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Mental health services for black and minority ethnic elders in the United Kingdom: a systematic review of innovative practice with service provision and policy implications

Published online by Cambridge University Press:  19 November 2012

Sarmishtha Bhattacharyya  and
Susan Mary Benbow
Sarmishtha Bhattacharyya
Affiliation:
Old Age Psychiatry, Black Country Partnership Foundation Trust, West Midlands, UK Centre for Ageing and Mental Health, Staffordshire University, Stafford, UK
Susan Mary Benbow*
Affiliation:
Centre for Ageing and Mental Health, Staffordshire University, Stafford, UK Older Mind Matters Ltd., Cheshire, UK
*
Correspondence should be addressed to: Dr. Susan Mary Benbow, Professor of Mental Health and Ageing, Centre for Ageing and Mental Health, BL 167 Staffordshire University, Blackheath Lane, Stafford ST18 0AD, UK. Phone: +44 (0)1785 353742; Mobile: +44 (0)7789 485435. Email: drsmbenbow@gmail.com.
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Abstract

Background: The proportion of older people from black and minority ethnic (BME) groups in the United Kingdom (UK) is increasing steadily as the population ages. The numbers with dementia, depression, and other mental health problems are predicted to increase. Government policy documents have highlighted gaps in services for BME elders and/or the need to develop culturally appropriate services, in order to prevent people from BME communities from becoming socially excluded and finding services hard to access. This paper reviews published examples of innovative services and key learning points from them.

Method: A search was carried out on Pubmed, Medline, and Google Scholar for service developments aimed at BME elders in the UK. Sixteen relevant papers and reports were identified and were analysed to identify learning points and implications for clinical practice and policy.

Results: Commissioning issues included were forward planning for continuing funding and mainstreaming versus specialist services. Provider management issues included were employing staff from the communities of interest, partnership, and removing language barriers. Provider service issues included were education for service provider staff on the needs of BME elders, making available information in relevant languages, building on carers’ and users’ experiences, and addressing the needs of both groups.

Conclusion: A model for structuring understanding of the underutilisation of services by BME elders is suggested. The main emphasis in future should be to ensure that learning is shared, disseminated, and applied to the benefit of all communities across the whole of the UK and elsewhere. Person-centred care is beneficial to all service users.

Keywords

person-centred careservice developmentblack and minority ethnic communities
Type
Review Article
Information
International Psychogeriatrics , Volume 25 , Issue 3 , March 2013 , pp. 359 - 373
Copyright
Copyright © International Psychogeriatric Association 2012

