SCIE Guide 21: Commissioning and providing mental health advocacy for African and Caribbean men
Needs and advocacy
Mental health and advocacy
Advocacy is usually defined as a process or intervention that ensures vulnerable people have a voice within services characterised by power inequalities between providers and users. Mental illness, and the social and statutory service response to it, can mean that individuals can find it difficult to speak up for themselves and be heard. This
- impacts upon decision-making and the opportunities to exercise choice
- can result in marginalisation and social exclusion
- places an individual’s rights in jeopardy.
This is recognised by the introduction of a statutory duty in relation to advocacy under the Mental Health Act 2007 (3). However it is important to recognise the need for advocacy for people experiencing mental health problems, who are not subject to the Act, and the risks to their self-determination and their rights.
Need within BME communities
In addition to the above, people from black and minority ethnic (BME) communities may also experience additional social disadvantage, racism and discrimination. Advocacy can support people from BME to access appropriate high quality services as early as possible. This need is clearly recognised within the Department of Health action plan Delivering Race Equality in Mental Health Care.
For people from specific BME communities, notably African and Caribbean communities, this means diversion to less restrictive services and reducing the risk of admission and detention under the Mental Health Act or via the criminal justice system.
For other communities, for example Chinese communities, it means increased engagement and access to support, as people from these communities are typically under-served by mental health services.
African and Caribbean men
There is a growing body of evidence for the negative relationship between mental health services and African and Caribbean men. This negative relationship can result in a lack of inclination to seek help or comply with treatment, leading to relapse and readmission and further social exclusion. The Better Health Briefing on African and Caribbean men and mental health from the Race Equality Foundation provides an overview of the key issues and examples of positive service developments.
This evidence provides information on the role of advocacy and it needs to address:
- The failure of services to understand and meet needs appropriately, including misunderstanding of African and Caribbean modes of self-expression.
- Fear and expectation of negative treatment,
including
- not having needs understood or met
- being stereotyped or ignored
- concerns about treatment (particularly medication)
- detention, leave arrangements
- day-to-day living
- access to appropriate treatment and practical support
- Low uptake of services and less desirable pathways into care.
- Lack of awareness of mental health and service provision.
- Lack of choices in relation to treatment offered – for example being more likely to receive physical treatments and less likely to get psychotherapy.
- Experiences of coercion, discrimination and racism in mental health services.
- Social disadvantage and exclusion, particularly homelessness, poor housing, unemployment and over-representation in prison.
Link: Race Equality Foundation: Better Health Briefing 5
Identifying needs
Assessing need for mental health advocacy is an essential task for both commissioners and providers. This assessment ensures that the services provided meet needs effectively, and do not disadvantage particular groups in the way they are designed and promoted. This process needs to:
- ensure that the heterogeneity of BME communities and the diversity of need within communities is understood
- draw on existing data to illuminate the need for mental health advocacy by people from BME communities
- build on methods, particularly community engagement, to develop a detailed understanding of needs in relation to advocacy, barriers and facilitators to service use and preferences for service provision
- critically examine the extent to which mainstream mental health advocacy services are meeting the advocacy needs of people from diverse local communities.
Potential sources of information include:
- National data sets, Office of National Statistics.
- Primary care trusts and local councils usually have detailed information on the local area, including a profile of BME communities.
- Annual census of mental health inpatients. Undertaken by the Health Care Commission, Mental Health Act Commission and the National Institute for Mental Health in England (NIMHE). Data on admission and detention rates and treatment analysed by ethnicity and gender. Results for individual trusts are available through a secure log-in facility.
- Mental Health Minimum Data Set. Information on numbers of patients receiving care from mental health specialist services by ethnicity, provider and number of patients on the Care Programme Approach (CPA).
- Views of local mental health service users and key informants from local BME communities. The community engagement project developed by NIMHE provides a method for gathering these.
