Black and Ethnic Minority Men in Mental Health Hospitals - Literature review Example

Why There Are More Black and Ethnic Minority Men in Mental Health Hospitals As Opposed To Their White Counterparts? Introduction In most parts of Europe, mental health problems are still a taboo to discuss how these problems are a challenge to the government, society and the people with the problem. There are major core issues that are hampering the process of mental health problems positive change; discrimination, prejudice and stigma are some of them. Families are increasingly becoming the carers of these patients in most European countries. The trend over the last two decades has been shorter hospital stays, reduction in the number of inpatient beds and provision of community-based mental health care services (Knapp, McDaid and Mossialos 2007, p374). Research that has been done relating to the representation of Blacks and minority groups in psychiatric hospitals indicate that Black Caribbean, Black Africans and other Black groups are overrepresented in these facilities. The prevalence of mental illness particularly schizophrenia in UK is high among the Black Caribbean people. Some studies have reported that the rates of diagnosis compared to the Whites are eight times higher (Hatloy 2010, p1). Admissions to intensive-care and medium-security psychiatric units are still high among the Black Caribbean patients than the White patients. However, for common mental disorders the prevalence is not different between the Whites and the Black Caribbean patients (Leese and Thornicroft 2006, p380). While several studies have been conducted with an aim of establishing the prevalence of minority groups in mental health facilities, no conclusive research has been conducted to establish the reason for this phenomenon. This research seeks to establish the reasons or factors behind the high mental health problems that are more common with blacks and other minority groups as opposed to the whites and other majority groups. This research will focus on the United Kingdom and therefore will preclude cases beyond the borders of the country. Research Participants Beyond doubts minority groups in the United Kingdom include the Black Caribbeans, Black Africans, Irish, and individuals from mixed ethnic communities. Other minor groups living on the UK include the Bangladeshi, Chinese, and other Asians. These are the very groups that feature highly in police cells, prisons and correctional institutions. These minority groups are also the ones that are prone to having mental problems according to past studies. This research will target the aforementioned minority groups with a focus on the 18-30 age bracket considering that this group is most targeted by law enforcement authorities. Although mental health problems are not only restricted to males, this survey will involve only males. Importance of the Research The high rate of mental health cases in the United Kingdom is a problem that faces not only the government but also social care organizations. Social workers are faced with a lot of challenges in dealing with mental health problems among the Black and ethnic minority groups. High levels of stigma related to some of the mental illness leads to social exclusion and this has affected the willingness of social groups to provide support to the patients with mental health problems. This has also been affected more by the socioeconomic status of the Black and ethnic minority groups because of their incapability to support others (Boardman p180). Social workers should be aware of the levels of socioeconomic status of the people and offer the necessary support. It is true that majority of these people are poor and unemployed but their mental status is very vital in getting meaningful employment. Potential Benefits of the Research to Social Workers and their Practice A number of researchers who have researched about mental illness among people from different ethnic communities have found that black and ethnic minority men are more likely to suffer from mental illnesses and conditions as compared to their white counterparts. These findings have had considerable impact on the work of social workers not only in the UK but in other parts of the world as well. Understanding the factors behind the high mental cases in the UK society will give social workers an upper hand in dealing with the social problems that are faced by the minority groups. Once such factors are established, social workers can reverse the status quo by focusing more on the root causes of mental problems so while not ignoring the problem itself. Literature Review Minority Groups in the UK As of 2002, minority ethnic population in the UK accounted for 7.6% of the total population I the country. Indians made up the largest minority group and they were followed closely by Pakistanis. The other minority groups in the country include Black Caribbeans, Black Africans and individuals from mixed ethnic communities. Other minor groups living on the UK include Chinese, Bangladeshi and other Asians. Irish in Britain are also considered a minority ethnic group for the purposes of this paper (National Statistics, 2002). Mental Health Problems Mental health problems encompass a wide range of problems that affect someone’s ability to go on with their daily normal life. These mental problems result from a number of interactions that include the biological, social and psychological factors. Mental health problems are not specific and they can affect anyone regardless of the age and background. They also have a great impact on the people who take care of these patients such as their families, carers and friends. Recovery from mental health problems varies depending on its intensity. Some patients get full recovery while others with long term problems take time before they recover. However, many of them find ways of dealing with the problems and are capable of