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References

Adamson, J. (2001). Awareness and understanding of dementia in African/Caribbean and South Asian families. Health and Social Care in the Community, 9, 391–396. doi:10.1046/j.0966-0410.2001.00321.x.CrossRefGoogle ScholarPubMed
Aday, L. A. and Andersen, R. (1975). Development of Indices of Access to Medical Care. Ann Arbor, MI: Health Administration Press.Google Scholar
Adelman, S. (2010). Prevalence and recognition of dementia in primary care: a comparison of older African–Caribbean and white British residents of Haringey. PhD thesis, University College London. Available at: http://discovery.ucl.ac.uk/19622/; last accessed 3 August 2012.Google Scholar
Age Concern London (2002). Age Concern Information and Advice Services for black and minority ethnic older people: a strategy for London.Google Scholar
Alzheimer's Society (2007). Dementia UK. The full report (165 pp). London: Alzheimer's Society.Google Scholar
Andersen, J. G. (1973). Health services utilization: framework and review. Health Service Research, 8, 184–199.Google Scholar
Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: does it matter? Journal of Health and Social Behavior, 36, 1–10.CrossRefGoogle ScholarPubMed
Andersen, R. and Newman, J. F. (1973). Societal and individual determinants of medical care utilization in the United States. The Milbank Memorial Fund Quarterly: Health and Society, 51, 95–124.CrossRefGoogle ScholarPubMed
Barker, J. (1984). Research Perspectives on Ageing: Black and Asian Old People in Britain, 1st ed. London: Age Concern Research Unit.Google Scholar
Benbow, S. M. (2012). Patient and carer participation in old age psychiatry in England. Part II: models of participation. International Psychogeriatrics, 24, 185–196. doi:10.1017/S1041610211001876.CrossRefGoogle ScholarPubMed
Bice, T. W., Eichhorn, R. L. and Fox, P. D. (1972). Socioeconomic status and use of physician services: a reconsideration. Medical Care, 10, 261–271.CrossRefGoogle ScholarPubMed
Blais, R. and Maïga, A. (1999). Do ethnic groups use health services like the majority of the population? A study from Quebec, Canada. Social Science and Medicine, 48, 1237–1245. doi:10.1016/s0277-9536(98)00423-7.CrossRefGoogle ScholarPubMed
Blakey, H., Pearce, J. and Chesters, G. (2006). Minorities Within Minorities: Beneath the Surface of South Asian Participation. York: Joseph Rowntree Foundation.Google Scholar
Butt, J. and O'Neil, A. (2004). “Let's Move on.” Black and Minority Ethnic Older People's Views on Research Findings. York: Joseph Rowntree Foundation.Google Scholar
Cambridge, J., Singh, S. P. and Johnson, M. (2012). The need for measurable standards in mental health interpreting: a neglected area. The Psychiatrist, 36, 121–124. doi:10.1192/pb.bp.110.031211.CrossRefGoogle Scholar
Centre for Community Mental Health (2008). Irish Mental Health in Birmingham: What is Appropriate and Culturally Competent Primary Care? Available at: http://www.bcu.ac.uk/_media/docs/ccmh_imh_full_report.pdf; last accessed 4 October 2012.Google Scholar
Chau, R. C. M. (2007). The Involvement of Chinese Older People in Policy and Practice. Aspirations and Expectations. York: Joseph Rowntree Foundation.Google Scholar
Cooper, C., Tandy, A. R., Balamurali, T. B. S. and Livingston, G. (2010). A systematic review and meta-analysis of ethnic differences in use of dementia treatment, care, and research. American Journal of Geriatric Psychiatry, 18, 193–203.CrossRefGoogle ScholarPubMed
Dementia Plus (2001). Twice a Child. Available at: http://www.dementiauk.org/assets/files/info_and_support/docs_and_reports/twice-a-child.pdf; last accessed 19 January 2012.Google Scholar
Dementia Plus (2003). Twice a Child II. Available at: http://www.dementiauk.org/assets/files/info_and_support/docs_and_reports/twice-a-child-2.pdf; last accessed 19 January 2012.Google Scholar
Department of Health (1999). National Service Framework for Mental Health. Modern Standards and Service Models. Available at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4077209.pdf; last accessed 6 February 2012.Google Scholar
