and qualitative studies; studies published in peer-reviewed journals and accredited websites. In terms of language, all selected studies had to be in the English language. In relation to the exclusion criteria the following studies were excluded: investigations if inequalities that BME experience with only general health services rather than mental health services; investigations where it was not possible to distinguish the barriers that lead to the disparities; investigations that did not apply social work theories but used theories from other disciplines such as psychology; studies that focused solely on children from BME communities and the barriers that they face; studies that did not fit within the set criteria date; non-peer reviewed studies; conference proceedings; review and comment articles; blogs; Wikipedia; unaccredited websites; PhD theses. The materials that were selected were scrutinized two times to ensure that they fit with the inclusion criteria. If one of the chosen articles did not meet the inclusion criteria after a second review, the whole process was repeated again. At the end of the search process, 10 articles were selected for the literature review section. By evaluating the date of publishing, title, abstract, methodology section, conclusion, and implications for future studies the articles were condensed into a manageable sample of 10 articles.

Data Analysis

Additionally, based on the collected information it was relatively more straightforward to note the implications that it would have on social work practice as well as the negative implications that BME communities experience whilst under mental health services. Furthermore, secondary research aided in identifying, evaluating and summarizing all the relevant studies that were selected which will make the information more easily accessible to decision makers. Since the range of studies used was relatively large, a narrative synthesis of the materials was adopted. The narrative synthesis aided in capturing and highlighting the methodological diversity of the identified literature as well as the diversity of their various settings and conclusions. A narrative analysis of the literature showed that there were extrinsic and intrinsic factors that contribute to the inequalities experienced my minority ethnic communities.

Literature Review

The literature review section is divided into different sections each one covering the barriers identified by other researchers. The barriers are not listed chronologically. However, the barriers at the top of the section are the ones that most recorded in the literature.

Racial Discrimination

The most blatant and barriers that stood out from the literature is that of racial discrimination. NHS (2017) observed that it was more likely for an individual from a BME community to be detained under the Mental Health Act of 1983 while a white man was likely to be held. The issue of the detention of the black man has been discussed for very many years (Grey et al. 2013). Laws and policies seem to be biased against the black man making him more likely to be detained. (Grey et al. 2013). Grey et al. (2013) observed that the death of black men is not only limited to psychiatric systems but is clearly evident in other public systems such as the prisons and immigrations systems. Grey et al. (2013) continue to note that what all public systems have in common is their fear of the black man informed by stereotypes of BME individuals characterized as being more antagonistic and dangerous. Grey et al. (2013) continue to note that while it is more likely that individuals from BME communities are going to be treated for a mental illness that does not mean that they have such illnesses. The diagnosis reached by the social workers may be as a result of racially biased interpretations of the presenting symptoms. The incidences of mental illnesses may be higher, but they may be related to the social circumstances and the discrimination that the individual faces. Furthermore, no evidence has been presented to suggest that individuals from BME communities are more likely to be violent as compared to their white counterparts yet social workers are more likely to perceive them as being violent. The evidence relates to social work because the social worker is not immune to racially preconceived ideas when they are dealing with individuals from minority ethnic groups.

The findings by Grey et al. were supported by Arday. According to Arday (2018), one of the reasons that BME individuals do not seek out proper mental health care is because they are afraid of racial discrimination. Individuals from minority communities are already aware that they occupy a vulnerable position in an environment that is predominantly white environment. They are aware that few social workers are able to deliver culturally appropriate treatment and since they are already at a disadvantage, they would instead not try to access medical care. Memon et al. (2016) observed that individuals from BME communities stated that social workers always struggled to understand “the Black experience.” The participants of the study indicated that they felt that healthcare providers were indifferent when providing them with care since they struggled to understand the experiences that BME people. The participants of the study further stated that they felt that they were being discriminated against as a result of their skin colour. (Memon et al. 2016). One woman from the BME community gave an example in which she and her white friend had the same issue. Both of them went to visit Social worker. The social worker evaluated her white friend and transferred her to a consultant, and her problem was solved. When the woman from the BME community was reviewed by the Social worker, she was just given some medicine, and her issue was not resolved. She has had to go back to the social worker’s office many more times, and each time she was given a different tablet. The woman stated that she felt angry because she believes that her friend was transferred because she was white and she was not moved because she comes from a BME community (Memon et al. 2016).

