Black Minority Ethnic Health Issues

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The State of Play in HIV Health Promotion for Black and Minority Ethnic Men Who Have Sex with Men

The State of Play in HIV Health Promotion for Black and Minority Ethnic Men Who Have Sex with Men

underestimated. This paper describes a highly successful peer education model in the US that reported very poor returns when repeated in the UK. Although urban structure is cited as important, the differences in attitudes and sexuality-grounded roles amongst MSM even between two westernised nations must also be considered as a crucial aspect of intervention planning. Akin et al. (2008) found that the sexual behaviour of Latino/Hispanic MSM in Florida was conducive to high rates of HIV transmission including psychological distress, recreational drug use, and issues around cultural and political integration. Although these factors are by no means exclusive to Latino/Hispanic MSM, or the behaviourally bisexual population, the disproportionately high HIV incidence amongst African American MSM, another minority population grouping, is not positively attributed to sexual behaviour (Malebranche 2003), thereby counteracting the popular belief that a health promotion intervention can target BME MSM as a singular group.
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Linking black and minority ethnic organisations with mainstream homeless service providers

Linking black and minority ethnic organisations with mainstream homeless service providers

Closer joint working between mainstream and minority ethnic agencies is likely to raise awareness of the existence of homelessness services among individuals from black and minority ethnic communities and to increase the possibility of early intervention, thus preventing homelessness. The generic nature of many black and minority ethnic agencies that offer a range of services, including health, support with accessing benefits and education, suggests that these agencies may be well placed to identify at an early stage individuals who are at risk of becoming homeless, and may be able to work with homelessness agencies in resolving housing issues. Publicising the availability of crisis homelessness services among black and minority ethnic agencies and communities may also help reduce or prevent homelessness; for instance, among women facing domestic violence. This may involve the targeting of specific groups through work with these agencies. Mainstream agencies can also raise awareness of the services provided by minority ethnic agencies by publicising these services in key locations, such as homelessness hostels. They can also support black and minority ethnic agencies in working with homeless individuals by providing training on homelessness law and statutory processes to overcome some of the barriers to accessing
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Research into the access and acceptability of services for the mental health of young people from Black and minority ethnic groups

Research into the access and acceptability of services for the mental health of young people from Black and minority ethnic groups

Whilst the data gathered indicated some geographic variations and also some differences amongst young refugees and asylum seekers that were related to their migration status, across the different sample areas, and in both the individual interviews and the focus groups, there was considerable consistency in some of the prominent issues and concerns raised by young people. For this reason, the following material does not attempt to break down the information by either focus group or interview but rather, presents a discussion of the key themes emerging from the data overall. Any differences between those who had experience of using CAMHS/statutory mental health services and those without are noted under the
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Dancing to our own tunes: Reassessing black and minority ethnic mental health service user involvement

Dancing to our own tunes: Reassessing black and minority ethnic mental health service user involvement

While some participants felt that as service users/survivors we needed to work towards “a common purpose,” there was no illusion that this common purpose would be achievable unless considerable effort went into building meaningful relationships between generic mental health initiatives and black and minority ethnic communities. This was clearly evident when NSUN was called to explain the objectives and agenda behind commissioning the current piece of work. There was a strong feeling among all participants that national organisations were often perceived as middle-class institutions. It was felt that a lot of work needed to be done before the person on the wards would identify themselves with these organisations. Relationships also needed to be built between different minority ethnic communities. The increasing tensions related to broader socio-political issues like immigration, the so-called “war on terror,” poverty and economy have created rifts between communities. Within health and social care, the ways in which the government and the statutory sector fund user involvement have further increased distance between different black and minority ethnic communities in areas where they have had to compete for funding. There have been instances (for example in Bradford and London) where funding for services targeting a specifi c ethnic minority community had been cut while new funding was given for services targeting another ethnic minority community. This was experienced as a “divide and rule” policy, creating resentment amongst communities. It was felt that national networks had a role to play in rebuilding these relationships.
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"Double trouble"? Black, Asian and minority ethnic offenders’
experiences of resettlement

"Double trouble"? Black, Asian and minority ethnic offenders’ experiences of resettlement

