Ethnicity: An Agenda for Mental Health

274 Pages·1999·0.81 MB·English

by  Dinesh Bhugra

1
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Edited by
DINESH BHUGRA
and VEENA BAHL
Ethnicity: An Agenda
for Mental Health
GASKELL
© The Royal College of Psychiatrists 1999.
Gaskell is an imprint of the Royal College of Psychiatrists
17 Belgrave Square, London SW1X 8PG
All rights reserved. No part of this book may be reprinted or
reproduced or utilised in any form or by any electronic, mechanical
or other means, now known or hereafter invented, including
photocopying and recording, or in any information storage or
retrieval system, without permission in writing from the publishers.
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from
the British Library.
ISBN 1-901242-15-3
Distributed in North America
by American Psychiatric Press, Inc.
ISBN 0-88048-585-X
The views presented in this book do not necessarily reflect those
of the Royal College of Psychiatrists, and the publishers are not
responsible for any error of omission or fact.
Gaskell is a registered trademark of the Royal College of Psychiatrists.
The Royal College of Psychiatrists is a registered charity (no. 228636).
Cover design by Graphic Creative, West Sussex
Printed by Bell & Bain Ltd, Glasgow
Contents
List of contributors v
Forward vii
Preface Dinesh Bhugra and Veena Bahl viii
1 Ethnicity – issues of definition Dinesh Bhugra
and Veena Bahl 1
2 Mental illness: a national perspective Veena Bahl 7
3 Cultural aspects of mental disorder in primary care
David Goldberg 23
4 Pathways into care: an explanation of the factors
that may affect minority ethnic groups
Dinesh Bhugra, Rachael Lippett and Eleanor Cole 29
5 Epidemiological factors in research with ethnic
minorities Julian Leff 40
6 Risk factors for psychosis in the UK African–
Caribbean population Kwame McKenzie and
Robin M. Murray 48
7 Common mental disorders among African–Caribbean
general practice attenders in Brixton, London
Keith Lloyd and Lynn St Louis 60
8 Ethnicity, drinking patterns and alcohol-related
problems in England Raymond Cochrane 70
9 Practice of child psychiatry in multi-ethnic Britain:
some issues and solutions Indira Vyas 85
10 Gujarati children in Manchester Richard Hackett 93
11 Cross-cultural approaches to dementia and
depression in older adults Marcus Richards
and Melanie Abas 106
12 Suicide and attempted suicide across cultures
Dinesh Bhugra, Menisha Desai and David Baldwin 123
iv Contents
13 Postnatal depression in Japanese women who have
given birth in England K. Yoshida, N. Kibe,
M. N. Marks et al 138
14 Forensic psychiatry Tony Maden 151
15 Satisfaction with mental health services: issues for
ethnic minorities Graham Thornicroft, Sue Parkman
and Mirelia Ruggeri 158
16 Joint working between the public and purchasing
authorities to determine mental health information
needs Carol M. Grant-Pearce and Julia Deane 166
17 Culture, ethnicity and mental health. A purchaser’s
perspective on the mental health of Black and other
ethnic minority groups Peter Gluckman 174
18 The National Health Service and ethnicity: services
for Black patients Janet La Grenade 183
19 Role of the general practitioner in the management
of mental illness in ethnic minorities Sangeeta Patel 192
20 Voluntary organisations’ perspective on mental health
needs Pat Gray 202
21 Alternatives to institutional psychiatry
S. P. Sashidharan 211
22 Service provision for ethnic minorities
Kamaldeep Bhui and Dinesh Bhugra 228
23 The Fourth National Survey of Ethnic Minorities
Sunjai Gupta 245
24 Conclusions Dinesh Bhugra and Veena Bahl 255
Contributors
Melanie Abas, Institute of Psychiatry, De Crespigny Park, London
SE5 8AF
Veena Bahl, Department of Health, Wellington House, 133–155
Waterloo Road, London SE1 8UG
David Baldwin, University of Southampton, Department of
Psychiatry, Royal South Hampshire Hospital, Graham Road,
Southampton, Hants SO9 4PE
Dinesh Bhugra, Institute of Psychiatry, De Crespigny Park, London
SE5 8AF
Kamaldeep Bhui, Institute of Psychiatry, De Crespigny Park, London
SE5 8AF
Raymond Cochrane, School of Psychology, University of Birmingham,
Edgbaston, Birmingham, B15 2TT
Eleanor Cole, Maudsley Hospital, Denmark Hill, London SE5 8AF
Julia Deane, Projecto Saude e al Algegia, TV Dom Anando 697,
Santeren-PA 68005–420, Brazil
Manisha Desai, Institute of Psychiatry, De Crespigny Park, London
SE5 8AF
Peter Gluckman, Lambeth, Southwark and Lewisham Purchasing
Authority, 1 Lower Marsh, London SE1 7NT
David Goldberg, Institute of Psychiatry, De Crespigny Park, London
SE5 8AF
Carol M. Grant-Pearce, PREST, University of Manchester, Oxford
Road, Manchester M13 9PL
Pat Gray, Barnado’s Family Service, Mornington Terrace, Liverpool,
L1 9DY
Richard Hackett, Holly House, Gladstone Terrace Road, Greenfield,
Oldham, OL3 7HF
N. Kibe, The Tavistock Centre, London
R. Kumar, Perinatal Section, Institute of Psychiatry, De Crespigny
Park, London SE5 8AF
Janet La Grenade, Department of Community Health & Psychiatry,
University of West Indies, Mona Campus, Kingston 7, Jamaica
Sunjai Gupta, Department of Health, Wellington House, 133–155
Waterloo Road, London SE1 8UG
v
vi Contributors
Julian Leff, MRC Social Genetic and Development Centre, Institute
of Psychiatry, De Crespigny Park, London SE5 8AF
Rachael Lippett, Institute of Psychiatry, De Crespigny Park, London
SE5 8AF
