Diversity, Difference and Mental Health

Question 1

What do we mean by valuing diversity and difference in mental health?

List 4 points

Answer 1

1. Being sensitive to diversity
2. Understanding diversity
3. Personalising practice
4. Improving services

Question 2

1. Being sensitive to diversity
2. Understanding diversity
3. Personalising practice
4. Improving services

These are the 4 areas of…?

Answer 2

Valuing diversity and difference in mental health

Question 3

How can we be sensitive to diversity?

Answer 3

By understanding the unique experiences, beliefs, values, and perspectives of individuals from diverse backgrounds

Question 4

How can we understand diversity?

Answer 4

Recognising that mental health challenges and their impact can differ substantially depending on cultural context, socioeconomic status, ethnicity, gender, and sexual orientation

Question 5

How can we personalise practice?

Answer 5

Recognising and incorporating various cultural, social, and individual preferences in mental health services

Question 6

Recognising / respecting
diversity in mental health care leads to…?

List 3 points

Answer 6

1. Increased help-seeking among underserved groups
2. More accurate assessment
3. Better engagement in intervention, therapeutic alliance, and outcomes (positive therapeutic change)

Question 7

1. Increased help-seeking among underserved groups
2. More accurate assessment
3. Better engagement in intervention, therapeutic alliance, and outcomes (positive therapeutic change)

These are the 3 advantages of…?

Answer 7

Recognising / respecting
diversity in mental health care

Question 8

Describe the UK Equality Act 2010

Answer 8

1. Individuals are afforded protection against discrimination, harassment and victimisation
2. To help achieve equal opportunities across all aspects of society based on nine protected characteristics

Question 9

What are the 9 protected characteristics included in the Equality Act 2010?

Answer 9

1. Race
2. Disability
3. Religion or belief
4. Gender
5. Sexual orientation
6. Sex
7. Age
8. Maternity and pregnancy
9. Marriage

Question 10

What is the aim of the UK Equality Act 2010?

Answer 10

Promote equality to groups of people who may be disadvantaged or under-represented or have particular needs

Question 11

What are the 2 important implications of the UK Equality Act 2010?

Answer 11

1. Discrimination based on mental health is an offence
2. Consideration of protected characteristics and equal treatment within mental health services is a legal duty as well as good practice

Question 12

What were the 2 main themes found in a systematic review of 14 studies by Rees et al. (2020) of lesbian, gay, bisexual and transgender communities’ MH experiences?

Answer 12

1. Experienced stigma and discrimination when accessing MH care
2. Professionals’ lack knowledge and understanding of LGBT people’s needs

Question 13

List 5 ways lesbian, gay, bisexual and transgender communities experience stigma and discrimination when accessing MH care

Answer 13

1. Being positioned as different through use of heteronormative language etc.
2. Felt ignored / mistreated due to sexuality or gender identification
3. Often felt pathologized for their sexuality/gender identity and under-treated for primary mental health problems
4. Or vulnerable if sexual orientation/gender were not acknowledged
5. Some felt questions were over-intrusive

Question 14

List 2 ways professionals’ lack knowledge and understanding of LGBT people’s needs

Answer 14

1. A need for MH care that promotes equity, respect for diversity, & self-acceptance
2. A need for culturally sensitive and LGBTQ+ friendly therapists that do not pathologise sexuality or assume that MH difficulties are due to sexual identity

Question 15

What % of gay young people (who have not been bullied) are depressed?

a. 20%
b. 35%
c. 46%
d. 18%

Answer 15

b. 35%

Question 16

The risk of suicide among gay men is ____ times the general population

Answer 16

2-4 times

Question 17

The risk of suicide among _____ is 2-4 times the general population

Answer 17

Gay men

Question 18

What contributes towards worse mental health among LGBTQ+ individuals?

List 5 factors

Answer 18

1. Discrimination
2. Social status
3. Concealment
4. Stigma
5. Internalised homophobias

Question 19

Common MH difficulties have steadily increased for ___

a. Men
b. Women
c. Non-binary
d. Children

Answer 19

b. Women

Question 20

Common MH difficulties have remained steady for ____

a. Men
b. Women
c. Non-binary
d. Children

Answer 20

a. Men

Question 21

What are the 2 common MH difficulties faced by women?

