LITERATURE REVIEW - EXECUTIVE SUMMARY

1. The purpose of the review is to write a piece of written work that summarises previous findings in this topic area. This is a scoping exercise and not a systematic review.
   
2. It should reflect knowledge and interpretations of the subject area, summing up the main arguments, criticisms and evaluating those studies
   
3. It has a reference / bibliography section which lists all the work reviewed

How the review was conducted

This included a methods section, detailing how the review was conducted, such as the terms used and databases searched. The review contains:

1. Introduction;
   
2. Policy section - Welsh and English documents that are related to mental health and specifically to BME communities;
   
3. Key findings from the research;
   
4. Conclusions and recommendations.

An important componet are the problems experienced throughout this process in accessing information within the Welsh context.

The audience

The review is aimed at those individuals responsible for planning, providing and delivering services. This includes members of the National Welsh Assembly Government, those working in the NHS, social services, nursing and professional bodies, those working in primary care, the Black voluntary sector and other organisations. It is also for users, carers and other family members who are affected by their significant others being ill.

Key findings from the research

• The significance of "race" and ethnicity in assessing health needs: This is crucial to understand how it influences people's access to health care and institutions.

• Pathways into care: This includes primary and secondary services, as well as specialist services.

• Formal and informal admissions: Some admissions are voluntary but evidence suggests that amongst BME communities, they are more likely to be sectioned under the Mental Health Act.

• Problems with statistics:Statistical data suggests that BME communities are more likely to be admitted to hospital. This misrepresents illness patterns and only shows the more severe end of psychiatric illnesses.

• Psychiatric management: This involves recognition of pathology, diagnosis, therapeutic interventions.

• Health beliefs about illness, the body and medical systems: Amongst many BME communities, illness is not viewed simply as a mechanical dysfunction but incorporates mind, emotion and spiritual aspects. As a result, the body is often viewed in metaphoric terms and use of medical systems outside of biomedicine, is common place.

• Health seeking behaviours and utilization of services:Amongst BME communities, these differ and influence the uptake of services. Therefore, public health campaigns need to take into account the way that different groups seek support for their illness experiences.

• Causative factors of good and ill health:Not just pathology that affects health but environmental, socio-economic, educational and other social factors that impact the quality of peoples lives and their physical and psychological well-being.

• Outcome of illness:Amongst different BME communities, the outcome of illness differs, with recovery and relapse rates being very different. Research needs to consider why this is happening and what steps can be taken to ensure that outcome rates are more equal across the communities.

• Stigma of illness: This exists amongst all communities, regardless of ethnicity and ways of tackling this more effectively, needs to be developed. This can be done through public education that is going to be socially inclusive, is understood and accepted by all communities.

• Community capacity building initiatives and their role amongst BME communties
  These are beneficial to the BME communities but not given secure funding, so that the sustainability of community projects are constantly under threat. More emphasis needs to be given to the importance of such projects.

• Role of carers:This is a significant group whose voices need to be heard and valued. The involvement of carers is still lacking and their significance in caring for their family members is not properly recognised.

Recommendations

We are currently in the process of analysing transcripts and identifying key issues. The main areas that need to be looked at are in relation to:

• Access to services and how to improve this;
  
• Access to information;
  
• Access to different therapeutic interventions and their availability;
  
• Interventions that address the needs of specific groups within those communities
  
• Need for sensitive services;
  
• Capacity building between community groups and those that address the needs of people experiencing illness.

Kalbir Kaur Mann
4 November 2003