The role of diaspora organisations in developing culturally appropriate mental health care in the UK

Ethnicity and mental health in the UK

Research suggests that different ethnic groups have different rates and experiences of mental health problems, reflecting their different cultural and socio-economic contexts and access to culturally appropriate treatments.^1-3 In general, people from black and minority ethnic groups living in the UK are:

• more likely to be diagnosed with mental health problems³
• more likely to be admitted to inpatient care³
• more likely to experience a poor outcome from treatment³
• more likely to disengage from mainstream mental health services, leading to social exclusion and a deterioration in their mental health^1,3,4

^​​These differences may be explained by a number of factors, including poverty, racism and also the view that mainstream mental health services often fail to understand or provide services that are acceptable and accessible to non-white British communities and meet their particular cultural and other needs.^1-4 It is also argued that mental health problems go unreported and untreated because people in some ethnic minority groups are reluctant to engage with mainstream health services.^1-4

As the All Party Parliamentary Group on Global Health suggests in a recent report, diaspora communities can and do play a significant role in addressing these inequalities, by raising awareness, developing and delivering services that draw from essential cultural understandings and skills, and sharing learning within and between individuals, communities, services and countries.​
 

Creating the framework for diasporas to contribute: Case of the Uganda Diaspora Health Foundation

Individuals with Ugandan heritage have been involved in projects with Butabika-East London NHS Link over the past 8 years. Members from the link noted that collaborations with members of the diaspora changed the culture of the link itself, fostering a broader global perspective and deeper appreciation of local context.⁵ Whilst “Western” concepts of mental healthcare provision have traditionally focused on a biomedical model, input from the diaspora helped the link to better understand and implement a community based approach to interventions from a Ugandan point of view, in which the community holds the responsibility and the solution. The link staff have reported a better understanding of community-oriented culture: an individual person's mental distress is not confined to the activity of the neurons; it’s part of a dynamic interaction with the environment and community. Input from the diaspora also helped the link to better understand the context in which projects in Uganda are being implemented.

Involvement and leadership in joint projects with the link formed the framework and opportunities for sustained, formal engagement through the Uganda Diaspora Health Foundation (UDHF), which was established in 2011 to bring together the expertise of UK based Ugandan health professionals. The foundation’s vision is to foster greater national and international development of culturally sensitive mental health care in the United Kingdom and Uganda, and it has organised a variety of activities to further this vision, for example:

World Mental Health Day 2014 roundtable

UDHF organised a round table discussions with Zimbabwe Health Training Support, which was hosted by the Butabika Link-East London NHS Foundation Trust on 10th October 2014 to mark World Mental Health Day. The aim of the roundtable was to explore ideas and share knowledge through open discussion with Ugandan and Zimbabwean diaspora representatives, including people with lived experience of mental health issues, their families, support networks and diaspora health care workers.

Discussions on suicide and physical health conditions such as HIV and malaria associated with mental health problems highlighted the need for a mental health awareness campaign.

Raising awareness of the diaspora community was identified as the first step toward behaviour change in terms of help seeking behaviour and reducing the stigma and discrimination attached to mental health problems among African diaspora communities in the UK.

Mr Stan Burnyeat ​(Head of Programme Management from Time to Change (TTC) anti-stigma campaign, far right) emphasized the importance of developing diaspora voices in the International Alliance and stressed the need to work collectively on an individual, community and national level to enhance the anti-stigma social movement. Discussions also highlighted the role of diasporas in bridging the treatment gap by providing culturally specific and tailored services.

Time to Talk Day diaspora community engagement

Following on the priorities identified through roundtable discussions, UDHF with partners including Uganda Diaspora Engagement and Butabika Link signed a pledge with Time To Change to reduce stigma and discrimination in December 2014.

On Time To Talk Day 05^th February 2015 a street campaign was led in predominately Ugandan-populated Forest Gate, East London, by UDHF members with special attendance by representatives from Time To Change, Butabika Link, and the Butabika National Referral Hospital of Uganda.
 

Intermittently retreating from the cold weather into the Uganda shop targeting information giving and conversations with Ugandans/African diasporas while they shop for their local food, joined by with Stan Burnyeat from Time to Change on the right

The campaigners initiated target conversations and gave out information, centering their activities around a Ugandan shop frequented by members of the African diaspora. 

Outside a Ugandan shop in Forest Gate with Dr Dave Baillie in the middle on the morning of the street campaign

Ugandan community leaders also led conversation about mental health on Ugandan social media sites by posting information throughout the day, with a special blog post published on Uganda Diaspora Engagement UK. 

CEO of UDE-UK Isabelle Gravenstein (second from the bottom left) join UDHF members on the street and social media campaign

Throughout the day, many people asked for information tailored to their community (i.e. language, core beliefs and other relevant themes). Community leaders will now be brought together on 13th March 2015 to discuss these issues at the Uganda High Commission, where High Commissioner and Professor HE Joyce Kikafunda will be making keynote remarks. 

Dr Juliet Nakku Deputy Director of Butabika National Referral Psychiatric Hospital Uganda 

Summary: Role of African Diasporas in the UK and beyond

Members from UDHF take advantage of their local knowledge and the personal connections they enjoy with their ‘home’ country, which then help facilitate co-operation within these communities during the implementation of particular projects. For example, knowledge about how to identify the initial stages of mental health problems was disseminated through local communities in the case of the Time to Talk Day event. This process works to break down stigma, encourage discussion of the role of culture and religion in mental health, aid employment, educate about medication, involve family and key community members, reduce violence, improve physical health and allow the communities to own and promote the prevention of relapse in their own societies, in their own ways.⁶ Members have also been able to quickly access partners at a more influential level in their ‘home’ country, contributing to more sustainable and effective international collaboration.

Diaspora health workers also foster greater national and international knowledge of culturally sensitive health care issues in the United Kingdom and home countries. They represent a unique resource for initiatives aimed at raising awareness among lay people, health personnel, lay workers, community and faith leaders about the challenges of mental health problems and physical health associated with mental health problems (and vice versa), and to prevent poor prognosis and reduce morbidity and mortality with the knowledge and skills necessary to influence, inform, educate and support African diasporas and their local communities.

References

1. Mclean C, Campbell C, Cornish F. African-Caribbean interactions with mental health services in the UK: experiences and expectations of exclusion as (re)productive of health inequalities. Soc Sci Med. 2003 Feb;56(3):657-69.
2. Fernando S: Multicultural Mental Health Services for Minority Ethnic Communities in Britain. Transcultural Psychiatry 2005, 42(3):420-436
3. Bhui K, Stansfeld S, Hull S, Priebe S, Mole F, Feder G: Ethnic variations in pathways to and use of specialist mental health services in the UK. Systematic review. Br J Psychiatry 2003, 182:105-16
4. Gary F A (2005) , Stigma: barrier to mental health care among ethnic minorities; Issues Ment Health Nursing , Dec;26(10):979-99.
5. Baillie,D, Aligawesa,M, Birabwa-Oketcho, H., Hall, C., Kyaligonza, D., Mpango, R., Mulimira, M, Boardman, J. (2015) Diaspora and peer support working: benefits of and challenges for the Butabika–East London Link. British Journal of International Psychiatry Vol 12 NUMBER 1. Page 10-13.
6. Mulimira, W. M. & Stoddard, A. (2014) Brain drain to brain gain: working with UK medical diaspora groups. BMA Communities, Policy Debate Blog, 17 July. Available here (accessed 17 February 2015).