The original project brief specified that the research should focus on four main areas of resettlement provision: namely, education and employment; accommodation; mental health services; and family services. While the literature review maintained a focus on these themes, we decided to broaden the empirical study beyond them, since we wished respondents to identify for themselves the main areas of need, and felt that if we restricted the areas of enquiry we would not gain insight into the full range of relevant issues, or the inter-connections between different aspects of resettlement. Moreover, whilst it is acknowledged in both the policy and research literature that employment, education, accommodation and family relationships are major needs in resettlement, there is now a consensus that prisoners and offenders often have additional, inter-related needs which must be tackled in a comprehensive and holistic fashion – including concerns relating to physical and mental health, drug and alcohol misuse, financial difficulties, and attitudinal and motivational challenges (Lewis et al. 2003; Hedderman 2007; O'Shea et al. 2003). As an empirical study involving a qualitative methodology, there are clear limitations to the conclusions that can be drawn from it. The views expressed in the interviews and focus groups cannot be claimed to be necessarily representative of all BAME offenders and service providers. Nevertheless, we were able to speak to sufficient numbers of individuals from diverse backgrounds to reflect a wide range of experiences of preparation for release. We believe that the value of this study lies in its ability to explore the attitudes and personal experiences of relatively small samples of prisoners, ex-prisoners and service-providers – including their concerns regarding discrimination that they may have suffered. Given the complexities of establishing whether different forms of racism and discrimination (direct, indirect,
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Improving Mental Health Services for Black and Minority Ethnic Communities in England

Improving Mental Health Services for Black and Minority Ethnic Communities in England

O’Sullivan 2001). Smaller more recent studies have produced conflicting results on Irish patterns of admissions to psychiatric care. One London study found that the pattern of Irish people having highest overall admission rates compared with Black and White British populations (Walls 1996), which replicated the prior national pattern found, while another study in Birmingham did not find an Irish hospital admission excess (Commander et al. 1999a). Data on sectioning of Irish under the MHA is harder to find due to monitoring issues, and therefore not as robust for this reason, as it is for the Black male population. However there is a strong perception among those working in Irish mental health that Irish men and women are
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Black and minority ethnic people with dementia and their access to support and services

Black and minority ethnic people with dementia and their access to support and services

because variations in factors such as migration history, politics, and systems for funding and delivering health and social care services make cross-country comparison very complex and some issues may not be relevant to a UK readership. Having found very little material specifically looking at social care-led interventions – none of which involved systematic ‘before and after’ comparisons − we decided to concentrate on some of the barriers to using dementia care services faced by BME people with dementia and their carers, and some of the ways in which they can be overcome.
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Working with black and minority ethnic communities

Working with black and minority ethnic communities

The second major need is to have community languages and staff who come from the communities you seek to serve. We also have a number of community volunteers. Over the years we have expanded our services, so families can come to us for their different needs. When these needs relate to sensitive issues such as mental health or learning disability, there are fewer barriers because we have proved that we respond to their needs in a culturally sensitive way. Within the local Muslim community, the view that a child has been possessed by a Jinn (evil spirit), will lead to a spiritual solution rather than a medical one. Another major issue is the lack of knowledge about the long-term effects of learning disability. For example, one parent came to the service with an older child who is doubly incontinent and autistic. We asked why she hadn’t sought help earlier; she replied that she thought he would ‘grow out of it.
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Engaging with Black and minority ethnic communities about the Mental Capacity Act

Engaging with Black and minority ethnic communities about the Mental Capacity Act

To discuss the issues involved, one participant cited the example of some sexual health leaflets that were produced to increase awareness within communities. These had been illustrated with naked bodies, which the local Black and minority ethnic youth groups found inappropriate for people from more traditional religious backgrounds, and hence less likely to be picked up and read. Issues relating to mental health, mental capacity, end of life etc also had cultural taboos attached to them and needed to be represented in leaflets and information material with caution. The conclusion was that having leaflets produced did not necessarily mean they were being used by communities.
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Review of the London Health Strategy high level indicators 2004 update focus on the health of London’s Black and minority ethnic communities

Review of the London Health Strategy high level indicators 2004 update focus on the health of London’s Black and minority ethnic communities

large African populations, they are one of the higher performing groups (ALG unpublished data, June 2002). Sub- Saharan Africa has many cultures and languages, and waves of migrants also differ in their class background. Attention to the specific language needs and circumstances of the different African communities, along with more broad- based economic policies, will benefit these pupils. Black Africans are, on average, of relatively recent arrival; therefore, it is important to tackle these issues quickly, before any negative cycles develop. There are other under-achieving groups, like Portuguese, Turkish and White working class pupils; the last two were identified by OFSTED for inner London. It is also important to realise that there are pockets of under-achievement among Indian and Chinese children, especially in the early stages, and that some of these pupils need long-term language support. The Association of London Government, having surveyed pupils in London
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35 Evening the odds Employment support, mental health and Black and minority ethnic communities