There is also a never-ending fear that the form of care that they will receive is punitive. Grey et al. (2013) noted that individuals from the BME community feared that if they sought out care for any of their mental health issues, then they will experience punitive forms of care. The disciplinary forms are informed by some professionals having preconceived notions about people from the BME community that are informed by prejudices and stereotypes. Some social workers have a misinformed idea that mental illnesses abound in BME communities they are an “inferior race, and they have an inferior culture” that is supported by the genetic predisposition and their behaviours. Such preconceived notions fuel racism and make it very challenging to access proper mental healthcare. Islam, Rabiee, and Singh (2015) also noted that the prejudice that people have experienced when seeking proper mental healthcare plays a huge role in whether they will decide to reaccess the services. The participants reported that there is a lack of cultural awareness from social workers and that highly affects the type of care the social workers will advance to their patient. This “insensitivity” makes seeking mental healthcare a considerable challenge for people who come from the ethnic minority. This relates to social work practice because it shows that part that cultural insensitivity plays in supporting the inequalities experienced by the BME community.

Cultural Views of Mental Health

The cultural views concerning mental health are important since the social worker must understand their client’s view of the issue so that they can offer them optimum care. Some studies showed that cultural beliefs concerning mental health determined the likelihood of the individual seeking professional mental health care services. Osman and Carare (2015) noted that religious beliefs which at times form the foundation for cultural values were a significant determinant of whether an individual will seek out mental healthcare. Majority of the individuals in BME communities follow non-Christian faiths namely Islam, Sikhism, Buddhism and other ethnic religions. The religion that one subscribed and their cultural views on mental healthcare determined their service access. Rabiee and Smith (2014) noted that in some communities mental health is stigmatizing. Some societies believe that the mental health issues that one is experiencing has a spiritual aspect to it and may be caused by malevolent spirits. Some may view the mental health issue as karmic justice being delivered against the individual; that they must have done something wrong and the mental health issues that they are experiencing is them getting punished for their wrong acts. Some participants in the study stated that they believed that Western medicine was not equipped to deal with the mental issues that they were experiencing (Rabiee and Smith 2014). They believed that Western medicine does not recognize the different causes of psychological problems such as mental illnesses that are caused by demon possession and magic which required a spiritual cure. Based on the various causes of mental illness some participants surmised that social workers did not have the expertise nor the understanding needed to accurately diagnose and treat mental illnesses (Rabiee and Smith 2014).

In some communities mental illness comes with stigma; thus people are not willing to seek mental healthcare services since they will be viewed differently by the community. Memon et al. (2016) noted that in some communities an individual is expected to “just deal with it.” Participants of the study stated that mental illness is not something that is talked about in BME communities and in some communities it is considered to be a taboo. Due to the stigma associated with mental health issues many people are reluctant to seek help for their mental problems. Moreover, the study found that people were also unwilling to seek out help on behalf of another individual because they were afraid of the social stigma that would follow (Memon et al. 2016). Seeking mental healthcare services was fundamentally announcing to the community that there was something wrong with you and seeking out help on behalf of another was deemed to be socially inappropriate. One participant stated that a mental health diagnosis would not only affect the individual but also the whole family since it would ruin their standing in the community which would have repercussions such as shrinking the employment opportunities that an individual can access. If the community finds out that an individual has mental issues, then the whole family is considered to have mental issues. Additionally, people with mental illnesses are considered to be ‘crazy people’, and that comes with a stigma of its own. Rather than seek professional help, individuals would instead seek out spiritual help. Osman and Carare (2015) observed that since some communities believe that the mental illness has a religious basis, they would rather seek help from their spiritual leader rather than seek professional help. Rabiee and Smith (2014) interviewed a number of spiritual leaders who stated that a number of people with mental health issues come to visit them every week for help. One spiritual leader said that he had two to three people who came to see him every week. The spiritual leader reported that though he had no medical training, he wrote down the symptoms that he observed and when it became too much for him to handle, he referred individuals to Social workers. Therefore, cultural views on mental issues were found to be a significant barrier to accessing mental healthcare.