Answer 21

1. Depression
2. Anxiety

Question 22

Women are ___ times as likely to be diagnosed with anxiety

Answer 22

2 times

Question 23

____ are 2x times as likely to be diagnosed with anxiety

a. Men
b. Women
c. Non-binary
d. Children

Answer 23

b. Women

Question 24

Obsessive compulsive disorder (OCD) and phobias more common among ____

a. Men
b. Women
c. Non-binary
d. Children

Answer 24

b. Women

Question 25

Post-traumatic stress disorder are more common among ____ a. Men b. Women c. Non-binary d. Children

Answer 25

b. Women

Question 26

Post-traumatic stress disorder are more common among women Why?

Answer 26

Majority of cases are due to sexual assault, which causes the trauma

Question 27

What are the 2 mental health difficulties women experience due to their reproductive cycle?

Answer 27

1. Prenatal depression 2. Menopause (anxiety, mood)

Question 28

_____ as many men as women die by suicide (linked to depression & adverse life events)

Answer 28

3x

Question 29

3x as many ____ as women die by suicide (linked to depression & adverse life events) a. Men b. Women c. Non-binary d. Children

Answer 29

a. Men

Question 30

___ % of referrals to psychological therapies in the NHS come from men

Answer 30

36%

Question 31

36% of referrals to psychological therapies in the NHS come from men What does this suggest?

Answer 31

Gender stereotypes contribute to low help seeking

Question 32

_____ ______ contribute to low help seeking

Answer 32

Gender stereotypes

Question 33

36% of referrals to psychological therapies in the NHS come from ____ a. Men b. Women c. Non-binary d. Children

Answer 33

a. Men

Question 34

___ are underrepresented in mental health services a. Men b. Women c. Non-binary d. Children

Answer 34

a. Men

Question 35

Men are underrepresented in mental health services Why?

Answer 35

Gender stereotypes Men are expected by society to not show emotions and to cope with their difficulties alone

Question 36

3x as likely to become alcohol dependent and frequently use drugs a. Men b. Women c. Non-binary d. Children

Answer 36

a. Men

Question 37

Men are ____ times as likely to become alcohol dependent and frequently use drugs

Answer 37

3 times

Question 38

More likely compulsorily detained under the Mental Health Act a. Men b. Women c. Non-binary d. Children

Answer 38

a. Men

Question 39

Describe Women's MH difficulties List 5

Answer 39

1. Common MH difficulties have steadily increased for women but remain steady for men 2. 2x as likely diagnosed with anxiety 3. Obsessive compulsive disorder (OCD) and phobias more common 4. Post-traumatic stress disorder (20.4% vs 8.1% for men) 5. Reproductive cycle: Perinatal depression, menopause (anxiety, mood)

Question 40

Describe Men's MH difficulties List 4

Answer 40

1. 3x as many men as women die by suicide (linked to depression & adverse life events) 2. 36% of referrals to psychological therapies in the NHS come from men – gender stereotypes contribute to low help-seeking 3. 3x as likely to become alcohol dependent and frequently use drugs 4. More likely compulsorily detained under the Mental Health Act

Question 41

True or False? Many minorities have worse mental health compared with White British groups

Answer 41

True

Question 42

______ individuals, esp men, are more likely to be diagnosed with psychosis (e.g. 6-9x more risk of schizophrenia) and compulsorily admitted to hospital a. Black b. White c. Asian d. Hispanic

Answer 42

a. Black

Question 43

____ individuals, esp men, are 6-9x more at risk of schizophrenia a. Black b. White c. Asian d. Hispanic

Answer 43

a. Black

Question 44

Black individuals, esp men, are 6-9x more at risk of _____

Answer 44

Schizophrenia

Question 45

Black individuals, esp men, are more likely to be diagnosed with ____ and compulsorily admitted to hospital

Answer 45

Psychosis

Question 46

Children from most ethnic minority backgrounds showed more MH difficulties from ____ years

Answer 46

3-14

Question 47

Compared to White British Individuals, which group is higher in common MH difficulties? a. Black Men b. Asian Men c. Black Women d. Asian Women

Answer 47

c. Black Women

Question 48

What 3 minority groups reported higher mental wellbeing than other minority groups?

