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Supporting race equality in mental healthcare
BME communities and mental health > Major population groups in the UK
Twenty-first century Britain is more diverse than ever before. Our modern society is multi-cultural, multi-lingual and multi-layered. According to the Office for National Statistics (ONS) UK Census, in 2001 nearly 8% of the UK population - over 4.6 million people - came from ethnic minority communities. And those communities are changing all the time.
Ethnic Group
- Eighty-seven per cent of the population of England and 96 per cent of the population of Wales gave their ethnic origin as White British.
- White Irish people make up 1.2 per cent of the population of England and Wales as a whole, with the highest proportion in the London borough of Brent (6.9 per cent of the population). The largest proportions of White Other (that is, not White British or White Irish) people are in central London, particularly the borough of Kensington and Chelsea (25.3 per cent).
- London has the highest proportion of people from minority ethnic groups apart from more who identified themselves as of Pakistani origin, of whom there is a higher proportion in Yorkshire and the Humber (2.9 per cent) and the West Midlands (2.9 per cent).
- Two per cent of the population of England and Wales are Indian, with Leicester having the highest proportion (25.7 per cent).
- Bangladeshis formed 0.5 per cent of the population of England and Wales, with the highest proportion in the London borough of Tower Hamlets (33.4 per cent).
- In England and Wales, 1.1 per cent of people are Black Caribbean, 0.9 per cent are Black African and a further 0.2 per cent are from Other Black groups.
- Black Caribbeans form more than ten per cent of the population of the London boroughs of Lewisham, Lambeth, Brent and Hackney. Over ten per cent of Southwark, Newham, Lambeth and Hackney are Black African. More than two per cent of people describe themselves as Other Black in Hackney, Lambeth and Lewisham.
- Chinese people form more than two per cent of the population in Westminster, Cambridge, City of London and Barnet.
- The largest proportions of people of Mixed origin are in London, with the exception of Nottingham, where two per cent of people are Mixed White and Black Caribbean.
ONS Statistics, Census 2001
The BME population is not evenly distributed across the country, with members tending to live in the large urban areas. The different groups share some characteristics, but there are often greater differences between the individual ethnic groups than between the minority ethnic population as a whole and the White British majority.
UK BME population snapshot
- Population size: 7.9% from a non-White ethnic group
- Age/sex distribution: non-white groups are younger
- Geographic distribution: 45% of non-White people live in London
- Inter-ethnic marriage: 2% of marriages are inter-ethnic
- Households: Asians have largest households
- Religion: 7 in 10 identify as White Christian
- Identity: 9 in 10 of mixed group identify as British
- Education: Chinese pupils have best GCSE results
- Labour market: Non-White unemployment highest
- Employment patterns: Pakistanis most likely to be self-employed
- Health: Asians have worst self-reported health
- Care: 1 in 10 White and Indian people provide unpaid care
- Smoking and drinking: Bangladeshi men have highest smoking rates
- Victims of crime: Highest risk for mixed-race people
BME communities and mental health > BME communities and mental health
In 2003, the Government report 'Inside Outside' identified significant disparities in mental health care access, experience and outcomes between BME people and the white British population:
"There does not appear to be a single area of mental health care in this country in which black and minority ethnic groups fare as well as, or better than, the majority white community. Both in terms of service experience and the outcome of service interventions, they fare much worse than people from the ethnic majority."
BME communities and mental health > The view from the ground
There are Race Equality leads working in communities around the country. Here are some of their thoughts on addressing the issue of race and mental health:
- Be prepared to develop friendships with everyone. Be politically astute and politically balanced. Don't get caught up in race politics.
- If your own ethnicity differs from that of a client or community member, never feel you have to apologise for that difference. Never feel you have to justify who you are. Saying things like, 'I'm not a racist, some of my best friends are black,' will only undermine your position.
- A white mental health staff worker is no less equipped to provide a culturally responsive service for BME clients than a Black or Asian staff worker. Competency and commitment will cross all ethnic boundaries.
- Be prepared to stop, reflect, and even start again if necessary... Keep the bigger picture in mind. A few setbacks and defeats don't mean you won't succeed in the long term.
BME communities and mental health > Hints and tips: tackling the problem
There are a number of steps that can be taken to help reduce the problem, for example:
- Train staff in race-equality issues, and culturally sensitive care
- This should include the provision of information packs for staff (drawn up in conjunction with local BME community representatives) covering issues such as faith, diet, language and personal care needs of different minority ethnic groups.
- Improve interpreting services
- Interpreters should, if possible, be trained in mental health issues. In emergencies, untrained interpreters should only communicate a minimum of information until a trained interpreter can be found. Family members and untrained staff shouldn't interpret on clinically important issues.
- Accurately record and monitor ethnicity
- Get trained staff to record and monitor ethnicity, covering all BME admissions and referrals, plus personal details, behaviour, cultural customs and practices once in care. Patients should be assured of confidentiality, and should self-assign their ethnicity.
- Have an effective policy in place that deals with discrimination by patients, staff and institutions
- The policy must contain clear definitions of subtle, overt and hidden forms of harassment; encourage staff to act on early signs of discrimination (such as racism); establish and publicise the presence of advisors who offer confidential support.