Children from different ethnic groups start life largely on a level playing field in terms of their mental health and wellbeing[1]. However, there is evidence of longstanding and persistent mental health inequalities affecting young people from some BME communities as they transition into adult years.
For example, historically African-Caribbean men have been over represented in the most restrictive forms of psychiatric care in the UK. Young African men are also more likely to enter mental health services via criminal justice routes such as courts or the police, rather than through primary care services, which is the most common way to access treatment. Despite longitudinal studies showing that African-Caribbean boys do not have higher levels of diagnosable conduct problems than other children in the UK[2], they remain more likely to be excluded from school, to end up in Local Authority Care and to end up in the criminal justice system[3]. As prevalence studies indicate, as young adults they are at greater risk of having severe PTSD symptoms than their contemporaries and are more likely to present with symptoms of very severe illness such as psychosis[4].
The reasons for this persistent pattern of over representation are complex and linked to a range of factors including:
- Institutional racism
- Stereotyping and misreading of diverse social cues by frontline professionals
- Generally higher levels of economic hardship experienced by African-Caribbean communities (there is a strong link between prolonged deprivation and higher prevalence rates of mental illness)
- Fear and suspicion among African-Caribbean communities about statutory services – particularly mental health services
- Lack of availability of culturally competent acceptable and services
- Higher levels of stigma and shame associated with mental illness
- Lower rates of help seeking even than other young men (mental health literacy and help seeking are generally far lower amongst males). This in turn limits opportunities for early intervention.
Any strategy to effect change in this area will need to be multi-faceted, addressing the range of risk factors driving poorer mental health as well as the range of service responses that lead to over representation in some areas of the system.
The Centre is working in partnership with The Integrate Movement (TIM) and Mind on one particular area of risk affecting worse outcomes for young African-Caribbean men. Through evaluation, we aim to support the development of three innovative bottom-up projects in the Birmingham area called the ‘Up My Street’ Projects With co-production with young men at their heart, these projects seek to open up an early non stigmatising dialogue on Young African-Caribbean male mental health and support resilience.
The “Up My Street” project
The Birmingham ‘Up My Street’ Projects are being taken forward by three local Birmingham organisations – First Class Legacy, the Birmingham Repertory and St. Basils group of hostels in the “Up My Street” project.
They aim to support Young African-Caribbean men who are between the ages of 15-25 by building their resilience. Specifically, the projects aim to increase their wellbeing, the extent to which they feel socially supported and problem solving and goal setting skills. They also aim to engage with local African Caribbean communities to support an open and less stigmatising dialogue on the importance of resilience and support for young male mental health.
TIM’s “Streetherapy” approach and training is being used to develop local skills and support change. Youth co-production is at the heart of TIM’s approach and it has recruited and trained Up My Street frontline practitioners leading the three local projects. Each of these frontline workers has chosen a different way to implement the resilience and ‘Streetherapy’ approach in. First Class Legacy are using social media, music production and black history to address and open up the issue of resilience and mental health, the Birmingham Repertory Theatre are using drama and theatre productions, and St. Basils are focusing on Black history.
The underlying principles of Streetherapy are that activity is co-produced with young people, is non-judgmental and actively reaches out to underserved young people.
How does Centre for Mental Health fit in?
Through action research, Centre for Mental Health is exploring emerging learning from these projects including:
- Whether TIM’s Streetherapy approach is relevant and appropriate for other underserved groups with higher mental health prevalence needs such as Young African Caribbean men
- How TIM’s approach builds on local ‘bottom up’ learning and developments
- How each Up My Street project’s theory of change operates and to what extent activity meets its desired outcomes
- What young people and local communities think of the Up My Street initiatives
- How helpful practitioners find the TIM and Mind training and approaches
- What implications emerge from this activity for national learning and for sustainability
Learning is being drawn together through collecting and analysing a range of data over 18 months. The Centre with gather quantitative data (pre and post use of the Mind resilience tools (Robinson, 2014)) and qualitative data (participant observation, semi structured interviews). The aim at the end of this period is to develop a clearer Theory of Change for the bottom up development of what works to support resilience, early intervention and to prevent mental health crises among young African-Caribbean men in England.
This project is proudly supported by Comic Relief.
If you have any questions about this research or the activities it involves please contact Lorraine Khan at lorraine.khan@centreformentalhealth.org.uk.
[1] Weisz, et al., 1997
[2] Gutman, Parsonage & Schoon, 2015
[3] (Afiya Trust, 2011)
[4] (McManus, Meltzer, Traolach, Bebbington, & Jenkins, 2009)