Answer 48

1. Indian 2. Pakistani 3. African-Caribbean

Question 49

What do these 3 minority groups have in common? 1. Indian 2. Pakistani 3. African-Caribbean

Answer 49

They are minorities that reported higher mental wellbeing than other minority groups

Question 50

What affects MH among individuals from ethnic minorities? List 3 factors

Answer 50

1. Racial discrimination 2. Social and economic disadvantage 3. Mental health stigma

Question 51

How does Mental Health Stigma affect MH among individuals from ethnic minorities?

Answer 51

In certain cultures, people don't believe in mental health difficulties and discourage seeking help simply = When mental health is little recognised or shameful to discuss

Question 52

What 3 factors leads to further isolation and deterioration in MH among minority groups?

Answer 52

1. A worse MH care experience 2. Poorer treatment outcomes 3. Disengagement from mainstream services

Question 53

What do these 3 factors lead to? 1. A worse MH care experience 2. Poorer treatment outcomes 3. Disengagement from mainstream services

Answer 53

Further isolation and deterioration in MH among minority groups

Question 54

When mental health is little recognised or shameful to discuss, what does this impact?

Answer 54

Minority groups' ability and willingness to care for themselves and seek MH care

Question 55

One of the goals of ____ treatment was more equitable access to therapy

Answer 55

IAPT

Question 56

One of the goals of IAPT was ...?

Answer 56

More equitable access to therapy

Question 57

One of the goals of IAPT was more equitable access to therapy What can help achieve this?

Answer 57

Allowing self-referral (rather than being referred to by a GP)

Question 58

Allowing self-referral may improve access for ethnic minorities, if access is affected by ...?

Answer 58

Organizational discrimination

Question 59

Allowing _____ may improve access for ethnic minorities, if access is affected by organizational discrimination

Answer 59

Self-referral

Question 60

According to Harwood et al (2021), compared with the White British group, Black African, Asian and Mixed groups were less likely to ...?

Answer 60

Self-refer to IAPT services

Question 61

According to Harwood et al (2021), compared with the White British group, ____, ____ and ____ were less likely to self-refer to IAPT services

Answer 61

Black African, Asian and Mixed groups

Question 62

According to Harwood et al (2021), compared with the White British group, Black Caribbean, Black Other & White Other were more likely to be...?

Answer 62

Referred by community services (e.g. employment agency, voluntary organisations, criminal justice system)

Question 63

According to Harwood et al (2021), compared with the White British group, ___, ____ and ____ were more likely to be referred by community services (e.g. employment agency, voluntary organisations, criminal justice system)

Answer 63

Black Caribbean, Black Other & White Other

Question 64

Black Caribbean, Black Other & White Other were more likely to be referred by community services (e.g. employment agency, voluntary organisations, criminal justice system) What are the implications of this?

Answer 64

MH difficulties may be severe by the time they are seen

Question 65

MH difficulties may be severe by the time they are seen for Black Caribbean, Black Other & White Other Why?

Answer 65

Because these groups are more likely to be referred by community services (e.g. employment agency, voluntary organisations, criminal justice system)

Question 66

According to Harwood et al (2021), compared with the White British group, all or almost all minority groups were ...?

Answer 66

Less likely to receive an assessment and treated

Question 67

According to Harwood et al (2021), compared with the White British group, ___ were less likely to receive an assessment and treated

Answer 67

All or almost all minority groups

Question 68

According to Harwood et al (2021), compared with the White British group, recovery rates rose by 6% among ____ and _____ groups

Answer 68

Black and Asian groups

Question 69

According to Harwood et al (2021), compared with the White British group, recovery rates rose by ____% among Black and Asian groups

Answer 69

6%

Question 70

According to Bhavsar et al. (2021), compared to non-migrants, migrants residing in UK <10 years were less likely to use _____ treatment

Answer 70

IAPT psychological treatment

Question 71

According to Bhavsar et al. (2021), compared to non-migrants, migrants residing in UK <10 years were less likely to use IAPT psychological treatment, and this was not explained by ___, ____ and ____ List 3 factors

Answer 71

1. English proficiency 2. Sociodemographic factors 3. Migrating for asylum reasons

Question 72

According to Bhavsar et al. (2021), compared to non-migrants, migrants residing in UK <10 years were less likely to use IAPT psychological treatment What 3 factors can help explain these findings?