continuing with their normal lives (Mental Health Foundation nd). Psychotic illnesses are not like other illnesses, they affect only a very small number of people. In the UK only one in 200 persons suffers from mental illnesses. This makes it easy to determine the prevalence of the illness among different ethnic communities. Some of these mental illnesses include anxiety disorders, depressive episodes, obsessive compulsive disorder and panic disorders. The trend of minority groups being more susceptible to mental illnesses has been the case for about 50 years. Minority Ethnic Groups and Mental Healthcare Black men Men form the black community; especially those from the Caribbeans are more likely to be transferred from prisons to psychiatric hospitals than their white counterparts. They are also more likely to be assessed as being more dangerous than white men. Although statistics show that black and minority men are more likely to be treated fro mental illnesses, some researchers believe that this is mainly due to misdiagnosis and not the presence of the actual illnesses (Black Medical Health UK, 2009). Misdiagnosis of mental illness in Black and ethnic minority men has been blamed on misunderstanding different cultures. Different people from different ethnic communities have different ways of communicating or expressing distress, illness and support expectations. Differences in linguistic needs have also resulted in misdiagnosis of mental problems in these men (Bhui and McKenzie, 2008). Some researchers have suggested that some healthcare providers are only too willing to classify certain actions and behaviours in certain cultures as being unacceptable. This is because they cannot or are not willing to understand the cultural differences in society. This means that if a healthcare worker perceives that certain behaviour is not normal or deviates from what he considers to be normal, then he will classify that behaviour as a mental illness, even when it is not (Black Medical Health UK, 2009). Asian men Asian men are not more likely to be diagnosed with schizophrenia than white men. However, they are more likely to be diagnosed with depression. Just like their black counterparts, men from an Asian background have recorded high compulsory admission rates to psychiatric hospitals, and they have also recorded higher levels of physical treatments than white men in similar conditions. However, they also have recorded very low rates referrals of talking treatments which include psychotherapy and counselling. They also lack access to after-care services (Bhui and McKenzie, 2008). This treatment of Asian men is very similar to that of black men in the same society. The same reasons have been suggested for this kind of treatment of Asian men in the mental healthcare sector. One of the reasons given for the prevalence of Asian male mental cases in the UK is a lack of awareness in the Asian community of the available treatment options for depression and other mental illnesses and conditions. There is also a lack of culturally sensitive health services for these patients. Therefore they have to be subjected to the degrading and prejudiced treatment they receive from the existing psychiatric facilities. Service providers hold in mental healthcare also has different stereotypes, which only hinder effective treatment of Asian men with mental illnesses (Feistein and Holloway, 2008). One of the most common of these stereotypes is that Asians take care of their own. This is one community that greatly appreciates the value of the extended family. For this reason, they have been made to miss out on many opportunities in the social scene and this include proper healthcare. Many Asian cannot access external support if and when they need it. Social service providers fail to offer proper medical care to Asians since they believe that their efforts might not be fully appreciated (Bhui and McKenzie, 2008). Chinese men Culture is an important part of the Chinese community living in the UK. In this culture, there is a lot of stigmatization associated with mental illness. This may explain why Chinese families are normally reluctant to let patients suffering from mental illnesses get the medical attention that they need. To avoid what the Chinese community perceives as untold shame to the family, they would rather not say a word about any mental health issues that they may be suffering from (Errol, 2004). Man Chinese men suffer more from emotional stress than any other kind of mental illnesses. However, due to cultural restrictions, they cannot seek medical help early enough, and this normally leads to more complicated mental problems. Chinese men are also taught from quite an early age that they cannot express themselves emotionally. This means that whenever they have something that might be bothering them; they cannot share it for fear of being labelled as weak. This may generate to depression and stress which is one o the reasons why many of these men are normally diagnosed with mental problems more than white men. In any case, for many Chinese men, feeling depressed is a normal way of life which should not warrant any psychiatric attention (Feistein and Holloway, 2008). It is also quite difficult for Chinese men to access mental healthcare and services when they need it. This is because very few of them actually understand or even speak English. It has been estimated that about 70% of all Chinese living in Britain cannot utter a single English word (Bhui and McKenzie, 2008). This makes it extremely tricky for mental healthcare workers to effectively work in this community. This may lead to misdiagnosis, leading to a high number of Chinese men being confined in mental hospitals (Errol, 2004). Irishmen Irishmen are among those minority groups who are more likely than anyone else to be diagnosed with severe mental illness. Although they normally have better access to basic health facilities and