Communication Barriers

The other barrier noted from the Literature is communication barriers. In the UK many people from the BME communities do not speak English as their first language. Grey et al. (2013) note that a diagnosis is reliant on the patient’s ability to explain their symptoms to their social worker. If the patient does not have the language ability needed to describe their symptoms and experiences, then that will have a bearing on the outcome. The researchers continued to note that a higher satisfaction level is achieved when the social workers and the patient speak the same first language. Memon et al. (2016) also observed that many individuals from the BME community chose not to go to a social worker because they were limited by their language. The language barrier was especially bigger for recent immigrants. The individuals from the BME community preferred not to report their medical issues until it was too late. Some individuals reported that due to their tenuous grasp on the English language when they visited the social worker, they were misdiagnosed since they could not express themselves well enough. In those moments they said one thing, but the social worker misconstrues it to mean something else.

According to Memon et al. (2016), communication barriers not only arise from linguistic barriers but from the social worker’s perceived inability to listen to the needs of their patients and their apathy towards engaging them. Some of the participants stated that they felt like the social workers took a general approach when treating them rather than tailoring the treatment to the individual's needs to (Memon et al. 2016). Some participants reported that when they went to see the social worker, they were treated just like the other person who was ahead of them in the treatment line rather than the social worker taking a nuanced view of the issue. Grey et al. (2013) noted that this generalization in treatment arises due to a Eurocentric Model of Mental Healthcare. The researchers argued that mental health in the UK operates within a European paradigm and that influences the way that individuals from BME communities are treated (Grey et al. 2013). The treatment model presents a number of cultural incompetencies when treating individuals that are not of European origin. Due to that, some practitioners exhibited some unconscious biases which reduced their effectiveness when they were treating individuals from BME communities (Grey et al. 2013). Some participants in the study stated that due to the implicit and unconscious biases social workers did not want to engage them especially when they sought out help on behalf of other people in the community (Memon et al. 2016). The researchers noted that during those instances’ social workers did not want to get involved but they did not state the reasons why the social workers chose not to get involved (Memon et al. 2016). The issue for BME communities is higher since they have to fight for their right to be heard. Memon et al. (2016) record a situation in which a family member tried to get help for another family member and in spite of the issue escalating the healthcare providers still maintained that there was no issue and that their family member was doing okay. The family had to fight hard, and eventually, the person with the issue was admitted, and it turned out that they were overdosing. The above situation is one of many, and it shows that it is not only linguistic issues which form the basis of communication barriers but also that fact that social workers do not listen to their patients.

Socioeconomic Barriers

Socioeconomic barriers were a consistent theme in the reviewed literature. Bhattacharya and Benbow (2013) noted that accessing mental healthcare is especially challenging for individuals from the BME communities since they are on lower rungs on the socioeconomic ladder. Recent immigrants were more disadvantaged since they did not have the means to access insurance nor the money to visit the social worker without insurance (Bhattacharya and Benbow 2013). Due to that, individuals from BME communities can barely access proper mental health care services. Additionally, since they do not have the financial means to obtain appropriate mental healthcare, individuals prioritize, and access to healthcare is not one of those priorities (Bhattacharya and Benbow 2013). The priorities are usually school, rent, food, and clothing. If anything falls outside that scope, then it is considered not to be important. Additionally, parents with little children were more likely to prioritize the needs of their children above their own needs even if they had apparent mental health issues. Relating to socioeconomic issues Rudford et al. (2015) observed that education was another major issue. Many respondents stated that they simply did not know to whom they should go to seek the necessary help. The researchers stated that previous initiatives to try and reach people from the BME community failed because the imagery used by the media did not resonate with the community (Rudford et al. 2015). Socioeconomic issues are at the core since they do not have the finances needed to access education facilities. The fault also partly lies with medical practitioners because they have not educated individual from the BME community which partly explains the fact that they do not know where they should go to access proper mental health services (Rudford et al. 2015). Thus, socioeconomic factors and education are a barrier to access to mental healthcare services.

