Counselling services should not be 'one size fits all,' say experts

by NADEEM BADSHAH

MENTAL HEALTH services need to be overhauled after figures showed south Asians were among the least likely to show improvement from NHS treatment, experts have urged.

The highest rate of improvement was shown by white men with anxiety and depression at 66.5 per cent, while patients of Asian origin had the lowest rate at 61.5 per cent, according to government data. Among minorities, 8.6 per cent of British Bangladeshi patients showed a “deterioration” in their condition, the highest percentage for any ethnic group.

Campaigners have called for counselling services to be tailored to ethnic minorities and community leaders to do more to encourage people suffering in silence to seek support as Mental Health Awareness Week (May 13-19) is marked.

Balraj Purewal, director of the Asian Health Agency, told Eastern Eye: “The idea of talking therapies (is something) we don’t connect with it culturally. It’s taboo.

“The idea of talking about issues to a professional whom you don’t know is difficult, particularly for some women. We need to sow those seeds so people are encouraged to recognise what is happening and take steps to seek support.”

He added: “The professionals are trained in ‘white models’. This approach is hit and miss, it is not accessible. It ought to be done in community centres and faith centres. BAME organisations and communities need to raise the issue of mental health to encourage people.

“Mainstream organisations (also) need to engage with BAME communities. In between the six NHS counselling sessions you are offered, where do these people go?”

NHS figures published in March also showed that among women patients in England, the ethnic groups most likely to feel worse after therapy were Bangladeshi (9.4 per cent) and Pakistani (8.1 per cent) females.

Previous research has shown south Asian women are two and-a-half times more likely than white women to take their own lives.

Dinesh Bhugra is professor of mental health and diversity at the Institute of Psychiatry at King’s College London. He told Eastern Eye:  “The findings confirm that one size does not fit all.

“Therapists, in particular, and the NHS, in general, need to be culturally competent where they are able to understand variations in approaches and tailor their therapies accordingly.

“Anxiety can have multiple causes and can also present in different ways, especially in symptoms and metaphors. [For instance] when a Punjabi woman presents with her ‘heart sinking’, that has to be understood in a different way than when people present with butterflies in their stomach.

“In some cases, meditation, music, physical exercise may need to be ‘prescribed’ in addition to therapies.”

Research carried out by the Rethink Mental Illness charity into attitudes towards mental illness in the south Asian community in

Harrow, in north London, found that barriers included feelings of shame or fear around conditions including anxiety.

In addition, the causes of mental illnesses are often misunderstood and there were also concerns about marriage prospects being damaged if a person opened up to relatives or friends.

Geoff Heyes is head of health policy and influencing at the Mind charity. He said: “These figures highlight the importance of services responding to the varied cultural needs of the people they are seeking to support.

“Discussing your mental health with a clinician can be a deeply difficult conversation that is made even harder when services don’t understand cultural or language needs an individual may have. This can be a serious obstacle to people getting the right support.

“As local areas begin planning health priorities for the next 10 years as part of the NHS Long Term Plan, they must do so with an understanding of the needs of all parts of their local communities. Culturally appropriate services are essential to make sure everyone can engage meaningfully with services, play an active role in their care, and avoid reaching crisis point.”

Health services bosses believe using digital platforms, including text messages and video conferencing in therapy, can help more ethnic minorities to seek help.

Esther Schmidt, the NHS children’s services commissioning lead in Swindon, Wiltshire, said anonymised online services “seem to reach some people from BAME and minority groups in a way that face-to-face services probably wouldn’t because of stigma around cultural assumptions of mental health”.

These services “will become an increasing part of treatment, especially for places with geographical challenges”, Schmidt added.