35 Evening the odds Employment support, mental health and Black and minority ethnic communities

People who have experienced the full spectrum of mental health issues value the project for its spiritual support, encouragement and commitment to self- help and mutual aid (Seebohm et al., 2005). In 2003, the project received a one year grant for an employment worker. During the year, 15 people were supported into paid work, nine into education, and six into other daytime activities. Partnerships included Jobcentre Plus, Bradford College, Remploy and the Bangladeshi Youth Organisation. Funding for the post was not continued, and there is no employment service on the individual placement and support model
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moving forward living life with mental health problems: a guide for black and minority ethnic communities

moving forward living life with mental health problems: a guide for black and minority ethnic communities

Certain health issues are more important to particular ethnic communities. For example, black Caribbeans are at much higher risk of stroke, with women being most at risk. Black and Asian people are also more likely to develop diabetes and heart disease than the general population. These conditions can be triggered by some medications for mental illness – you should be aware of the risks and carefully monitor your physical health for changes.

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Volume 1 The health of minority ethnic groups

Volume 1 The health of minority ethnic groups

The public health White Paper Choosing Health: Making healthy choices easier 8 set out the Government’s commitments for action on obesity and on reducing ethnic inequalities in health in general. Delivering choosing health, 9 Food and Health Action Plan 10 and Physical Activity Plan 11 specified the action that needs to be taken at national, regional and local level to combat obesity and improve people’s health through better diet and nutrition and increasing physical activity. It is widely acknowledged that both treatment and prevention are important to combat obesity. The Health Development Agency has reviewed the evidence on the best approaches to prevent and treat obesity in individuals. 12 A wide range of evidence-based approaches exist, including low-calorie diets, increased physical activity, combinations of physical activity and dieting, and a combination of behavioural therapy with other practices. The National Institute for Clinical Excellence (NICE) is
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Access to health care and minority ethnic groups

Access to health care and minority ethnic groups

. The report points out that for each apparent ‘difference’ between a minority ethnic group and the majority, closer scrutiny of the evidence reveals big differences within minority groups, suggesting that simple ‘genetic’ or ‘cultural’ explanations for ill health are unlikely to be correct in explaining why some groups seem to experience more illness than others. Another review, conducted in 2001, came to similar conclusions. 11

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Challenge plus: the experience of black and minority ethnic school leaders

Challenge plus: the experience of black and minority ethnic school leaders

Dhruev (1992), a UK social work education academic, brings another perspective to this review of the literature when he identifies all black professionals as in part social tokens in that their positions are always in danger of being used politically to spread the illusions that a) black interests and needs are being attended to; and b) there is an equal ease of social mobility for black people and that they occupy a significant proportion of powerful positions. Dhruev does also, however, identify another aspect to this and it is that these positions are also places to maximise a black voice of resistance from within the structures of the establishment. In recognising this possibility school leaders of BME heritage will be in a position to counteract the status quo and so take on the role of being a pioneer for change. This point could be understood to correlate with Osler’s finding in relation to black head teachers and their understanding of managing as a political activity. In fact, the HMI report on Responses to Ethnic Diversity in Teacher Training (DES, 1989) in acknowledging that BME students act as a catalyst for change in ITE could also be understood as highlighting the greater potential that BME headteachers are likely to have in a leadership role. In contrast to this, however, is the perceived requirement (at a cost) of having to conform to certain cultural standards and become colourless (Douglas, 1985) or not too ‘black’. This experience supports the view of critics of the integrationist and pluralist models:
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Black and minority ethnic housing associations: the challenge of growth and viability

Black and minority ethnic housing associations: the challenge of growth and viability

associations this is difficult, it should become an aspiration of all housing associations and a cornerstone of good practice. The housing associations which form the case studies in this review have a population of Board Members which, is in the main narrowly drawn. Some successful housing associations assess Board skills on a regular basis. Some form of skills audit is used, and the missing skills are provided. Some have adopted themed Board meetings, in order to focus on specific areas of the business, and have allocated to Board Members specific areas of responsibility. This tends to mirror their personal or professional interest, skills or knowledge. There is a danger here of a conflict of interest with the collective responsibility of the Board. The evidence provided by this study showed no specific BME issues regarding the development of a
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Explaining levels of wellbeing in Black and Minority Ethnic populations in England