Power and Authority

The other theme that emerged is the theme of power and authority. Salway et al. (2016) noted that individuals from BME communities did not like going to the social worker’s office because it elicited the feeling of “being talked down to.” Participants stated that clinicians rarely explained to them what the issue is (Salway et al. 2016). They simply listened to them, wrote something on a paper and sent them to buy medicine. Memon et al. (2016) also noted that BME people were afraid of accessing mental health services because the clinician had the power to decide one’s future simply at the stroke of a pen. As noted above individuals from BME communities are more likely to be locked up under the Mental Health Act of 1982, and that is part of the reason why they prefer not to access the services (Memon et al. 2016). Some participants stated that they felt a sense of helplessness when they went to the social worker and that was reinforced by the passivity that the social worker showed. The participants stated that they felt helpless because they had to do whatever the Social worker said even if it was culturally insensitive and may lead to clashes with their community (Memon et al. 2016). Arday (2018) also noted that individuals from BME communities are more likely to experience condescending and patronizing behaviour from healthcare providers and that increased their reluctance to visit a social worker. Some of the participants stated that it is important to challenge such condescending behaviour when experienced, but it may come at a price. Memon et al. (2016) note one individual’s experience in which they challenged the patronization that they were experiencing and that ended with them being denied access to further medical care. Moreover, participants stated that when accessing mental healthcare, the best thing to do to avoid coming across as belligerent or unyielding since that increases the probability that one may be remanded to care (Memon et al. 2016). Challenging the established power dynamics was considered to be a sure way through which one could worsen their situation. Arday (2018) records one black female participant who stated that in such circumstances one realizes how powerless they truly are since they cannot challenge what is being asserted by the clinician since one risks being labelled unstable and troublesome. Therefore, a power dynamic that does not favour individuals from BME communities is another barrier to the access of proper mental healthcare services.

Discussion

The research that emerged was enlightening in the sense that it showed that inequalities faced by BME communities are caused by both intrinsic and extrinsic factors. The quality of research was vast, and it usually involved papers in which the inequalities experienced by the BME community when accessing mental healthcare were documented. Qualitative research was carried out in which various secondary literature was perused to acquire information that would meet the aims that had been set at the beginning of the study. The research met the set objectives in the sense that it explored the impacts on the mental health of the BME community and the implication that it has for social worker practice. It also met the second aim since it carried out an exploratory study in adult mental health service and recognized anti-oppressive practice concerns within the BME community. It also identified the negative implications that the BME community experiences whilst under the mental health services and contributing factors such as race, culture judgements attitudes and stigma and its effects on BME service users experience within the mental health service. The theory that was synthesized from the literature was the same as the one that was expected. The method in the majority of the literature was the Systems Theory. The argument advances that issues are not caused by one thing but that different systems work together to create or to solve the issue. The theory was abundant in the literature since the literature showed different factors such as race, culture, government policies, religion, communication barriers and other different facets need to be accounted for if the issue is going to be understood in a better and more holistic manner. The topic shows that for the inequalities to be solved many of the problems need to be addressed at the core and that begins with educating both social workers and the BME community so that by gaining knowledge issues that arose due to ignorance are handled.

One of the barriers that contribute to the inequalities faced by the BME community was language and communication. A number of the literature reviewed showed that in terms of communication the barrier is not only linguistic, but there is also an issue of the social worker and the patient not understanding each other. The core of the matter was noted to be apathy on the side of the social workers and social workers and lack of a grasp of the English language by the individual from the BME community. Memon et al. (2016) noted that the inability to express one’s symptoms is a barrier and that causes many individuals not to seek help. The practice that has been recommended to solve this issue is the provision of interpreters. Interpreters will serve as the bridge between the social worker and the individual from the BME community. The individual from the BME community will state their symptoms to the interpreter, and the interpreter will tell them to the social worker, and if the social worker has any follow up questions, they can ask them through the interpreter. The better option would be to have social workers who can speak the language since some nuance may be lost in the course of translation. This would work well in a community that has many individuals from the BME community since it will unequivocally surmount the language barrier. However, in situations where a social worker or social worker that speaks the language cannot be gotten, then an interpreter will serve the purpose too.

The advantage implementing interpretive services is that it will help overcome the language and communication barrier and it will encourage individuals whose chief issue was that they did not have a grasp of the English language to seek mental health services. Additionally, in its implementation, new personnel do not need to be hired when there are healthcare providers who can speak the language, and if new staff need to be employed, then it will be better if they are healthcare personnel too since they will serve a double purpose. However, in communities where there are many individuals from the BME community a full-time interpreter will be better since they will be devout all their time to helping surmount the language and communication barrier. There are a number of obstacles to the implementation of the service. First, there will be a high initial cost of hiring new personnel in healthcare facilities that do not have people that speak the language. Second, a lot of nuances may be lost when interpreting one language to the other. Third, it will not be possible to roll out the service in every healthcare facility. It will be more prudent to implement the service in areas where the BME community presence is relatively higher as compared to other areas. Regardless of the barriers, if the service is successfully implemented then, language and communication barriers will be surmounted.