Department of Health (2001). National Service Framework for Older People. Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4003066; last accessed 6 February 2012.Google Scholar
Department of Health (2005). Delivering Race Equality in Mental Health Care: An Action Plan for Reform Inside and Outside Services and the Government's Response to the Independent Inquiry into the Death of David Bennett. Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4100773; last accessed 6 February 2012.Google Scholar
Department of Health/Care Services Improvement Partnership (2005). Everybody's Business. Integrated Mental Health Services for Older Adults: A Service Development Guide. Available at: http://www.nmhdu.org.uk/our-work/mhep/later-life/everybodys-business/; last accessed 26 July 2012.Google Scholar
El Ansari, W., Newbigging, K., Roth, C. and Malik, F. (2009). The role of advocacy and interpretation services in the delivery of quality healthcare to diverse minority communities in London, United Kingdom. Health and Social Care in the Community, 17, 636–646.CrossRefGoogle ScholarPubMed
Faculty of the Psychiatry of Learning Disability Working Group (2011). Minority Ethnic Communities and Specialist Learning Disability Services. Available at: http://www.rcpsych.ac.uk/pdf/FR_LD_2%20for%20web.pdf; last accessed 1 August 2012.Google Scholar
Ferri, C. P.et al. (2005). Global prevalence of dementia: a Delphi consensus study. The Lancet, 366, 2112–2117. doi:10.1016/s0140-6736(05)67889-0.CrossRefGoogle ScholarPubMed
Gibson, G. (1972). Explanatory models and strategies for social change in health care behavior. Social Science and Medicine, 6, 635.CrossRefGoogle Scholar
Hipwell, A., Hicks, L., Juttla, H., Pearson, L. and Benbow, S. M. (2006). Meeting the needs of Asian elders with dementia. Journal of Dementia Care, 14, 14, 16.Google Scholar
Horn, C., Markey, H. and Bracher, M. (2007). Report of the Community Led Research Project Focussing on the Mental Health Needs of the Older Irish Adults Community in Birmingham. Available at: http://www.nmhdu.org.uk/silo/files/report-of-the-community-led-research-birmingham.pdf; last accessed 4 October 2012.Google Scholar
Iliffe, S. and Manthorpe, J. (2004). The debate on ethnicity and dementia: from category fallacy to person-centred care? Aging and Mental Health, 8, 283–292. doi:10.1080/13607860410001709656.CrossRefGoogle ScholarPubMed
Jang, Y., Chiriboga, D. A., Kim, G. and Phillips, K. (2008). Depressive symptoms in four racial and ethnic groups. Research on Aging, 30, 488–502. doi: 10.1177/0164027508316617.CrossRefGoogle Scholar
Jutlla, K. and Moreland, N. (2007). Twice a Child III. Available at: http://www.dementiauk.org/assets/files/info_and_support/docs_and_reports/twice-a-child-3.pdf; last accessed 19 January 2012.Google Scholar
Katbamna, S. and Matthews, R. (2007). Ageing and Ethnicity in England. A Demographic Profile of BME Older People in England. Available at: http://www.ageuk.org.uk/documents/en-gb/for-professionals/equality-and-human-rights/419_0207_ageing_and_ethnicity_in_england_a_demographic_profile_of_bme_older_people_in_england_2007_pro.pdf?dtrk=true; last accessed 3 August 2012.Google Scholar
Kaur, H., Jutlla, K., Read, K. and Moreland, N. (2010). How a link nurse ensured equal treatment for people of Asian origin with dementia. Nursing Times, 106, 12–15.Google ScholarPubMed
Kendall, J. and Kohler, I. (2010). Bringing dementia out of the shadows for BME elders. Journal of Dementia Care, 18, 16–17.Google Scholar
Koehn, S. (2009). Negotiating candidacy: ethnic minority seniors’ access to care. Ageing and Society, 29, 585–608.CrossRefGoogle ScholarPubMed
Lane, P. and Hearsum, S. (2007). The Mental Health and Well Being of Black and Minority Ethnic Elders: A Foundational Report on the Research Literature and a Mapping of National Resources. Available at: http://www.nmhdu.org.uk/silo/files/bme-report.pdf; last accessed 3 August 2012.Google Scholar
Lindesay, J., Jagger, C., Hibbett, M. J., Peet, S. M. and Moledina, F. (1997a). Knowledge, uptake and availability of health and social services among Asian Gujarati and white elderly persons. Ethnicity and Health, 2, 59–69. doi:10.1080/13557858.1997.9961815.CrossRefGoogle ScholarPubMed
