Inequalities in Mental Health Service Provision

Question 1

how many to black caribbean make up of the population in Tower Hamlets but how many mental health service registrations do they make up

Answer 1

• make up 10-15% of the population.

- but make up 52% of the registrations in mental health services

Question 2

What factors lead to mental health inequalities

Answer 2

Material inequality - poverty, poor housing, lack of employment opportunities.

Social inequality and injury - stigma and discrimination or experiences related to:

• living in care
• immigration status
• ethnicity
• sexual orientation
• disability
• experience of violence or abuse.

Health inequality - including having long-term physical health conditions

Question 3

what are the types of inequalities are there in tower hamlets

Answer 3

Lack of access to high quality medical care

Food deserts in poor neighbourhoods

Exposure to environmental toxins

High rates of incarceration

Experiencing the stress of racial discrimination

Question 4

what does racism and racial discrimination in the NHS lead to

Answer 4

• disparity in access to and experiences of various areas of psychiatric care including crisis care, admissions, detentions, pathways into care
• although black british adults had the highest mean score for severity of mental health symptoms they were the least likely to receive treatment for mental illness

Question 5

What is structural racism

Answer 5

The macro-level systems that create, sustain, and reinforce inequities among racial and ethnic groups

Question 6

What are the forms of structural racism

Answer 6

• social segregation
• disproportionate criminalization
• unequal resources
• inequalities in access to high quality personalised HIV care which are overlapping and mutually reinforcing

Question 7

how many children from BAME backgrounds are in youth justice systems

Answer 7

over 40% in youth justice system are from BAME backgrounds & more than 1/3 have a diagnosed mental health problem

Question 8

who is more likely to be picked up in terms of mental health when arrested

Answer 8

• BAME groups are more likely to be diagnosed with a mental health condition when they are arrested
• Diagnosis and arrest go together

Question 9

What are ethnic minority people more likely to report in comparison to white British people

Answer 9

• adverse, harsh, or distressing mental health experiences and poorer outcomes
• issues are persistant and driven by societal disadvantage and institutional and interpersonal racism

Question 10

How long have ethnic inequalities in mental health care systems been documented for

Answer 10

at least 3 decades
these include
- compulsory admission and treatment (sectioning)
- being subjected to forcible treatment, seclusion and restraint

Question 11

What is an explanation for the adverse experiences felt in mental health

Answer 11

One set of explanations is based on the notion of structural racism and institutional racism.

This means the way that institutions, such as health agencies, organise practices, policies and priorities, reflect and replicate power dynamics in broader society.

This then has an adverse effect on ethnic minority groups compared to White majority groups

Question 12

what are the consequences for the lack of recognition and awareness of the role of racism in mental health care

Answer 12

• lack of ability to access appropriate therappy at a time they need
• stigmatising
• ## experience of not being heard, mistrusted or being treated with hostility are commonly expressed

Question 13

What is the life expectancy of a homeless person

Answer 13

Life expectancy for a homeless person is currently 47 years for men and 44 years for women.

Question 14

What do homeless people find difficult to access

Answer 14

Homeless persons often find it hard to access primary health care which results in homeless people being 60 times more likely to visit Accident and Emergency departments compared to the rest of the population.

Question 15

what factors lead to homelessness (Bramley and fitzpatrick)

Answer 15

• Individualistic - explanations focus on personal vulnerabilities and behaviours of homeless people such as mental health and addictions
• structural explanations - housing, market conditions, poverty and unemployment

Conflate individualistic explanations with personal agency - person has no control over there situation

Question 16

what is the interrelationship between poverty and domestic violence a key trigger for

Answer 16

Interrelationship between poverty and domestic violence which in turn is a key trigger for homelessness amongst women and children.

Question 17

in terms of well developed countries what is homelessness like

Answer 17

Countries with benign social and economic conditions – well functioning housing and labour markets and generous social security policies – will have a low overall prevalence of homelessness, but that a high proportion of their (relatively) small homeless populations will have complex personal problems

Question 18

how do welfare regimes impact on homelessness

Answer 18

impact on the scale, causes and nature of homelessness

Question 19

According to the scottish household survey

Answer 19

Demographics – accounts for <2% of variance; females greater risk, ‘other’ ethnicity

Childhood Poverty – single largest contributor – 52% variance

Geographical factors – rural, housing pressures, 6% of variance

Teenage experiences – not living with both parents, excluded from school, serious drug use, ever in care, mother’s mental state; moderate level of explanation of 15%

Adult Economic Situation – unemployment, rented housing 16% variance

Adult family & life events – lack of relationships, long term illness/disability, can trigger or reinforce poverty, accounts for 11% of variance

Question 20

What is the biggest predictor of homelessness

Answer 20

Poverty

- homelessness can also reinforce adult vulnerability to poverty

Question 21

What is co-production

Answer 21

Co-production means delivering public services in an equal and reciprocal relationship between professionals, people using services, their families and neighbours; recognising people as assets

Question 22

What is synergi collaborative

Answer 22

an independent centre of excellence on ethnic inequalities, severe mental illness and multiple disadvantage.

Question 23

What does synergi do

Answer 23

Invest in infrastructure

Invest in relational roots

Devolving decisions

Access through clear roads, bolt on/off bridges, and tunnels

Who’s got power?

Enable safe spaces for dialogue & negotiation, or creative spaces for relational & network actions on health systems

What is the offer we make to this community?

Question 24

What does syndemic suffering apply to

Answer 24

Syndemic suffering applies to the clustering of poverty, homelessness, discrimination, mental health issues and (lack of) family support.