Re inventing children communities culture and mental health policy
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Re-inventing Children: Communities, Culture and Mental Health Policy. Begum Maitra Consultant Child and Adolescent Psychiatrist East London and the City Mental Health Trust. Culture in practice Clients.

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Re inventing children communities culture and mental health policy

Re-inventing Children: Communities, Culture and Mental Health Policy

Begum Maitra

Consultant Child and Adolescent Psychiatrist

East London and the City Mental Health Trust


Culture in practice clients

Culture in practice Clients

  • 2 year old Rokeya in Care proceedings (under the Children Act) for significant harm thought to be attributable to ‘parental neglect’

    little evidence available of the impact of diverse cultural styles of child care and parent-child interaction

    professional bias in observation, and attribution of meaning (the nature of cultural training)

    little relationship between psychological and legal criteria

  • ME professional refers 5 year old Osman for ‘disturbed behaviour’ (challenges authority, disrespect for women)

    who judges ‘appropriateness’ of culturalpatterns ?


Culture in practice clients1

Culture in practice Clients

  • White mother (convert to Islam, S Asian dress, name and language) with 2 children ‘of dual heritage’ judged more severely for parenting difficulties common to other single parents

    the failure of notions of ‘racism’ or ‘ethnic identity’ to address hybrid, and often changeable, identities that are based on only partly conscious choices

  • British Asians who choose partners from their country of origin with the express intention to renew cultural ties and resources

    social class and relationship hierarchies – impact on cultural practice, child care ‘expertise’ family, ‘community’ relationships (C of O; Br Asians; other diasporic communities; mainstream Br culture)


Culture in practice professionals

Culture in practice Professionals

  • ME staff in NHS mental health services

    Hierarchical relationships (often white British seniors)

    ‘Pressure’ to accommodate to British norms of interpersonal behaviour

    ‘Training’ produces uneven mixed belief systems (expectations and behaviour)

    What impact do these factors have on the ‘identity’ of these professionals ?

  • Organisational policy on ‘race’

    NHS - ‘culture-blind’ stance; the expectation that the patient will ‘lead’ Social services - matching ‘race’ in allocations (and placements)


The uneasy place of culture in mental health

The uneasy place of culture in ‘mental health’

  • Culture and ‘mainstream’ (adult) psychiatry

    ‘Universals’ and ‘culture-bound’ syndromes

    ‘Cultural psychiatry - a move from ‘categories to contexts’

  • ‘Race’ and Organisations

    The effects of racist mental health services - poor access, abusive and culturally irrelevant

  • The influence of ‘systemic’ therapies on child mental health

    Thinking in relational/interactional terms

  • UN Convention on the Rights of Children

    Universal notion of the best interests of ‘all’ children


Recent events impact of race culture on mental health policy

Recent events: Impact of Race/Culture on Mental Health Policy

  • Race Relations (Amendments) Act 2000

  • Report on Ethnic Health Inequalities 2001

    Children

    High rates of smoking and alcohol use among Irish children

    Low rates of dental care in all ME groups

    Low rates of participation in sports/exercise in all ME girls


Recent events impact of race culture on m h policy contd

Recent events: Impact of Race/Culture on M H Policy (contd)

  • Inside Outside: Improving Mental Health Services for Black and ME communities in England 2003

  • 10 point Race Equality action plan (Chief Exec NHS) 2003

  • Report of the Social Exclusion Unit June 2004

  • Appt of NHS Equality and Human Rights Director Oct 2004

  • ‘Celebrating our cultures’ Dec 2004

    Guide to mental health promotion with BME communities


Recent events impact of race culture on m h policy contd1

Recent events: Impact of Race/Culture on M H Policy(contd)

  • Delivering Race Equality (DRE) in Mental Health Care Jan 2005

    Ensuring MH services are more responsive to BME patients

    Better links between services and communities through

    500 new ‘community development workers’ andthe (expertise of) independent sector BME providers

  • Black and Minority Ethnic National Steering Group

  • National Institute for Mental Health in England (NIMHE) and Department of Health BME Mental Health Programmes


And children

and Children …?

  • National Service Framework (NSF) for Children, Young People and Maternity Services 2004

  • Funding (total £1.5 million) March 2005

    over 2 years for 5 projects aimed at developing culturally competent services for young BME people


Culture the children s nsf

Culture & the Children’s NSF

  • ‘Services for children and young people should be provided irrespective of their gender, race, religion, ability, culture or sexuality’. (Rationale, 2.11)

    Emphasises the importance of improving access to CAMHS to ensure greater equity

  • ‘Specific arrangements may need to be made to provide appropriate mental health care for children and young people in families of refugees/asylum seekers’


Culture the children s nsf contd

Culture & the Children’s NSF(contd)

  • ‘Concepts of mental illness and the understanding of the origins of children’s emotional and behavioural difficulties vary across cultures. Services need to be sensitive to these differences and ensure that staff are equipped with the knowledge to work effectively with the different groups represented within the community they serve.’ (Enhancing partnerships with BME groups, 5.3)

  • Ensure all staff working within CAMHS are sensitive to the particular needs of ch and yp from different BME groups

  • Training is available for staff to work effectively with families from specific BME groups within their community


Culture the children s nsf contd1

Culture & the Children’s NSF (contd)

  • Provide local directories of services for ME groups to enable BME ch, yp and their families to receive appropriate support

  • Recruit and train professionals from the ethnic minorities for whom services are being provided

  • Review the provision and training of interpreters to ensure that best practice is achieved

  • Planning & commissioning services to be based on locally adjusted epidemiological information on the prevalence of MH problems to reflect the diversity of the population


Common features

Common Features

  • ‘Ethnic monitoring’

    To provide data on ethnic patterns of service provision and service uptake

  • Improve access to services

    Provide interpreting and translation

    Provide information leaflets

    Promote user feedback (on relevance and satisfaction)


Common features contd

Common Features … (contd)

  • Increase cultural awareness / sensitivity / competence

    Staff training on ‘diversity issues’

    Recruit BME staff

    ‘Capacity building’ in ME ‘communities’

    ‘Engage’ communities through consultation, use of advocates

    Address cultural ‘needs’ - dietary needs, ‘respect’ for religious belief

  • ‘Modernising the professions for a new health and social care system’

    Evidence based practice

    ‘User/Patient’ involvement, service design, choice


The problem with some solutions

The problem with (some) solutions

  • Response to ‘Inside Outside’ Report - Transcultural Psychiatry Society (UK) in 2003

    Vague recommendations; the only ‘new money’ is for old (and ineffective) solutions eg CDW. CDWs need to be at a senior level. Their training, supervision and accountability to be defined with the BME communities, not statutory authorities

  • MH Professional culture – pervasive influence of narrow, culturally biased views of child development, long-term psychological goals, ‘health’ and illness, culture

  • A new and jarring brand of (‘friendly’) jargon ‘Race Equality champions’ ‘Facing up to difference’ (FUD) ‘Challenge, consult, compare and compete’


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