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 Caribbeans twice that of White
  population (16 per 1000)

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 Caribbeans
  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 Drs 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 Caribbeans higher than
  average for Indian and Other White groups

14
Pathways to Care

• Referrals by the courts almost double for African
  Caribbeans
• Referrals by Social Services higher than average
  for African Caribbeans 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