Lindesay, J., Jagger, C., Mlynik-Szmid, A., Sinorwala, A., Peet, S. and Moledina, F. (1997b). The mini-mental state examination (MMSE) in an elderly immigrant Gujarati population in the United Kingdom. International Journal of Geriatric Psychiatry, 12, 1155–1167.3.0.CO;2-E>CrossRefGoogle Scholar
Livingston, G., Leavey, G., Kitchen, G., Manela, M., Sembhi, S. and Katona, C. (2001). Mental health of migrant elders – the Islington study. The British Journal of Psychiatry, 179, 361–366. doi:10.1192/bjp.179.4.361.CrossRefGoogle ScholarPubMed
Manthorpe, J. and Hettiaratchy, P. (1993). Ethnic Minority Elders in the UK. International Review of Psychiatry, 5, 171–178. doi:10.3109/09540269309028308.CrossRefGoogle Scholar
Matthews, Z. (2008). The health of Gypsies and Travellers in the UK. Better Health Briefing 12. London: Race Equality Foundation.Google Scholar
McCracken, C. F.et al. (1997). Prevalence of dementia and depression among elderly people in black and ethnic minorities. The British Journal of Psychiatry, 171, 269–273. doi:10.1192/bjp.171.3.269.CrossRefGoogle ScholarPubMed
Mechanic, D. (1978). Medical Sociology: A Comprehensive Text, 2nd ed. New York: Free Press.Google Scholar
Meri Yaadain (2009). The Meri Yaadain Project. Available at: http://www.meriyaadain.co.uk/about_meri_yaadain_project.html; last accessed 3 August 2012.Google Scholar
Mir, G., Nocon, A., Ahmad, W. and Jones, L. (2001). Learning Difficulties and Ethnicity Report to the Department of Health. London: Department of Health.Google Scholar
Mukadam, N., Cooper, C. and Livingston, G. (2011). A systematic review of ethnicity and pathways to care in dementia. International Journal of Geriatric Psychiatry, 26, 12–20. doi:10.1002/gps.2484.CrossRefGoogle ScholarPubMed
National Audit Office (2007). Improving Services and Support for People with Dementia. Available at: http://www.nao.org.uk/publications/0607/dementia_services_and_support.aspx; last accessed 3 August 2012.Google Scholar
National Mental Health Development Unit (n/d). A National Mapping of Projects for BME Elders to Support Their Mental Health Well‐Being. Available at: http://www.nmhdu.org.uk/silo/files/bme-national-mapping.pdf; last accessed 3 August 2012.Google Scholar
Office for National Statistics (2011). Population Estimates by Ethnic Group (Experimental), Mid-2009. Statistical Bulletin. Available at: http://www.ons.gov.uk/ons/rel/peeg/population-estimates-by-ethnic-group-experimental-/current-estimates/index.html; last accessed 3 August 2012.Google Scholar
Parker, C. and Philp, I. (2004). Screening for cognitive impairment among older people in black and minority ethnic groups. Age and Ageing, 33, 447–452.CrossRefGoogle ScholarPubMed
Rait, G., Burns, A. and Chew, C. (1996). Age, ethnicity, and mental illness: a triple whammy. BMJ, 313, 1347–1348. doi: 10.1136/bmj.313.7069.1347.CrossRefGoogle ScholarPubMed
Ramsey, V., Stevens, S., Bryan, K., Binder, J. and Cockle-Heame, J. (2009). Using the Barnes Language Assessment with older ethnic minority groups. International Journal of Geriatric Psychiatry, 24, 426–431.CrossRefGoogle ScholarPubMed
Redelinghuys, J. and Shah, A. (1997). The characteristics of ethnic elders from the Indian subcontinent using a geriatric psychiatry service in West London. Aging and Mental Health, 1, 243–247. doi:10.1080/13607869757137.CrossRefGoogle Scholar
Richards, M.et al. (2000). Cognitive function in UK community-dwelling African Caribbean and white elders: a pilot study. International Journal of Geriatric Psychiatry, 15, 621–630.3.0.CO;2-4>CrossRefGoogle ScholarPubMed
Royal College of Psychiatrists (2009). CR156. Psychiatric Services for Black and Minority Ethnic Older People. Available at: http://www.rcpsych.ac.uk/publications/collegereports/cr/cr156.aspx; last accessed 3 August 2012.Google Scholar
