✅ L11 - Diversity and Difference in mental health

Question 1

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

Answer 1

1. Being sensitive to diversity: understanding the unique experience, beliefs & values of those from diverse backgrounds.
2. Understanding diversity: Recognising that mental health challenges and their impact can differ due to different backgrounds.
3. Personalising practice: Recognising and incorporating preferences in services.
4. Improving services: Recognising / respecting diversity in mental health care leads to:
   - Increased help-seeking (minority groups).
   - More accurate assessment
   - Better engagement in intervention & outcome

Question 2

What is the UK Legislation: Equality Act about?

Answer 2

1. Individuals are afforded protection, to help achieve equal social opportunities across nine protected characteristics.
2. Aims to promote equality to disadvantaged/ under-represented groups with special needs
3. Two important implications:
   - Discrimination based on MH is an offence.
   - Equal treatment within mental health services is a legal duty and good practice

Question 3

Disadvantages in receiving mental health services for sexuality and gender identity?

Answer 3

1. Statistics:
   - 35% of gay young ppl (NOT bullied) are depressed
   - Risk of suicide among gay men is 2-4 times the general population
2. Evidence: meta-analysis of 14 studies on LGBT+ experience with MH
   - Experienced stigma and discrimination when accessing MH care
   - Professionals’ lack understanding of LGBT people’s needs

Question 4

Disadvantages in receiving mental health services for men and women (UK)?

Answer 4

1. Men’s mental health:
   - 3x more men to women die by suicide
   - 36% of referrals come from men –> gender stereotypes contribute to low help-seeking
   - 3x as likely to use drugs and alcohol
2. Women’s mental health:
   - Common MH difficulties have steadily increased for women but remain steady for men
   - 2x as likely diagnosed with anxiety
   - OCD, phobias, and PTSD more common (20.4% vs 8.1% for men)
   - Reproductive cycle affects mood (MH difficulties)

=> A need for gendered services, such as peer support / trauma programmes.

Question 5

Disadvantages in receiving mental health services for ethnic minorities (EM) in the UK?

Answer 5

1. Many EM have worse mental health compared with White British groups
   - Black men are more likely to be diagnosed with psychosis (e.g. 6-9x more risk of schizophrenia) and compulsorily admitted to hospital
   - Children from most EM backgrounds showed more MH difficulties from 3-14 years
2. However, there are within and between group differences
   - Common MH difficulties: 29% Black women vs 20.9% White British (13.5% Black men)
   - People of Indian, Pakistani and African-Caribbean origin: higher mental wellbeing
3. What affects MH among individuals from EM?
   - Racial discrimination (overt, subtle, systematic)
   - EM often face social & economic disadvantage
   - Mental health stigma
   => Also worse MH care experience, poorer treatment outcomes, and disengagement from mainstream services.

Question 6

Comparing IAPT treatment variation by ethnicity and migration in the UK?

Answer 6

1. Allowing self-referral may improve access for ethnic minorities, if access is affected by
   organizational discrimination
2. Harwood et al (2021): Compared with the White British group:
   - EM groups less likely to self-refer to IAPT, but instead referred by community services => MH difficulties may be severe then.
   - (Almost) all groups were less likely to receive an assessment and treated
   - Recovery rates rose by 6% among Black and Asian groups
3. Bhavsar et al. (2021): migrants residing in UK <10 years were less likely to use IAPT psychological treatment. => not explained by English proficiency, sociodemographic factors or migrating for asylum reasons.
4. Why?
   - Lack of information and effective communication about services
   - Stigma within the community and wider society,
   - Mistrusting professionals

Question 7

Disadvantages in receiving mental health services for socioeconomic status in the UK?

Answer 7

1. Among the lowest fifth of household income compared to the highest fifth:
   - Risk of psychotic disorders is 9x higher
   - Common MH problems is doubled
2. Complex relationship between SE disadvantage & MH
   - MH can lead to low SE (e.g. difficulties gaining employment, substance abuse, poor handling of personal finances etc.)
   - SE deprivation creates conditions of MH risk (e.g. lack of resources, high perceived crime)
3. In IAPT - More disadvantaged individuals are less likely to:
   - Be referred for treatment
   - Receive or complete treatment
4. Therapy may also be less effective for those from low SES (maybe reasons listed above)

Question 8

How does intersectionalities of all categories mentioned above contribute to MH difficulties?

Answer 8

1. Biological, social and cultural categories linked with social disadvantage often intersect or overlap
   - Part of personal/social identity
   - Disadvantage (or oppression) often comes from multiple sources
2. Across Europe (N = 40k): those belonging to more minoritised ‘categories’ have more depressive symptoms (stronger in Eastern and Southern European countries)
3. In the UK, men are less likely to seek / complete treatment for common MH difficulties, especially if they are also:
   - From EM
   - Of Muslim faith
   - Unemployed & Living in deprived neighbourhood (low SE)

Question 9

Explain what is meant by cultural competence and cultural humility? How does this relate to respecting diversity in clinical practice?

Answer 9

1. Cultural competence: the ability to understand backgrounds of the client that may differ from our own
   - Considers client’s lived experiences and their backgrounds: culture, ethnicity, SES, sexuality
   => and what they value
   - Being sensitive to the role of culture without stereotyping
2. Cultural humility: ongoing process of self-exploration with willingness to learn from others.
   - Intention of understanding and honoring clients’ beliefs, customs, and values (reflecting a specific cultural lens)
   - Understanding that culture influences help-seeking or care pathways => may bias the process of assessment and choice of management.

Question 10

Why is diversity in mental health important? What are the 2 implications?

Answer 10

1. Culturally-adapted interventions: 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.
2. People from marginalised backgrounds are under-represented in:
   - Mental health research
   - Qualitative research on lived experiences, such as experiences of recovery
   => Both of these inform policy and practice

Question 11

Summary of this lecture? (since I can’t save the Deck description)

Answer 11

1. An individual’s identity and their MH are intrinsically tied
   - Higher rates of MH difficulties in particular groups
   - Different life experiences, including discrimination and internalisation of stigma
2. Healthcare systems are part of a system that is designed for the majority
   - Systemic factors lead to unfair access and treatment
   - Actual experiences and perceptions of MH care professionals
   - IAPT has not really succeeded in improving access for under-represented ethnic groups
3. Considering diversity is critical to meeting individual’s mental health care needs:
   - Training workforce: Intersectionality, cultural competence and cultural humility
   - Tailored services: Culturally adapted interventions, gendered services, LGBTQ+ services