Chapter 5: Mental health

This page forms part of the Transcultural Health resource, published in 2004, and is preserved as a historical document for reference purposes only. Some information contained within it may no longer refer to current practice. More information

Author: Balakrishnan Rajamanickam

Aim and learning objectives

The aim of this chapter is to introduce learners to the main themes in the care of mentally ill patients from minority ethnic groups in contemporary Britain.

The learning objectives include:

critically examine the role culture plays in shaping the health beliefs and health seeking behaviours of people from different cultural backgrounds.
recognise the importance of cultural influences in the communication patterns of patients.
develop robust assessment tools in practice to highlight the cultural profile of patients.
appreciate the pathways to care followed by patients and ascertain the effectiveness of the three sectors of mental health care for minority ethnic patients.
critically evaluate your own strengths and weaknesses in working with people from different ethnic backgrounds.
actively seek to influence change in knowledge, skills and attitudes, making it more receptive to the needs of patients from different backgrounds.

Introduction

About this module

The module attempts to identify the main themes in the care of mentally ill patients from minority ethnic groups in contemporary Britain. The main developments of psychiatric care are critically explored and put in the context of current concerns around health care provision for these groups. Government policies in the form of Health Department initiatives and directives have highlighted inadequacies in the public mental health sector. There is an urgent need to address these shortcomings in the care and service provisions for the mentally ill in our minority ethnic populations. With this in mind it seems appropriate to explore the changes in this area from a continuum of health to illness.

In Section One health beliefs and healing practices are explored in order to gain an appreciation of the historical as well as the cultural context of our migrant population. In order to understand this it is necessary to examine the health practices and healing rituals of the countries of their origin as a way of understanding its value and relevance. This is contrasted with Western biomedicine, the predominant vehicle for treatment in this country for those who suffer from psychological problems. The tension between the different cultural traditions of health care is critically assessed.

In Section Two the discussion covers the area of communication, which is culturally determined. The language of distress used by minority ethnic communities is explored. The possibility of misunderstanding and misinterpretation is prevalent, with consequences for the treatment the likely outcome. An attempt to minimise these misunderstandings is discussed, and measures that health care professionals can employ to develop their skills and competencies are explored.

Section Three looks critically at examples of assessment tools to ascertain the cultural profile of patients from minority ethnic communities. How useful are the tools the students currently use and what are the improvements you can bring to them? The role that racism and stereotyping can play is examined.

Section Four explores the business of making clinical judgements; whether the person is mentally ill or not. The interaction between therapist and patient is critically examined to look at the expectations and suspicions each has of the other. How this is dealt with to free up the therapeutic process is one of the issue touched on in this session. Debates about normal and abnormal behaviour as criteria for the mental state of the patient are explored within different cultural contexts.

Section Five concludes with the impact of culture in treatment programmes. Taking an example from adolescent psychiatry the case study looks at the influence of culture on family therapy and the care that should be taken to avoid mistakes. The second part looks at the role carers from minority ethnic communities play in the care of the elderly mentally ill. The cultural expectations and roles of many involved in the care of minority ethnic groups are some of the issues that will be explored here.

Link with other modules

The format of this module has been structured to fit in with other modules in this programme, therefore, it is intended that you should have access to these to familiarise yourself with the discussion of relevant concepts and theories on the subject. As most students have been introduced to many of the concepts in the Transcultural Health Care Practice: Foundation Module, it is intended here to apply these to the Mental Health Branch.

Those who are approaching this module without prior introduction to the Foundation Programme as many of the Post-registration students might be, it would be advisable to have access to the modules listed below:

Husband C The Politics of Diversity, Royal College of Nursing
Anionwu E, Sookhoo D and Adams J Transcultural Health Care Practice: Foundation Module, Royal College of Nursing
Norton N and Watt S Transcultural Nursing Care of Children and their Families, Royal College of Nursing
Johnson, R D Towards an Epidemiology of Diversity: Ethnic Minority Demography, Disease Patterns and Pathways to Care, Royal College of Nursing

Students are strongly advised to undertake prior reading, or to be prepared to access these modules, where appropriate, on the web or CD-Rom.

The Sections of this module are presented with the view to their being appropriate for its teaching and learning objectives. Students should feel free to use these sections in a way that meets their needs and requirements:

the text of the module guides you through key concepts and theories that inform the discussion or debate. They are presented in a clear and concise way for readers to engage with the issues easily. You will be required to read journal articles or chapters of books furnished through the references and bibliography lists
you will find exercises and activities to consolidate your learning. These can be done individually or as a group exercise to encourage peer support and group sharing skills. Students are encouraged to reflect on their reading and ask questions about self or aspects of care that needs changing.
tutor or facilitator notes are guidance given to facilitators who are intending to use these materials as a teaching guide and offer tips to anticipate problems and avoid difficulties.

Learning activities

Activities will take the form of a care study undertaken from your relevant practice area to look at the service provision for minority ethnic patients. Areas of focus would be:

assessment tools to illustrate the cultural profile of patients
statutory and voluntary service involvement in the care of minority ethnic patients
health seeking behaviour and healing practices engaged by patients
literature review of the developments in mental health care for the minority ethnic patients
personal development plan extending your own knowledge, skills and attitudes working with patients from different cultural backgrounds

More experienced staff would be able to negotiate a topic, mode of presentation and date of submission covering any one or many of the areas identified above and explore them in greater depth.

For use by allied health care professionals

Most of the activities identify the nurse as using his or her assessment and interactive skills to engage with minority ethnic patients. Where it reads nurse's activities other health professionals like social work students, community workers, school nurses, occupational therapists, etc could easily use them. It is hoped other allied health care professionals working with mentally ill minority ethnic patients will find most of the content and activities equally challenging and thought provoking. With greater emphasis on inter-professional working the materials here could be used by a multi-disciplinary team to work on practice issues together and hopefully this should impact to enable professionals to learn and work together.