Mental illness in Black and Asian ethnic minorities: pathways to care and outcomes

Kamaldeep Bhui is a senior lecturer in social and epidemiological psychiatry at St Bartholomew’s and The Royal London School of Medicine and Dentistry (Queen Mary and Westfied College, Mile End Road, London E1 4NS, UK; [email protected]). He is interested in cross-cultural and epidemiological psychiatry, service development and explanatory models of illness. Dinesh Bhugra is a reader in cultural psychiatry and heads the Section of Cultural Psychiatry at the Institute of Psychiatry, London. His research interests include cultural factors in the aetiology and diagnosis of mental illness, religion, sexual dysfunction and sexual deviation. A substantial body of research indicates that, for people from Black and Asian1 ethnic minorities, access to, utilisation of and treatments prescribed by mental health services differ from those for White people (Lloyd & Moodley, 1992; for a review see Bhui, 1997). Pathways to mental health care are important, and the widely varying pathways taken in various societies may reflect many factors: the attractiveness and cultural appropriateness of services; attitudes towards services; previous experiences; and culturally defined lay referral systems (Goldberg, 1999). Contact with mental health care services may be imposed on the individual, but people who choose to engage with services usually do so only if they think that their changed state of functioning is healthrelated and potentially remediable through these services. In such cases, they will contact whoever they perceive to be the most appropriate carer, and these carers are often not part of a national health care network. The pathway to care approach focuses on the point of access to care and the integration of care by culturally diverse carers. For example, if for African– Caribbean men in crisis the most common point of access to mental health services is through the police and the criminal justice systems rather than through their general practitioner (GP), then the challenge is to explore the reasons for this at the interface of these agencies. Carers include the popular and folk sectors of health care provision as well as standard primary and secondary care services and the voluntary sector. Once the range of perceived carers for a cultural group is known, these can be considered as potential sites of case identification and intervention. The development of a model for Black and Asian ethnic minorities requires that these other access points be taken into consideration.