The other barrier noted in the reviewed literature was that of racism and discrimination, and that can also be tied to cultural views. Racism and was found to be one of the main issues that discouraged individuals from the BME community from pursuing mental healthcare services and it was one of the most significant contributors to the inequalities faced by the individuals of the BME community (Grey et al. 2013; Arday 2018; Islam, Fatemeh, and Singh 2015; Memon et al. 2016). Racism and discrimination were also tied to the cultural barrier in the sense that people from BME communities felt that the social workers did not take their time to try and understand their culture (Memon et al. 2016). Some of the participants state that they always had to explain “the minority experience” to their social workers because they simply did not understand their experiences and their culture (Memon et al. 2016). This was further reinforced by the overt racism and discrimination that some individuals face at the hand of healthcare providers (Grey et al. 2013). Moreover, many participants stated that they did not seek mental healthcare services because if the social worker had prejudiced and negative preconceived notions of how people from BME communities act then they more likely to be locked up under the Mental Health Act of 1983 (NHS 2017). Furthermore, racism and discrimination contributed to the Power and Authority dynamic in which individuals from BME communities felt powerless when they sought mental health services (Salway et al. 2016). Some of the social workers were condescending and looked down upon individuals from BME communities (Salway et al. 2016). Due to that individuals felt that it was better not to seek mental health services. Furthermore, due to healthcare providers not understanding the experiences of individuals from the BME community, participants stated that social workers did not listen to them when they tried to explain their symptoms and experiences (Grey et al. 2016).

The practice recommended to overcome the racism and discrimination barrier is the education of healthcare providers in relation to the culture of BME communities. When diagnosing social workers failed to account for cultural views of the issues and this partly contributed by ignorance of culture (Grey et al. 2016; Islam, Rabiee & Singh 2015). Educating healthcare providers may help overcome the racism and discrimination issue since it will teach healthcare providers and social workers to be culturally sensitive to the needs of the people that they are treating (Grey et al. 2016). They will have a greater understanding and appreciation to the plight of individuals from BME communities, and that will help reduce the overt or covert discrimination that the individuals may hold against individuals from BME communities (Islam, Rabiee & Singh 2015). Moreover, education will help reveal any subliminal prejudices they have which have been contributing to the way which they treat individuals from BME communities. The advantage of educating social workers on the need for cultural sensitivity is that it may increase the number of people who seek mental healthcare services. Culturally sensitive social workers will encourage people from BME communities to seek help since they will know that social workers at least have an inkling of what their experiences and they will take that into account when they are treating them. Furthermore, social workers will be more respectful and courteous, and they will learn to truly listen to individuals from BME communities rather than projecting the experiences that they have had onto BME people. The obvious barrier to this implementation is that some social workers will learn, but still, they will choose not to apply the knowledge that they have learnt instead preferring to stick to their racist and discriminatory ways. Second, there is a time, and financial constraint; time because cultural sensitivity cannot be taught in a day; finances because culturally competent professionals will need to hired to educate healthcare providers about cultural sensitivity. However, implementing cultural sensitivity classes will be the best way to overcome racial prejudices and discrimination.

The other barrier was the cultural views on mental health issues within BME communities. The reviewed literature showed that some BME communities believe that mental health issues have spiritual origins and they are caused by demons, djinns, curses and other spiritual things (Osman and Carare 2015). Some have no issue with where the mental issues come from, but they are afraid of the ripple effect caused when the community finds out that one has mental issues (Rabiee and Smith 2014). Seeking help will affect the whole family through lowering their standing in the community, reducing work and marriage opportunities and causing stigma for the individual and the family as a whole (Rabiee and Smith 2014; Memon et al. 2016; Osman and Carare 2015). The practice that has been recommended to battle the cultural aspect is educating BME communities on the true nature of mental health issues (Rudford et al. 2015). Educating BME communities will help combat the ignorance that revolves around mental problems and also help fight the stigma. Moreover, education should also revolve around ways through which they can access proper mental health services (Rudford et al. 2015). The barrier to teaching BME communities about mental health lies in language and communication. It will be a great challenge to find a professional who is well versed in mental issues and who speaks their language. Second, there will be a financial and time constraint since professionals have to be paid, social halls have to be booked, people have to be fed, and it takes time to teach people. However, educating on mental issues in the community will help individuals feel less apprehensive about seeking mental health services since the stigma surrounding the issue will be significantly reduced.

