“There isn’t a stronger connection between people than storytelling.” – Jimmy Neil Smith.
I wanted to start with a story that inspired my own research on ethnicity and mental health. Since I was a child, my grandparents shared stories of their migration from India to the UK. They would smile at parts, but I could also feel their pain when describing a world of struggle and discrimination. My grandparents suppressed these feelings as they grew up in a culture where talking about mental health was taboo.
Mental health awareness seems to grow with each generation; however, the effects of stigma and social inequality are still present for ethnic minority groups. This can be seen in their higher risk of mental health problems, reduced access to support and poorer treatment outcomes.
Although these inequalities exist, little research has explored whether they emerge for ethnic minorities when part of a vulnerable population such as people with long-term physical conditions (LTCs). This term describes ongoing health problems that cannot be cured currently.
Impact of LTCs
Children and young people (CYP) with LTCs and their parents experience poorer mental health than the general population. Despite this, patients struggle to access support as their physical condition can overshadow their psychological needs. They also face numerous health care barriers such as long waiting lists and strict criteria.
To overcome this challenge, researchers have proposed a ‘drop-in service’ where CYP with LTCs and their family can receive shorter and less intensive treatments for their mental health. Previous studies have found this to improve the mental health of families with LTCs. However, research has not yet explored whether it addresses the needs of ethnic minorities.
The development of interventions that are culturally informed remains a large gap within research and clinical practice. This inspired my own study as I wanted to understand whether a drop-in service for families with LTCs promoted equal access across ethnicities.
With this as my goal, I was able to formulate my research question…
Is a drop-in service an accessible way of providing mental health support for ethnic minority families with LTCs?
What does “accessible” mean?
In this study, the word “accessible” referred to how well the service was reached and appreciated. Accessibility was understood via different concepts that were compared for ethnic minority and white British families with LTCs. As shown in the image below, these comparisons inspired my three research aims.
What was done?
A drop-in service was introduced into six NHS hospitals. CYP with LTCs and their parents accessed the service through self or clinician referral. They were given a clinical assessment by a practitioner who allocated them to a suitable treatment. This included low intensity CBT (a form of self-guided help), signposting (given information about other support routes) or referral to external services.
All participants were given four questionnaires that measured their mental health levels before treatment. They were given the same questionnaires at a six-month follow-up, alongside a measure of their satisfaction.
Mental health levels at baseline, referral routes and satisfaction scores were then compared between ethnic minority and white British families.
Excitingly, we were able to recruit a total of 119 families across all sites!
What was found?
We found that ethnic minority parents reported a lower quality of life for their child compared to white British parents. Ethnic differences were not found for other measures of mental health in both CYP and parents. Regardless of ethnicity, all groups had scores above clinical average suggesting that their mental health was more severe than the general population.
Ethnic minority families also accessed the drop-in service more frequently via clinician referral compared to self-referral (see image below). This differed from white British families who used both pathways similarly. Lastly, no difference in service satisfaction was found between ethnic minority and white British families.
What does this mean?
These findings have some exciting and promising implications!
Firstly, they highlight the need for a drop-in service to be made available for families with LTCs as the population had high levels of mental health distress. They also show that participants from all ethnic backgrounds were satisfied with accessing care via this model.
The inclusiveness of the drop-in service can be seen when comparing the proportion of ethnic minorities in our sample to that of national services. In the UK, 21% of people using child mental health services identify as an ethnic minority, whereas this study had a total of 29%.
The study also shed light on two findings that not only provoke questions but could be used to modify the drop-in service and inspire future research:
Ethnic minority parents reported a lower quality of life for their child.
- Is this a true reflection of their child’s experience?
- Studies should explore whether parental reports provide an accurate measure of their child’s mental health.
Ethnic minority families accessed the drop-in service more often via clinician referral.
- Why was the self-referral pathway not used as much?
- Studies should explore the role of cultural stigma as this may have deterred ethnic minorities from seeking help themselves.
Taking these findings together, a drop-in service seems to be an accessible way of providing psychological support for all families with LTCs. Ethnic minorities did not differ in their mental health or satisfaction; however, the self-referral pathway may need to be adapted to reduce cultural stigma.
Final Message
This study is close to my heart as it speaks to a larger issue within research and health care. There seems to be a small number of studies exploring the mental health needs of ethnic minorities. I hope that this number increases over time and inspires the development of interventions that reduce inequality and encourage equal access.
Reflection
I would love to hear what barriers you think reduce help-seeking in ethnic minority groups and how you think mental health services could be adapted.
Watch this video for inspiration and comment your thoughts down below!
References
- Van West, C. (2018). National storytelling festival. In Tennessee encyclopedia. Tennessee Historical Society. https://tennesseeencyclopedia.net/entries/national-storytelling-festival/
- Bamford, J., Klabbers, G., Curran, E., Rosato, M., & Leavey, G. (2021). Social capital and mental health among black and minority ethnic groups in the UK. Journal of immigrant and minority health, 23, 502-510.
- Cooper, C., Spiers, N., Livingston, G., Jenkins, R., Meltzer, H., Brugha, T., … & Bebbington, P. (2013). Ethnic inequalities in the use of health services for common mental disorders in England. Social psychiatry and psychiatric epidemiology, 48, 685-692.
- Amati, F., Green, J., Kitchin, L., Watt, H., Jones, S., AlRubaye, N., … & Greenfield, G. (2023). Ethnicity as a predictor of outcomes of psychological therapies for anxiety and depression: a retrospective cohort analysis. Behavioural and Cognitive Psychotherapy, 51(2), 164-173.
- Moore, D. A., Nunns, M., Shaw, L., Rogers, M., Walker, E., Ford, T., … & Coon, J. T. (2019). Interventions to improve the mental health of children and young people with long-term physical conditions: linked evidence syntheses. Health Technology Assessment (Winchester, England), 23(22), 1.
- Catanzano, M., Bennett, S. D., Kerry, E., Liang, H., Heyman, I., Coughtrey, A. E., … & Shafran, R. (2021). Evaluation of a mental health drop-in centre offering brief transdiagnostic psychological assessment and treatment for children and adolescents with long-term physical conditions and their families: a single-arm, open, non-randomised trial. BMJ Ment Health, 24(1), 25-32.
- NIHR PenARC. (2022). Are ethnic minority children and young people treated differently in CAMHS in terms of the services or treatment they receive? https://arc-swp.nihr.ac.uk/wp/wp-content/uploads/2023/03/rise-07-ethnic-minority-treatment-in-camhs.pdf
Credits
- Cover picture from pixabay: https://pixabay.com/illustrations/hands-hold-diversity-partnership-6467494/
- Video from YouTube: https://www.youtube.com/watch?v=83c3UwXRy0Y
Word count: 996