Answer 72

1. Lack of information and effective communication about services 2. Stigma within the community and wider society 3. Mistrust trust of professionals

Question 73

Among the lowest fifth of household income compared to the highest fifth, the risk of ____ is 9x higher

Answer 73

Psychotic disorders

Question 74

Among the lowest fifth of household income compared to the highest fifth, the risk of psychotic disorders is ___ times higher

Answer 74

9 times

Question 75

Among the lowest fifth of household income compared to the highest fifth, _____ is doubled

Answer 75

Common mental health problems

Question 76

Among the lowest fifth of household income compared to the highest fifth, common mental health problems is ____

Answer 76

Doubled

Question 77

True or False? There is a complex relationship between Socioeconomic disadvantage and MH

Answer 77

True

Question 78

List 2 reasons why there is a complex relationship between Socioeconomic disadvantage and MH

Answer 78

1. MH can lead to difficulties gaining employment, substance abuse, poor handling of personal finances etc. 2. Socioeconomic deprivation creates conditions of MH risk due to lack of resources, but also low social trust in area / high perceived crime

Question 79

Socioeconomic deprivation creates conditions of MH risk due to ...? List 3 factors

Answer 79

1. Lack of resources 2. Low social trust in area 3. High perceived crime in area

Question 80

In IAPT, more socioeconomically disadvantaged individuals are less likely to...? List 2 points

Answer 80

1. Be referred for treatment 2. Receive or complete treatment

Question 81

Therapy may also be less effective for those from low socioeconomic backgrounds Why?

Answer 81

Because of the multiple factors that might be affecting engagement in the process and/or one's MH e.g. someone who works 2 jobs have multiple stressors in their life, not enough time to get adequate MH care

Question 82

Multiple factors that might be affecting engagement in the process and/or one's MH e.g. someone who works 2 jobs have multiple stressors in their life, not enough time to get adequate MH care What is the result of this?

Answer 82

Therapy is likely to be less effective for those from low socioeconomic backgrounds

Question 83

According to Alvarez-Galvez & Rojas-Garcia (2019), those belonging to more minoritised ‘categories’ have more depressive symptoms This effect is stronger in which countries?

Answer 83

Eastern and Southern European countries

Question 84

Those belonging to more minoritised ‘categories’ have more _____ symptoms, an effect that is stronger in Eastern and Southern European countries

Answer 84

Depressive

Question 85

In the UK, men are less likely to seek / complete treatment for ...?

Answer 85

Common MH difficulties

Question 86

In the UK, ____ are less likely to seek / complete treatment for common MH difficulties a. Men b. Women c. Non-binary d. Children

Answer 86

a. Men

Question 87

In the UK, men are less likely to seek / complete treatment for common MH difficulties This is especially true if they are from ...? List 4 groups

Answer 87

1. From minoritised ethnic background 2. Of Muslim faith 3. Unemployed 4. Living in deprived neighbourhood

Question 88

Various biological, social and cultural categories that are linked with social disadvantage/oppression often intersect or overlap What does this suggest?

Answer 88

Disadvantage (or oppression) often comes from multiple sources, not just one

Question 89

Define cultural competence

Answer 89

The ability to understand the beliefs, backgrounds, and values of the client that may differ from our own

Question 90

The ability to understand the beliefs, backgrounds, and values of the client that may differ from our own This is known as...?

Answer 90

Cultural competence

Question 91

Define Cultural Humility

Answer 91

An ongoing process of self- exploration and self-critique combined with a willingness to learn from others

Question 92

An ongoing process of self- exploration and self-critique combined with a willingness to learn from others This is known as...?