Keith Lloyd, Department of Mental Health, University of Exeter,
Wonford House Hospital, Exeter EX2 5AF
Kwame McKenzie, Institute of Psychiatry, De Crespigny Park, London
SE5 8AF
Tony Maden, Institute of Psychiatry, De Crespigny Park, London
SE5 8AF
Maureen N. Marks, Perinatal Section, Institute of Psychiatry, De
Crespigny Park, London SE5 8AF
A. Matsumoto, Department of Neuropsychiatry, Faculty of Medicine,
Kyushu University, Fukuoka, Japan
Robin M. Murray, Institute of Psychiatry, De Crespigny Park, London
SE5 8AF
H. Nakano, Department of Obstetrics and Gynaecology, Faculty of
Medicine, Kyushu University, Fukuoka, Japan
Sue Parkman, PRiSM, Institute of Psychiatry, De Crespigny Park,
London SE5 8AF
Sangeeta Patel, St George’s Hospital Medical School, Division of
General Practice and Primary Care, Hunter Wing, Cranmer
Terrace, London SW17 0RE
Marcus Richards, Institute of Psychiatry, De Crespigny Park, London
SE5 8AF
Mirelia Ruggeri, Department of Psychological Medicine, Ospedale
Policlinico, 37134 Verona, Italy
Lynn St Louis, Institute of Psychiatry, De Crespigny Park, London
SE5 8AF
S. P. Sashidharan, North Birmingham Mental Health Trust, Academic
Unit, 71 Fentham Road, Erdingham, Birmingham B23 6AL
N. Tashiro, Department of Neuropsychiatry, Faculty of Medicine,
Kyushu University, Fukuoka, Japan
Graham Thornicroft, PRiSM, Institute of Psychiatry, De Crespigny
Park, London SE5 8AF
Indira Vyas, Child & Family Psychiatric Service, Westcotes House,
Westcotes Drive, Leicester LE3 0QU
H. Yamashita, Department of Neuropsychiatry, Faculty of Medicine,
Kyushu University, Fukuoka, Japan
K. Yoshida, Perinatal Section, Institute of Psychiatry, University of
London
Foreword
The report Modernising Mental Health Services (Department of Health,
1998) sets out the Government’s vision for safe, sound and supportive
mental health services. Our Healthier Nation (Secretary of State, 1998)
sets out the Government’s agenda for tackling inequalities in health.
It is clear that modern mental health services should be evidence-
based, recognise the differing needs of the diverse community groups
in the population and provide care which is integrated.
It is well known that Black and minority ethnic groups find it
difficult to access mental health services through primary care and
there are high rates of certain mental illnesses in some Black and
minority ethnic groups. The nature of mental illness in relation to
Black and minority ethnic groups is not always understood by health
and social services and requires continuous assessment and an
improved knowledge base.
Both the Green Paper Our Healthier Nation and the Inequalities in
Health report (Acheson, 1998) provide a new opportunity to address
mental health of Black and minority ethnic groups and offers an
approach to tackling mental health of Black and minority ethnic
groups based on local intiatives.
References
ACHESON, D. (1998) Independent Inquiry into Inequalities in Health Report. London: HMSO.
DEPARTMENT OF HEALTH (1998) Modernising Mental Health Services: Safe, Sound and Supportive.
London: Department of Health.
SECRETARY OF STATE (1998b) Our Healthier Nation. London: HMSO.
Tessa Jowell, MP
Minister for Public Health
Department of Health
vii
Preface
DINESH BHUGRA and VEENA BAHL
Mental health is a subject which has been of relevance and import-
ance to governments as well as Black and ethnic groups for a number
of years for a number of reasons. There remain key issues in delivery
of mental health services which have highlighted serious gaps in
provision in various parts, yet at the same time there are examples
of good clinical practice which deserve better exposure. Some of
the key topics in delivery in mental health services as well as clinical
research have been the over-representation of African–Caribbean
patients in hospital, being treated with more physical therapies and
being diagnosed as having schizophrenia. Several studies have
suggested that schizophrenia is indeed more common in African–
Caribbean groups, whereas for South Asians attempted suicide in
women and problems of alcohol misuse in men are higher than the
native population. The health needs of minority ethnic groups and
Black patients vary. The recent White Papers on the future of the
National Health Service (NHS) for England, Wales and Scotland,
along with the Green Paper Our Healthier Nation, provide a framework
within which service delivery can be improved. With an emphasis
on Primary Care Services it is important that psychiatrists and other
mental health professionals take into account the needs of Black
and minority ethnic groups. These proposed changes in the delivery
of services within the NHS provide a suitable opportunity for
involving the stakeholders at local level and also giving the
communities a voice. With the problems of social exclusion linked
intimately with the mental health needs of Black and minority ethnic
groups it is essential that the service providers are aware of the
problems in delivery as well as acceptance of clinical services as they
stand. Voluntary organisations have often been more successful than
statutory services by involving the communities at a very local level
in planning and delivery of services and taking into account their
opinions and views about the models of illness as well as require-
ments from services. These changes are an essential element in
viii