Implication on the Social Worker

The implication of all the reviewed literature on the social worker is that it shows that the social worker needs to act as a bridge between healthcare professionals and BME communities. The social worker will need to be culturally competent and understand both sides so that they can offer the most help. Additionally, it shows that social work policies need to be revamped a bit and take into consideration the cultural nuances that exist in BME communities. The procedures are a bit Eurocentric since they were created with the European individual in mind. However, the influx in BME communities requires adjustments, and that will begin at a macro level before it spreads to a micro level. Furthermore, the study calls social workers to examine themselves and see if they have any covert prejudices that contribute to the cynical and apathetic treatment of BME communities. By examining one’s self then the social worker will be able to advance more help and aid in bridging the inequalities that individuals from BME communities experience. Moreover, the most significant implication for social work practice is that it shows that all systems need to be changed in tandem if any positive changes are going to occur. Healthcare practitioners and social workers, BME communities, and government and social work policies need to be included in the change process if the inequalities that are experienced by BME communities are going to be bridged. The social worker will play a key role in bringing all parties to the table and charting a path that will reduce the inequalities that BME communities face when they are trying to access mental healthcare.

Conclusion

BME communities experience many inequalities when accessing mental health services. The research carried out helped in meeting the aims of the study since it explored the impacts that disparities in accessing mental health services have on the mental health of the BME community and the implication that it has for social worker practice. Secondly, the research enumerated anti-oppressive practice concerns within the BME community and also identified the negative consequences that the BME community experiences whilst under the mental health services. The analysis showed that the most significant contributors to the inequalities faced were racism and discrimination, cultural views on mental health, communication and linguistic barriers, socioeconomic barriers and power and authority barriers. The implication for social worker practice is that the social worker must act as the bridge between healthcare providers and individuals from the BME community. It is the duty of the social worker to be culturally competent and to use that knowledge to teach healthcare providers cultural sensitivity. At the same time, they should educate individuals from BME communities on mental health issues with the aim of reducing the stigma associated with the issue and teaching them how to access proper mental health services.

Reflection on Research Journey

The research experience was challenging from start to finish. The challenge lied in selecting the aims for the study and finding the literature that would meet the goals. Synthesizing the literature into themes was also a significant challenge but a fulfilling one when the studies were whittled down to ten. The writing of the dissertation was also another challenge, but different parts of the project were carried out at different times and on different days which made writing the project a bit more manageable. The practices that can be implemented is about teaching cultural sensitivity to healthcare providers and offering classes on mental health issues and ways to access the proper services to BME communities. Lack of knowledge was the main issue with both social workers and the BME community, and that can be solved through education. Future research can concentrate on specific barriers by expounding on how much the barrier contributes to the inequalities that are faced by BME communities when they try to access mental health services. Additionally, future research can concentrate on how governmental policies have contributed the inequity faced by individuals from BME communities and how the same systems can be changed to combat the imbalances that have been encountered by the BME community.

References

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Bhattacharyya, S. & Benbow M, S., 2013. Mental health services for Black and Minority Ethnic elders in the United Kingdom: A systematic review of innovative practice with service provision and policy implications. International Psychogeriatric Association, vol. 25(3), pp.359-373.

Grey, T., Sewell, H., Shapiro, G. & Ashraf, F., 2013. Mental health inequalities facing U.K. minority ethnic populations. Journal of Psychological Issues in Organization Culture, vol.3(1), pp.146-157

Islam, Z., Fatemeh, R. & Singh P, S., 2015. Black and minority ethnic groups’ perceptions and experience of early intervention in psychosis services in the United Kingdom. Journal of Cross-Cultural Psychology, pp.1-17

Memon, A., Taylor, K., Mohebati, L., Sundin, J., Cooper, M., Scanlon, T. & de Visser, R., 2016. Perceived barriers to accessing health services among black and minority ethnic communities: a qualitative study in Southeast England. BMJ Open, vol. 6.

Rabiee, F. & Smith, P., 2014. Understanding mental health and experience of accessing services among African and African Caribbean Service users and carers in Birmingham, UK. Diversity and Equality in Health and Care, vol.11, pp.125-134.

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