Touchstone Community Development Service

CDS@touchstonesupport.org.uk

Presented at:

Yorkshire & Humber Public Mental Health and Suicide Prevention Forum

Leeds Civic Hall

8 July 2015

(Dis)parity in Mental Health & Physical Health

Needs of BME Communities: A Scoping Review

Bereket Loul (bereketl@touchstonesupport.org.uk)

John Halsall

Sarah So

Vanysha Sahota

About Touchstone

One of the Leading Community Mental Health & Wellbeing

Providers

Operates in Leeds, Kirklees & across West Yorkshire (WYFI BME Project)

9 BME Specific

Services & 15

different services

overall

SU involvement & coproduction at the heart of governance, service delivery & design

Serve over 2000 people a year &

almost half from BME background

Over 30 years of providing

Innovative Services

Promoting

Equality

&

Diversity

Bridging the

‘Culture-Gap’

between

Services &

Communities

Challenging

Stigma &

Discrimination

Outside/Inside

Mental Health

Community

Capacity

Building

Asset-based =

Look at what

people can do,

not what they

can’t

Over 8 Years of

Effective

Engagement

with BME

Communities

Community

Development

Service

Our Service

Our Team

Crisis

Prevention:

Alcohol

Crisis Resolution:

Home Treatment

Crisis Prevention:

Mental Health

Triage

7 Community Development Workers

From 7 National/Ethnic Backgrounds

7 Lead Areas

Parity of

Esteem

Refugees &

Asylum

Seekers

Islam and

Mental Health

Community

Data &

Intelligence

One PH Contract One Key Health and Wellbeing Priority

Improving Quality, Equality and Equity of Mental Health

Access, Experience & Outcomes for Black and Minority

Ethnic Communities in Leeds

People with Mental Health

Conditions

Have increased risk of physical ill health

People diagnosed with schizophrenia or bipolar disorder die, on average,16-25 years younger than the general population

Have high rates of respiratory, cardiovascular & infectious disease, and of obesity, abnormal lipid levels & diabetes

Are less likely to benefit from mainstream screening and public health programs

People with Long-term

Physical Conditions

Are 2-3 times more likely to develop depression than the rest of the population

People with three or more conditions are seven times more likely to have depression

Co-morbid depression doubles the risk of coronary heart disease in adults and increases the risk of mortality by 50%

Co-morbid physical and mental health problems delays recovery from both

WHY PARITY OF ESTEEM?

Source: Investing in emotional & psychological wellbeing for patients with LTC – Mental Health

Network NHS Confederation (2011)

Why BME Focus?

The Change: Demographics

Leeds BME population has increased from

77,285 (10.8%) in 2001 to 141,771(18.9%)

in 2011. This represents a 83% increase in

the local BME population since 2001.

Assuming that the local BME population

continues to grow at the same pace and the

overall population increasing around 5%, it

is projected that the BME population of

Leeds by the next Census could be around

a third of the total local population

Number of residents born outside the UK

rose from 47,636 (6.7%) of the population

in 2001 to 86,144 (11.5%) in 2011. More

than half arrived in the last 10 years.

4.5% of households do not speak English

as a main language

Leeds Population 2011 Census

White British

609,714 (81.1%)

BME, 141,771 (18.9%)

‘White Other’ has more than doubled

since the 2001 Census mainly due to

migration from Eastern European.

Mixed Ethnic Groups have more than

doubled since 2001. Notably Black African

and White has increased two fold since

2001.

The number of people belonging to

Non-Christian faiths has increased by

54% over a 10 year period

• The largest rise is within the African

community which has increased five fold

since 2001

Why BME Focus?

The Challenge: Super-diversity & Closing the ‘Culture Gap’ between

Services & Communities ‘Culture includes a person’s beliefs, norms, values, and language. It plays key role in how

people perceive and experience mental illness, whether or not they seek help, what type of help they seek, what coping styles and supports they have, what treatment might work,

and more.’ Dr. Dawit Mengistu (MPH,DVM)

Why BME Focus?

The Impact: Health Inequality

I. Mental Health disparities between communities • Report worse

experience & outcome

• Higher rates of use of specialist mental health services (HSCIC)

• Rates of admission to mental health wards 2-6 times higher than average for Black and Dual Heritage people (Count me in census 2010)

• Young Asian women are more than twice as likely to take their own life as young White women (Race for Health, 2008)

01,0002,0003,0004,0005,0006,0007,000

Standardised rates of people using specialist mental health services England 2013-14 (Source: HSCIC)

Contactsper100,000people

• Men and women of Pakistani and Bangladeshi origin are more than six times as likely as the general population to have diabetes. Rates for Indian men and women are three times higher and are significantly higher for African Caribbean.

• Adults with diabetes are 2 - 4 times more likely to have heart disease or suffer a stroke than people without diabetes

• The prevalence of stroke among African Caribbean and South Asian men is 40 – 70% higher than for the general population

• South Asian people are 50% more likely to die prematurely from coronary heart disease than the general population.

0%

2%

4%

6%

8%

10%

12%Men

Women

Prevalence of Doctor-Diagnosed

Diabetes, England Health Survey 2004

The Impact: Health Inequality

II. Physical Health disparities between communities

• Some 35% of African Caribbean men smoke, compared with 39% of White Irish

men, 44% of Bangladeshi men and 27% of the general population. (Race for

Health, 2008)

Aims of our Scoping Review • To review national and local information on parity of esteem and its implications

for BME communities

• To review existing data and intelligence to see any major differences with regard

to parity of esteem between the general population and BME communities in

Leeds

• Identify good practices that promote better parity of physical and mental health

needs of BME communities in Leeds

What we found out? Very limited reports and research

No national or local research that jointly consider the

physical and mental health needs of BME communities

Higher levels of poor mental health and wellbeing are

inextricably linked with deprivation. 28% of people with

severe mental illness live in the most deprived areas of

Leeds

Third sector organisations work in more holistic way

that cater for both the mental and physical needs of

local communities

What we are proposing

(From a Public Health Perspective) An Integral View of Health Determinants

• Collective

• Visible • Inter-objective

• Collective

• Invisible

• Intersubjective

• Individual

• Visible

• Objective

• Individual

• Invisible

• Subjective Mind

Values

Belief

Emotions

Body

Behaviour

Lifestyle

Social

System Structures

Policies

Institutions

Ecology

Culture

Worldview

Language

Faith

The way forward… Towards Integral Health Development

Mental Health Physical Health

IND

IVID

UA

L • Assess & support physical health

needs

• Increase knowledge and resilience

• Support for better self-management

• Assess & support mental health

needs

• Increase knowledge and

resilience

• Support for better self-

management

CO

LLE

CT

IVE

• Community engagement and

intelligence

• Bridging the ‘culture-gap’

• Awareness raising – including the

link between culture/ethnicity and

health risk/protective factors

• KEY MESSAGE – What is not good

for you body, is not good for your

mind!

• Robust system of integrated data

and intelligence gathering

• Further research?

• Platform for best practice sharing

& collective learning

• Joined up training for health

professionals

• All Levels, All Sectors Partnership

• Parity of Investment

The ties that bind individuals to their culture and ethnic communities are invaluable and instructive resources in the

understanding of mental illness and in the delivery of responsive and responsible mental health support.

Dr. Dawit Mengistu (MPH,DVM)