Assessing the mental health needs of older people
Black and minority ethnic communities
The proportion of people aged 65 and over among Britain 's minority ethnic population is growing and the specific needs of many minority groups are increasingly being identified. Minority ethnic communities may have higher rates of poor health than the host community, and poorer people and those less well placed to access health and social care will be more vulnerable.
For a more detailed account, see Research summary 6 (443kb PDF).
- The mental health needs of older people from black and minority ethnic communities have been particularly neglected.
- There are small but significant differences in the incidence of particular health problems among different ethnic groups.
- There are lower levels of awareness of problems such as depression and dementia within black and minority ethnic communities.
- Older people and their families from black and minority ethnic communities have problems accessing help from services.
- There is insufficient evidence to date on whether integrated or separate services are more effective, but there is a need for more culturally appropriate and sensitive services.
- Find out the older person's preferred language, and arrange for a professional interpreter to be present. Families and friends are essential sources of information about the older person, and will have many valuable insights, but they should not be put in the position of interpreting for the older person's assessment.
- Make sure that the older person and their family has all the information they need in an appropriate format. If printed material in the right language is not available, or the older person would have difficulty reading it, consider making an audio tape of essential information in the person's own language.
- Find out as much as you can about the culture and religious beliefs of the older person you are assessing. Make links with people from their local community who can help you by explaining things and who can tell you about local sources of support within the community. Remember to maintain confidentiality.
- Get information about your services and how to access help out into the local community through the services and points of contact which are trusted and used by people from minority ethnic communities, for instance GPs and places of worship.
- In your assessment, check that the older person's health needs have been fully assessed, and that they and their family have understood the diagnosis and any information they have been given.
- Don't assume that the older person and their family understand what you mean when you talk about services which may be offered, for instance home care services.
- If there is a charge for a service, explain why that is and how it will be calculated.
- Don't assume that mainstream services will not be acceptable to older people from minority ethnic communities. Offer them and discuss what might need to be done to ensure they are culturally acceptable.
- Talk to service providers about what they can do to make their services more culturally sensitive and acceptable. Make sure that specific requirements are detailed in the care plan and any contract, so that they can be monitored and reviewed.
- The manager of a Midlands residential care home with a single Asian resident was proud of the efforts they had made to meet her needs, arranging for meals to be brought in for her from the local Asian day centre, and for festivals to be celebrated. As part of a plan to attract more Asian residents, the home recruited a number of Punjabi speaking staff and arranged the rotas so that there was always at least one Punjabi speaker on duty. They were astonished to see the transformation in their existing resident, who had been regarded as successfully settled in but who was now talking and laughing with staff, joining in activities and demonstrating a lively personality which had had no opportunity for expression before.
- London Borough of Redbridge (Dementia Resources Centre), Age Concern and Redbridge Carers Support Service developed an innovative approach to meeting the needs of older people from ethnic minority groups locally. The programme initially aimed to target isolated and vulnerable older people with dementia and their carers from local black and minority ethnic groups to assess need and to provide information, support and services. The results of the survey were fed in to mainstream commissioning to ensure needs were met and an information, training and support group was established meeting weekly. The groups support individuals and their carers, assessing appropriate needs and facilitating and providing information. Feedback from the groups is very positive and encouraging in relation to supporting carers, providing information, being a valued service, linking with other agencies such as primary care, increasing awareness and providing valued information and support impacting on the well being of those who attend.For further information contact: Chris Ghiotti at London Borough of Redbridge - 020 8708 9156 - email - Chris.Ghiotti@redbridge.gov.uk
Different communities may have specific difficulties. For instance, higher rates of high blood pressure and diabetes among African, Caribbean and Asian people increase the risk of vascular dementia in later life, while some ethnic groups appear particularly prone to depression in older age.
A recent study of the Asian community in north west Kent by Alzheimer's and Dementia Support Services and the Mental Health Foundation (40) researched the service-related needs of Asian older people with dementia, and the needs of their carers, and the understanding and awareness of dementia within the community.
Older people with mental health needs from black and minority ethnic communities face a number of potential barriers to effective assessment of their needs:
V. Seabrooke and A. Milne (2004) Culture and care in dementia: A study of the Asian community in north west Kent, London : Mental Health Foundation,
- There may be little awareness of older people's mental health issues within black and minority ethnic communities, for instance, Asian languages do not have an equivalent word for dementia (41). Symptoms may therefore be unrecognised or misunderstood.
- In some communities a lack of understanding and the stigma attached to mental illness may prevent families from seeking help. This may particularly be the case where the community culture places great emphasis on self-reliance.
- Language barriers may prevent people from receiving information about what is available and how to access help. Even where printed information in minority languages is available, this may not help those older people who have a limited level of literacy in their own language.
- Unfamiliarity with social care services, which may not exist in minority cultures, may prevent people from requesting services or lead to misunderstandings about their role. Medical services, which are better understood, and free from stigma, are often considered more acceptable than social care services. Low uptake of social care services by older people from minority ethnic communities may lead to demand being overlooked or underestimated by commissioners.
- The lack of a professional interpreting service may make it difficult for assessors who do not speak the older person's preferred language to conduct an effective assessment. The use of friends or family members as interpreters may compromise confidentiality or influence the assessment. Older people affected by dementia, who were once able to speak English as a second language, may lose the skill as their memory deteriorates. Even with good language skills, cultural differences may result in meaning and nuance being lost.
- Standard diagnostic tests for dementia, or depression, may not be culturally appropriate and may lead to inaccurate diagnosis.
- Assessors may not be able to offer a sensitive and effective assessment because they are not sufficiently familiar with the lifestyles, health, religious and cultural needs of older people and their carers from minority ethnic communities.
- No suitable services may be available where the older person's language is spoken and their cultural, religious and dietary needs met.
- Conversely, assessors may make assumptions about the lack of acceptability of mainstream services to older people and their families, and not offer them.
Mrs K, an Armenian who had met her husband in Paris, spoke fluent French and English until the last years of her life, when advancing dementia and progressive memory loss took away her acquired languages and left her unable to converse with her husband and children. This was devastating for her and her family.
An inspection of community care services for black and ethnic minority older people carried out by the Social Services Inspectorate in 1998 (42) found that although procedures existed for involving black elders in their assessments and developing their care plans, this practice was dependent upon the knowledge and skill of individual workers. Without appropriate training, knowledge and skills, some white staff did not have the confidence to make judgements about the contribution of religion and culture in the assessment of older people. In some cases staff still took the view that black and ethnic minority families 'look after their own', and there was a danger that white ethnocentric values resulted in inappropriate assessments.
The Race Relations (Amendment) Act 2000 places a general duty on all public authorities to promote race equality and to make this aim explicit in their policies, practices and procedures. For more information on the legal and policy context, see section 8.
A report by The Royal College of Psychiatrists (39) suggests that a key method of improving access to services for minority ethnic elders is through their GPs, and recommends joint meetings between GPs and voluntary groups to achieve this.
Age Concern England hosts a Black and Minority Ethnic Elders Forum promotes the interests of black and minority ethnic elders, and produces a regular newsletter.