Explaining levels of wellbeing in Black and Minority Ethnic populations in England

'Ethnic minorities in the labour market', a report by Ken Clark and Stephen Drinkwater highlighted that there was little evidence of occupational progress among ethnic minorities between 1991 and 2001 when other factors such as education had been adjusted for (Clark & Drinkwater, 2007). Their analysis concluded that the only group to experience notable advancement was Black Caribbean men. Higher education graduates also appeared to have increasing difficulty in obtaining professional or managerial jobs, with this being greatest for women, especially Black Caribbeans and Black Africans. Moreover, Labour Force Survey data showed wide differences in earnings between the White group and ethnic minority men in particular, the largest differences being observed among the Black Africans, Pakistani and Bangladeshi groups and the lowest in the Chinese, Black Caribbeans and Indians. Within occupations, the largest earnings gaps were seen in managerial and professional groups confirming that BME people find it difficult to obtain high-ranking executive positions. A plethora of evidence is now available to demonstrate the 'ethnic penalties' in employment in the UK and the poorer outcomes for BME groups in terms of rates of unemployment, the level of work attained and rates of pay, which persist even after differences in the groups such as age profiles and levels of education are controlled for. But, to demonstrate that discrimination is the key factor underlying such differences, other plausible factors that may contribute to the gap in labour market outcomes (for instance a lack of established contacts with potential employers among ethnic minority groups) need to be ruled out. Field
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Developing health assessment for black and minority ethnic groups

Developing health assessment for black and minority ethnic groups

The same proportional approach was applied to the investigation of differences by ethnic group in a selection of NHS High Level Performance Indicators. Low values on indicators of access to surgery may indicate problems in delivering interventions of proven effectiveness in an area. Comparing relative admissions for cataract operations and heart surgery, i.e. coronary artery bypass grafts (CABG) and percutaneous transluminal coronary angioplasty (PTCA), higher than average rates were seen for some minority ethnic groups. This would be expected given differences in diabetes and coronary heart disease prevalence, although the relative admissions for Bangladeshis was not as high as might be expected. Admission for knee and hip replacements appeared to be lower for minority ethnic groups, suggesting, in the absence of any evidence on less need, poorer access.
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Black, minority ethnic and refugee women, domestic violence and access to housing

Black, minority ethnic and refugee women, domestic violence and access to housing

The debate on how to house homeless women needs to address three issues: (1) the cost of homelessness; (2) the need for ongoing comprehensive support services; and (3) the need to address gender inequality of access to good quality housing. Walby (2004) suggests that ‘the demonstration of the scale of the impact of domestic violence on society by estimating its cost may enable a wider range of both policymakers and the general public to understand the extent of the problem … this is consistent with a move towards evidence-based policymaking and the development of transparent comparable measures of the cost and benefits that flow from policy action and inaction. It shows the cost of inaction’ (Walby, 2004, p. 3). The cost of domestic violence on local authority housing, housing associations, housing benefit and emergency and refuge accommodation is approximately £1.6 billion per annum. Taking all these costs into account, and including all public expenditure, the loss of economic output and the cost of
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Looking to the future: changing black and minority ethnic housing needs and aspirations

Looking to the future: changing black and minority ethnic housing needs and aspirations

conducted to explore issues such as the extent of ‘ no-go areas ’ , the needs and aspirations of minority ethnic disabled and older people, the possibilities of reducing homelessness among BME populations with preventative measures, and the needs of BME families who care for their ageing relatives at home or would like to do so. High-quality research findings, preferably generated by engaging the target groups, are essential to ensure that sufficient resources will be allocated for this type of provision in the future and that the developed services meet the needs of the people they have been designed to help. For the most part, the wishes and aspirations of average BME households are similar to those of white British households in similar circumstances, although racism continues to restrict ‘ non-white ’ people ’ s area choice. So-called cultural needs, such as preference for showers and good ventilation and insulation, are factors that ought to be considered in the building and design process - but as a measure of meeting the needs of all social tenants. Because the demand for social housing from BME communities is likely to remain high and even increase in the future, strategic provision and allocation of high-quality affordable housing could potentially function to address ethnic inequalities, to promote equal opportunities and to minimise the likelihood of intergenerational persistence of poverty and disadvantage among England ’ s minority ethnic populations.
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