daily necessities than other ethnic non-whites, they also record high levels of mental illnesses than their fellow white men (Errol, 2004). Rate of Mental Health Problems and Admission to Psychiatric Hospitals in UK Black men and White/Black mixed groups had the highest rates of admission to psychiatric hospitals in 2009. Their admission being three or four times than the rest of the population. On the other hand, women admitted were two or three more times than the rest of the population. In other ethnic minorities like the White British, Indian men and Chinese, their admission to psychiatric hospitals was less compared to the rest of the population. Surveys conducted show that the Irish men have higher rates of mental health problems than the rest of the general population. The Irish people are not studied much because they are perceived as White (Hatloy 2010, p1). According to Errol, black men in Britain are ten times more likely to have schizophrenia than their white counterparts. Errol goes to say that black patients in mental health facilities are also more likely to be kept under lock and key while at the same time being given high dosages of medicines as compared to white patients. Very few of these black patients are normally given the option of psychiatric counselling while the same options are normally provided to almost all white patients suffering from similar illnesses or conditions. Feinstein and Holloway (2008) also concur with the above findings. They say that some ethnic communities are “over-represented in psychiatric hospitals. They claim that those blacks diagnosed with schizophrenia are eight times as many as white patients suffering from similar illnesses. According to Feinstein and Holloway, men from the black community are more likely to be detained under the mental health legislations more than any other ethnic communities. Bhui and McKenzie observed that some ethnic groups were at a higher risk of mental health problems than others. The researchers also noted that the differences in mental health according to ethnicity may be explained by the differences in socioeconomic risk factors. These risk factors include: migration, social exclusion, resettlement and lack of access to healthcare. In England for instance, 21% of psychiatric patients come the minority ethnic community (Bhui and McKenzie, 2008). Although there are many research statistics showing that blacks and people from ethnic minority communities who visit mental health facilities for psychosis treatment, some researchers say that the statistics may not reflect the situation as it is. For instance, although there are many Blacks in the UK who are treated for psychosis, they do not necessarily suffer from mental illnesses. Rather, their symptoms may be misinterpreted. Reasons for the High Number of Blacks and Ethnic Minorities in Mental Hospitals In every society around the world, people have interacted in many ways and there are possibilities of finding ethnic minorities in such a society. Blacks and other ethnic minority groups especially from Asia are among the people found in most Western countries. They are the most ignored people in the society because of their cultural backgrounds. They live in neighbourhoods with little or no facilities like houses, water, hospitals and schools. Majority are poor and unemployed and at most times they experience ill health. Apart from being ignored and living in sub-standard conditions, these people face a lot of jeopardy, racial crime and racial harassment from the rest of the population. These problems have had tremendous impact on their mental health and well being. It is evident that black and minority group people experience discrepancy and inequalities compared to their white counterparts in terms of the intensity of mental ill health, service outcome and service experience (Department of Health 2004, p8). As a matter of fact, the majority of blacks in the United Kingdom and other minority ethnic groups are in tangled in poverty or of low social standing. The blacks are generally socially disadvantaged and commonly grapple with problems such as unemployment and poor housing. In the event that they get employed, blacks are often compensated with lower pay compared to their white counterparts. Many individuals that come from minority ethnic groups such as blacks commonly face discrimination and racism to great levels in their ay to day lives. On top of this kind of discrimination, blacks face to some level institutional discrimination as practiced by the society’s institutions. Stereotyping is always the order of the day by many societies against minority groups – Blacks as a minority group against a background of whites and other majority groups being no exception. This kind of stereotyping normally reinforces the kind of social exclusion that they already are faced with. People of African-Caribbean and African backgrounds are always stereotyped as people who are violent and therefore dangerous. Compared to majority ethnic groups, men who come from minority ethnic groups, especially Blacks, have a much higher compulsory admission rate in psychiatric healthcare centres. They are much unlikely to receive psychotherapy and counselling but are more likely to be treated with ECT. Possible Reasons Why Minority Groups More Likely to Be Diagnosed With Mental Health Problems Poverty The cost of living in England is one of the highest in the world today. Yet, there are very many people in Britain who cannot afford the most basic of their needs. Some of the poorest people in the UK are Blacks, Asians and Irishmen (National Statistics, 2002). Many of this people cannot afford daily meals. Proper housing for most of them is a big problem and they have to rely on external support, which is becoming harder to get as the days go by (Feistein and Holloway, 2008). This kind of living has left many of these men and women dejected and hopeless. Many men