Publications: Maudsley Discussion Papers

Specialist services for minority ethnic groups?

Paper No.8
Dr Kamaldeep Bhui, Dr Dinesh Bhugra, Dr Kwame McKenzie
Institute of Psychiatry, King's College, London

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Summary

This paper considers the advantages and disadvantages of special mental health services specifically for black and ethnic minority patients. The diversity of the population of black and ethnic minorities is discussed alongside the dynamic demographic restructuring of such groups. The influence of culture, race and ethnicity on the process of acculturation adds to the complexity of health beliefs and helps seeking patterns amongst any single ethnic, cultural or religious group.

Culturally specific services are established in the United States. In the UK the voluntary sector supply special services and these are considered as an attractive and effective means of engaging and treating those who otherwise would not seek help in the statutory sector because of ethnic and cultural barriers. Such an approach might improve engagement of patients who report that existing services are culturally unattractive or insensitive to their distress. The call for specialist services challenges the status quo of service provision for black and ethnic minorities, and potentiates ethnic, cultural, linguistic and religious matching where service users feel this to be beneficial. Some research suggests concordance of value orientations between service user and health professional is critical. Specific services will help the service user feel understood as the providers will be informed of the service user's cultural beliefs and values.

In the UK there have been no well established or sustainable services, and none which have been evaluated for clinical efficacy, sustainability and economic viability. Distinct cultural, religious, ethnic and racial groups might emphasise quite different demographic variables as the foundations of their distinct identity. The special provision of services to each of these potential groups on the basis of preferred identity does not guarantee improved outcome, satisfaction or cost-efficiency. Specialist services models can work with statutory sector services in many ways, but there will be variations in lines of accountability, funding, and ideology. If specialist services became a reality, and worked in isolation from the statutory sector, this might increase marginalisation, and will lead to the fragmentation of generic mental health services.

We outline the benefits of special services as an interim measure towards the development of comprehensive multi-culturally effective generic mental health services. We anticipate that the best treatment models will involve a full range of independent and voluntary providers with effective working relationships with the statutory sector in order to optimise benefit to black and ethnic minority patients. The barriers to health working alliances necessary to achieve a multi-culturally competent service cannot be underestimated; these and ethical dilemmas in achieving this outcome are discussed