Ethnicity
264. EU Member States have had very different
migration patterns and hence have diverse populations and especially
rather different ethnic mixes. Consequently, the policy and practice
issues in relation to mental health and ethnicity also tend to
vary between countries. The issue is a major one in the UK because
of the accumulating evidence that people from black and minority
ethnic communities are relatively disadvantaged in the care and
treatment they receive from the mental health system. The independent
report into the death of David Bennett after being restrained
in an NHS clinic identified "institutional racism" in
the Health Authority.[58]
Since then, increasing attention has been paid to the implications
of culture and faith when designing systems to identify and treat
needs.
265. Mind cited the 2003 report by the National
Institute for Mental Health for England on race equality and mental
health. That report had concluded that black and ethnic minority
people were more likely to experience problems accessing mental
health services. They were more likely also:
- to express lower satisfaction
with those services;
- to have a greater likelihood of
being transferred to medium and high secure facilities;
- to have higher rates of voluntary
admission hospital but to be less satisfied with hospital care;
- to stay for longer in hospital;
- to be readmitted to hospital more
frequently and to be more likely to get coercive treatment; and
- to be less likely to access talking
treatments (i.e. treatments that provide an opportunity to explore
issues with a trained professional such as a psychologist) (pp 54-60).
A number of other witnesses made similar points about
unequal patterns of experience and discrimination, for example
Ms Camilla Parker (Q 187) and Ms Rosie Winterton (Q 224).
266. The NHS Confederation (pp 144-145)
urged the European Commission to look at this issue of differential
service use by ethnic group, arguing that there was much to learn
about improving access for black and minority ethnic users across
the European Union. But although there is not enough understanding
of this area in the UK, it is possible that we have a more credible
platform of acceptance of ethnic minorities in society generally
and also a better record on disability (broadly defined) and ethnicity
than in many other countries. Obviously, there are no grounds
for complacency, but we think it possible that experiences and
practices in the UK with these population sub-groups in the UK
could serve as useful guides for other mental health systems.
267. The Mental Disability Advocacy Center suggested
that other groups such as Roma, migrants and asylum seekers, who
already suffered from discrimination, could be at even greater
risk if they suffered mental health problems. These groups should
perhaps be separated for the purposes of formulating a mental
health strategy at European level and in the policy responses
of national governments. Migration itself could be a very stressful
experience (pp 134-140).
268. There are known to be differences in the
incidence and prevalence of mental health problems across ethnic
groups. There are a number of possible reasons for these differences,
including social deprivation and associated stressors (including
different feelings of isolation and exclusion from employment,
quality housing, social networks and education), affordability
of preventive action which could affect resilience, cultural acceptability
of symptoms, levels of awareness and insight (perhaps linked partly
to language), different thresholds of shame or stigma, and genetic
risk factors. See the evidence from: Rethink (pp 60-63);
Kent County Council (pp 123-124); the Open Society (pp 155-159);
and Dr Matt Muijen (Q 213).
269. Mr Paul Corry from Rethink noted that
all the available information suggested that the occurrence of
new cases of mental illness and the overall number of people with
such problems were much higher in "second generation"
groups in society. It did not matter where their first generation
came from—Africa, Caribbean, Eastern Europe, Ireland or
faith communities—there was no doubt, he argued, that the
second generation experienced significantly higher rates of severe
mental health problems. He did not think that the reasons for
these higher rates of illness were fully understood, but suggested
that it may be linked to the tensions and stresses of living in
two cultures, although other factors were likely to be playing
a part. He stated the view that, as population movements across
Europe increased, particularly as people moved in search of employment,
it would be very important for those groups who settled that services
were in place for their children (Q 164).
270. This last point about migration patterns
was one to which a number of witnesses referred during the course
of the Inquiry, linked in part, but not exclusively related, to
refugees and asylum seekers. The King's Fund (pp 124-127)
suggested that the stigma of having a mental health problem might
be compounded by the stigma of being from an ethnic minority.