Answer 92

Cultural humility

Question 93

List 3 ways we can practice cultural competence in MH

Answer 93

1. Consider client’s lived experiences and their social and cultural contexts: culture, race, ethnicity, SES, and sexuality 2. ‘Seeing’ all aspects of the client and taking into account the things that they value 3. Being sensitive to the role of culture without stereotyping

Question 94

List 3 ways we can practice cultural humility in MH

Answer 94

1. Entering a relationship with the intention of honouring their beliefs, customs, and values 2. Understand own beliefs, background and values as reflecting a specific cultural lens 3. Understanding that culture influences help-seeking or care pathways; may bias the process of assessment and choice of management of MH care

Question 95

Entering a relationship with the intention of honouring their beliefs, customs, and values What does this statement apply to? a. Cultural humility b. Cultural competence c. Neither d. Both

Answer 95

a. Cultural humility

Question 96

Considers client’s lived experiences and their social and cultural contexts: culture, race, ethnicity, SES, and sexuality What does this statement apply to? a. Cultural humility b. Cultural competence c. Neither d. Both

Answer 96

b. Cultural competence

Question 97

‘Seeing’ all aspects of the client and taking into account the things that they value What does this statement apply to? a. Cultural humility b. Cultural competence c. Neither d. Both

Answer 97

b. Cultural competence

Question 98

Understand own beliefs, background and values as reflecting a specific cultural lens What does this statement apply to? a. Cultural humility b. Cultural competence c. Neither d. Both

Answer 98

a. Cultural humility

Question 99

Understanding that culture influences help-seeking or care pathways; may bias the process of assessment and choice of management of MH care What does this statement apply to? a. Cultural humility b. Cultural competence c. Neither d. Both

Answer 99

a. Cultural humility

Question 100

Being sensitive to the role of culture without stereotyping What does this statement apply to? a. Cultural humility b. Cultural competence c. Neither d. Both

Answer 100

b. Cultural competence

Question 101

Define culturally-adapted interventions

Answer 101

The systematic modification of a mental health programme or treatment that considers language, culture etc. in ways that are compatible with the client’s values, cognitions etc.

Question 102

The systematic modification of a mental health programme or treatment that considers language, culture etc. in ways that are compatible with the client’s values, cognitions etc. This is known as...?

Answer 102

Culturally-adapted interventions

Question 103

People experiencing poverty, homelessness, intersecting oppressions (based e.g. on ethnicity, gender, sexuality, disability or class), and other forms of marginalisation remain highly under-represented in..? List 2 types of research

Answer 103

1. Mental health research 2. Qualitative research on lived experiences, such as experiences of recovery

Question 104

Which 3 minority groups are highly under-represented in mental health research and qualitative research on lived experiences, such as experiences of recovery?

Answer 104

1. Poverty 2. Homelessness 3. Intersecting oppressions (based e.g. on ethnicity, gender, sexuality, disability or class)

Question 105

What research informs policy and practice? List 2

Answer 105

1. Mental health research 2. Qualitative research on lived experiences, such as experiences of recovery

Question 106

1. Mental health research 2. Qualitative research on lived experiences, such as experiences of recovery These researches inform ___ and ____

Answer 106

1. Policy 2. Practice

Question 107

True or False? An individual’s identity and their mental health are intrinsically tied

Answer 107

True

Question 108

An individual’s identity and their mental health are intrinsically tied What 3 points support this claim?

Answer 108

1. Higher rates of mental health difficulties in particular groups 2. Different life experiences, including discrimination and internalisation of stigma 3. Mental health tends to affect different groups in different ways

Question 109

True or False? Healthcare systems are part of a system that is designed for the minority

Answer 109

False Healthcare systems are part of a system that is designed for the majority

Question 110

Healthcare systems are part of a system that is designed for the majority What 3 points support this?

Answer 110

1. Systemic factors lead to unfair access and treatment 2. Actual experiences and perceptions of MH care professionals (part of the system) 3. Despite attempts to improve access, IAPT has not really succeeded in doing so for under-represented ethnic groups

Question 111

True or False? Considering diversity is not a priority to meet individual’s mental health care needs

Answer 111

False Considering diversity is critical to meeting individual’s mental health care needs

Question 112

Considering diversity is critical to meeting individual’s mental health care needs How can we achieve this? List 2 ways

Answer 112

1. Train workforce 2. Tailored services

Question 113

Considering diversity is critical to meeting individual’s mental health care needs List 3 ways we can train workforces

Answer 113

Train them in: 1. Intersectionality 2. Cultural competence 3. Cultural humility

Question 114

Considering diversity is critical to meeting individual’s mental health care needs List 3 types of tailored services that would be useful

Answer 114

1. Culturally adapted interventions 2. Gendered services 3. LGBTQ+ services