Royal College of Psychiatrists (2011). The Equality Act and Adult Mental Health Services: Achieving Non-Discriminatory, Age-Appropriate Services. Joint Guidance from the Royal College of Psychiatrists’ Faculties of Old Age and General and Community Psychiatry. Occasional Paper 82. Available at: http://www.rcpsych.ac.uk/files/pdfversion/OP82.pdf; last accessed 3 August 2012.Google Scholar
Sayed, A. (2008). Good Practice Case Study “Are you really listening”? Available at: http://www.healthscotland.com/uploads/documents/15972-Are you really listening-case study.PDF; last accessed 3 August 2012.Google Scholar
Scheppers, E., van Dongen, E., Dekker, J., Geertzen, J. and Dekker, J. (2006). Potential barriers to the use of health services among ethnic minorities: a review. Family Practice, 23, 325–348. doi:10.1093/fampra/cmi113.CrossRefGoogle Scholar
Seabrooke, V. and Milne, A. (2009). Early intervention in dementia care in an Asian community. Lessons from a dementia collaborative project. Quality in Ageing, 10, 29–36.CrossRefGoogle Scholar
Shah, A. (2007). Demographic changes among ethnic minority elders in England and Wales: implications for development and delivery of old age psychiatry services. International Journal of Migration, Health and Social Care, 3, 22–32.CrossRefGoogle Scholar
Shah, A. (2008). Estimating the absolute number of cases of dementia and depression in the black and minority ethnic elderly population in the United Kingdom. International Journal of Migration, Health and Social Care, 4, 4–15.CrossRefGoogle Scholar
Shah, A. and Elanchenny, N. (2002). Dementia services for ethnic minority elders with dementia. In Benson, S. (ed.), Dementia Topics for the Millennium and Beyond (pp. 27–35). London: Hawker Publications.Google Scholar
Shah, A. and MacKenzie, S. (2006). Disorders of ageing cross cultures. In Bhugra, D. (ed.), Textbook of Cultural Psychiatry. Cambridge: Cambridge University Press.Google Scholar
Shah, A. K. and Oommen, G. (2006). Designing and delivering culturally appropriate mental health services for older people. In Moodley, P. and Williams, R. (eds.), A Manual to Support Training in Cultural Capability. London: Gaskell.Google Scholar
Shah, A., Lindesay, J. and Jagger, C. (1998). Is the diagnosis of dementia stable over time among elderly immigrant Gujaratis in the United Kingdom (Leicester)? International Journal of Geriatric Psychiatry, 13, 440–444.3.0.CO;2-W>CrossRefGoogle ScholarPubMed
Silveira, E. and Ebrahim, S. (1995). Mental health and health status of elderly Bengalis and Somalis in London. Age and Ageing, 24, 474–480. doi:10.1093/ageing/24.6.474.CrossRefGoogle Scholar
Silveira, E. R. T. and Ebrahim, S. (1998). A comparison of mental health among minority ethnic elders and whites in East and North London. Age and Ageing, 27, 375–383. doi:10.1093/ageing/27.3.375.CrossRefGoogle Scholar
SubCo Trust Ltd. (2007). Reach Out to Elders Report. Research Project Focussing on Asian Elders Views of Services in Newham. Available at: http://www.aseg72.dsl.pipex.com/subco trust reach out to elders.pdf; last accessed 5 October 2012.Google Scholar
Suchman, E. A. (1965). Social patterns of illness and medical care. Journal of Health Human Behaviour, 6, 2–16.CrossRefGoogle ScholarPubMed
Tribe, R. (2009). Working with interpreters in mental health. International Journal of Culture and Mental Health, 2, 92–101. doi: 10.1080/17542860903115976.CrossRefGoogle Scholar
Tribe, R., Lane, P. and Heasum, S. (2009). Working towards promoting positive mental health and well-being for older people from BME communities. Working with Older People, 13, 35–40.CrossRefGoogle Scholar
Vulpiani, P., Comelles, J. M. and van Dongen, E.(eds.), (2000). Health for All, All in Health. European Experiences on Health Care for Migrants. Perugia: Cidis/Alisei.Google Scholar
Westminster Advocacy Service for Senior Residents/Dementia Advocacy Network (2009). Bringing Dementia Out of the Shadows for BME Elders. A Report on the Work of the Ethnic Minorities Dementia Advocacy Project (EMDAP). Available at: http://dan.advocacyplus.org.uk/data/files/publications/EMDAP_Report_PDF.pdf; last accessed 3 August 2012.Google Scholar
Yu, W. K. (2000). Chinese Older People. A Need for Social Inclusion in Two Communities. Bristol: Policy Press.Google Scholar