Mr David McDaid and colleagues from the London School of
Economics (pp 10-12) noted the challenges posed by the mental
health needs of people displaced through conflict, persecution
or economic migration. Mind argued that refugees and asylum seekers
were exceptionally vulnerable to developing mental health problems,
because of past experiences, but also because of current experiences
of abuse, exclusion and marginalisation (pp 54-60).
271. The Samaritans commented that many of the
migrant workers now based in the UK came from new accession countries
with high rates of suicide which, combined with a lack of normal
support networks as a result of migration, could be a source of
additional stress. The Samaritans themselves advertised and offered
their services in a variety of languages (pp 164-167).
272. The Royal College of Psychiatrists urged
the Commission to ensure that its Strategy targeted migrants as
a vulnerable group (pp 161-164). More broadly, a number of
organisations gave emphasis to the added value of European-level
action, given that, by definition, migration and its consequences
had an international dimension. Turning Point saw the mental health
of migrants and asylum seekers as an issue with a scope beyond
individual countries (pp 172-173). The NHS London EU unit
wanted the European Commission to encourage information sharing
about cultural attitudes to mental health problems to support
effective and culturally sensitive help for migrants and others
from minority ethnic groups (pp 145-148).
273. Dr Marcus Roberts of Mind wanted the
Commission to go further. He advocated that the Commission should
provide financial and other support to help countries developing
culturally appropriate services in the necessary range of languages
(Q 164). The Mental Health Research Network wanted to see
support for research on cultural issues in any European mental
health strategy (p 174).
274. Whether or not the initiative should come
from the Commission or from national governments, there is a strong
need for culturally appropriate mental health services. The Minister
gave examples of what had been done in England, such as the Delivering
Race Equality programme, which issued guidance about promoting
mental health for people from black and minority ethnic communities
(Q 224).
275. In the Green Paper,[59]
the Commission recognises that migrants and other marginalised
groups are at increased risk for mental ill health, but they do
not discuss the issue further. Nor do they discuss either the
specific need for a better understanding of the complex links
between ethnicity and mental health, or the need for culturally
appropriate service responses. Perhaps this lack of attention
arose because these topics appear to have been debated much less
in the EU generally than in the UK. Possibly also, as Mr Bowis
MEP suggested to us (Q 123), there is a better understanding
of these issues in this country than in most other EU Member States.
However, with rapidly increasing rates of migration, this will
surely become a growing challenge more widely across the EU.
276. We anticipate that, as migration patterns
change, so will the ethnic diversity of Europe's populations.
Our view is that more attention needs to be paid to the mental
health needs of people from minority ethnic groups, both established
populations and migrants, and including refugees and asylum seekers.
277. We draw attention also to the pressing
need to develop culturally appropriate mental health services.
Women
278. The European Parliament has expressed concern
about the limited attention given to gender in the Green Paper,
and particularly that the needs of women were overlooked.[60]
Mr Bowis MEP summarised for us some of the concerns expressed
in that paper. One concern was the high rate of pre- and post-natal
depression, linked to evidence that if society could promote good
mental health among mothers then their children were less likely
to grow up with difficulties themselves. Asian women had very
specific health problems, including mental health problems, which
needed to be understood better (Q 123).
279. The Mental Disability Advocacy Center referred
to research that showed that men and women had significantly different
experiences in mental health systems, with women being more vulnerable
to discrimination and abuse (pp 134-140). Rethink drew attention
to the psychological vulnerability of women who were single parents
or who experienced domestic violence (pp 60-63). The European
Public Health Alliance (pp 115-117) and Mind (pp 54-60)
both advocated gender-sensitivity when designing and reforming
mental health services.
280. We recommend that differences in the
prevalence and impact of mental health problems between men and
women should be recognised in the European Commission's mental
health strategy, and in the design of mental health systems in
Member States.
56 op. cit. p. 9 Back
57
Department of Health National Service Framework for Older People:
published 27 March 2001 Back
58
Report under HSG(94)27 by the Norfolk, Suffolk and Cambridgeshire
Strategic Health Authority: published December 2003 Back
59
op. cit. p. 9 Back
60
European Parliament resolution on Green Paper 2006/2058(INI)-adopted
6/9/2006 Back