from ethnic minority communities who are admitted in mental institutions are from these poor backgrounds. Unemployment The employment environment in the UK favours whites more than any other communities. Therefore, it is very hard to get proper employment if one is black, Asian or from Ireland. Blacks and people from Bangladesh have recorded the highest unemployment rates in the past (National Statistics, 2002). Unemployment increases poverty levels, which makes life very challenging. This brings about mental disorders, and this might explain the large number of blacks and ethnic minorities being treated for mental illnesses (Feistein and Hooloway, 2008). Social Discrimination Racial and class discrimination is a prevalent way of life in Britain. This makes it difficult for everyone to have equal access to employment and social services and amenities. Blacks and people from ethnic minority groups in the UK are the ones who suffer the most from this discrimination. Not only do they lack access to good jobs, they also are denied access to proper healthcare services (National Statistics, 2002). Many workers in various mental facilities normally treat non-white patients differently from their white counterparts. This is one of the major causes of misdiagnosis which has led to many blacks and minority groups being overrepresented in mental institutions (Bhui and McKenzie, 2008). Misdiagnosis Misdiagnosis is a common occurrence in most hospitals and psychiatric health facilities in the UK. It has been reported that healthcare use has increased over the years; however, the quality of treatment has not improved at all (Feistein and Hooloway, 2008). Low quality treatment that blacks and ethically minority groups in the UK are subjected to has often led to misdiagnosis (Errol, 2004). This has resulted in many people being treated for mental conditions that they did not have in the first place. Cross-Cultural Misunderstandings Most workers working in psychiatric centres and other mental health facilities do not have an adequate understanding of cultures other than their own, hence, what they perceive as being abnormal is applicable to other cultures as well. Many of the workers do not have an awareness of how the blacks and ethnic minority groups with whom they work normally communicate and live (Errol, 2004). This has resulted in a high level of misunderstanding of certain behaviours which have been termed as being mental abnormalities, even when they are not. Impacts and Challenges of Mental Health Problems to Social Work Practice Social workers have a challenge of understanding how the Black and other minority groups offer care and support to their members. These communities have different ways of providing care and support to its ill members. South Asian groups have high levels of involvement with their family members and people who were likely to get married. In contrast, the Blacks and other minority groups detest any form of close involvement or relationships with other people. Black and minority group people have more contact with their friends than their relatives. Negative view of close relationships by these people is attributed to the increase of mental health problems among these communities. Black Caribbean people receive less support (emotional and practical support) than the others. Those of Bangladesh origin tend to receive high levels of practical and emotional support from their closest people. However, they still experience high levels of negative influence. Among the Indian and Pakistani women, friendship networks are relatively small. Some studies indicate that these small friendship networks contribute to the high rates of mental health problems such as depressive episodes, common mental disorders, anxiety and other common mental disorders found amongst Pakistani women (Boardman p181). Research Methods Research Design Considering the huge geographical extent of the United Kingdom, it would need a huge amount of resources to consider every element of the mentally ill population. Furthermore, visiting every health care centre would be costly, time consuming and theoretically impractical considering the nature of this study. Taking the aforementioned factors into consideration, this research will be conducted using mailed questionnaires. The questionnaires which will mainly consist of closed ended questions will be sent to mental healthcare facilities and completed by healthcare officials. A second set of questionnaires will be presented to patients’ parents or close relatives to get qualitative information about their conditions. Considering that the population of blacks and minority groups in the UK is huge, it is only realistic and practical to use samples. Considering that the study will focus on those who are considered to be mentally unsound, the research will sample two mental healthcare centres Merseyside and Yorshire boroughs. Sampling Method .This research will involve minority groups and blacks in the two boroughs. The sample will consist of men from minority groups who have mental disorders of various types. Owing to ethical and legal considerations, the study will not involve interviewing of those who are mentally ill. Instead, mental health care officials will be asked to provide information regarding the patients that they have. This will however be restricted to providing certain information only – information that will not breach patients’ privacy. In this regard, patients’ names, addresses, and other personal identification data will not be collected. In each of the two mental healthcare facilities, a sample 50 patients will be systematically drawn. The patients to be sampled will be drawn by considering the mental health patients’ registers. For each centre, the register list will be divided into ten. Every third person in the divisions will be considered as part of the sample. This will ensure that the data is truly representative of the population under study. Once the sample is determined, the health official will be required to fill the questionnaire on behalf of the patient based on their records. The statistics collected from the healthcare officials will be used for qualitative analyses. The research will then focus on finding the families of the sampled patients who will be interviewed with an aim of getting qualitative data. Since the costs associated with conducting country wide surveys are huge, this research will be done on a small scale and later on a country-wide scale if the necessary funds are available. Data Analysis The research will involve the review of secondary data as well as the collection and analysis of primary data. A quantitative analysis will be done on the primary data collected to establish the various descriptive statistics that exist in regard to minority groups and mental health. Demographic data will also be analysed to establish any correlations between age, income level, and race and mental health prevalence. Furthermore, the various factors that cause mental health will be considered in establishing correlations with various demographic factors. Beyond correlation analysis, regression analysis will be conducted to establish the relationships between various variables that will be considered in the study. In order to make a more reliable analysis, the regression and correlation analysis will consider the types of mental disorders that mental health patients have. The data collected will be analysed using SPSS software which is specially designed to perform a wide variety of statistical analysis and graphic displays. The raw data will be first coded in the program and analyses done in consideration of the specific objectives of the study. Social workers working with or among patients with mental health problems have to come to terms with the fact that there are more ethnic minority and black men in mental hospitals than there are whites. According to Errol there is deep rooted prejudice in mental hospitals, and this prejudice is normally directed towards non-white patients. Errol says that racist stereotypes are to blame for the pathetic conditions that black and ethnic minorities have to be subjected to when they need medical attention. Implication of Research on Social Work Social workers need to be made aware of the needs of different individuals in society. There is need for better communication and understanding if blacks and ethnic minorities in mental healthcare. Training staff for cultural awareness is paramount to get rid of the unfortunate but real discrimination that mentally ill black and ethnic minority patients have to go through. Social workers have to understand that there is nothing wrong with being a non-white and that everybody has the right to healthcare. Workers need to start treating mentally ill blacks and individuals from minority ethnic communities like other patients rather than as lesser human beings. Taking the above stated facts into consideration, the findings of this research will be presented in report form to key policy makers both in private and public centres that work with mentally ill people from minority groups. It is hoped that the findings of this study will bear positively on the state of minority groups and somehow will help in providing better social care for them. Time Schedule Time, being a most important resource, must be properly spent in the course of research. This study is expected to take a total of nine weeks assuming that nothing major disrupts the work schedule. In the event that an unanticipated circumstance comes into view, the time schedule will be re-adjusted to ensure that the work is completed within reasonable short time. The time schedule presented below will be followed in conducting this research. Activity Time in Weeks 1 2 3 4 5 6 7 8 9 Preliminary Preparations Literature Review Review the secondary data Device approach to research Pilot Test and questionnaire revision Administer questionnaire Data Analysis Draft Revision Submission and Presentation of Report References Bhui, K. and McKenzie, K., 2008, Rates and Risks Factors by Ethnic Group for Suicides Within a Year of Contact With Mental Health Services in England and Wales, Accessed 8 November 2010, from: http://psychservices.psychiatryonline.org/cgi/content/full/59/4/414 Black Medical Health UK, 2009, People with Mental Health Diagnosis More Likely to Receive Inferior Quality of Medical Care, Accessed 9 Nov. 2010, http://www.blackmentalhealth.org.uk/index.php?option=com_content&task=view&id=606&Itemid=117 Boardman, J. (2010) Social inclusion and mental health. London: RCPsych Publications. Department of Health. (2004) Celebrating our cultures: Guidelines for mental health promotion with Black and Minority communities. Leeds, UK: Department of Health. Errol, F., 2004, “Society: Comment: Too little too late: The Bennet Inquiry Should go a Long Way towards Addressing Problems in our Mental Health System”. The Guardian, p.9 London. Feistein, A and Holloway, F., 2008, Psychiatric Intensive care Units: a Literature Review, International Journal of Social Psychiatry, Vol. 54, pp.56-68 Hatloy, I. (2010) Statistics 3: Race, culture and mental health, Mind, February. Knapp, M., McDaid, D. & Mossialos, E. (2007) Mental health policy and practice across Europe: The future direction of mental health care. Berkshire, UK: McGraw-Hill International. Leese, M. & Thornicroft, G. (2006) “Ethnic differences among patients in high-security psychiatric hospitals in England”, The British Journal of Psychiatry, 188, pp. 380-385. Mental Health Foundation. (n.d.) Mental Health Problems. [Online]. Available at: http://www.mentalhealth.org.uk/information/mental-health-overview/mental-health-problems/ (Accessed: 9 November 2010). National Statistics, 2002, Minority Ethnic Groups in the UK, Accessed 9 Nov. 2010, http://www.statistics.gov.uk/pdfdir/meg1202.pdf Read More