Diversity matters: promoting greater cultural competence in mental healthcare

Mary Seacole award winner Saeideh Saeidi argues that all nurses need to understand cultural comtepence

Mary Seacole award winner Saeideh Saeidi argues that all nurses need to understand cultural competence

Saeideh Saeidi Picture: Barney Newman

All of us experience a mental health issue at some point in our lives, but what happens to those who have poor access to mental health services or to those who delay seeking help due to poor experience of care and trust in mental health services?

Research over the past 50 years and national data suggests that people from black and minority ethnic (BME) communities experience worse health outcomes, shorter life expectancy and lower levels of access to, and satisfaction with, mental health services than the rest of the population. There have been policies, initiatives and training on diversity to reduce health inequalities in BME communities, but they have not been effective.

Overrepresentation in secure settings 

Data from surveys and research studies consistently show that people from BME groups are more likely to be diagnosed with mental health problems, more likely to be admitted to hospital, and more likely to be detained compulsorily. BME individuals are 40% more likely than white British to enter mental health services through the courts or the police than from primary care. They are more likely to be detained under the Mental Health Act and are overrepresented in high and medium secure units and prisons.

BME individuals with mental health problems, particularly young black men, do not seek help at the early stage of their illness and are more likely to reach crisis point before accessing services.

In addition, BME groups are over-represented in the UK’s secondary mental health services and are often admitted into hospital through emergency services, including emergency departments, crisis teams or via the police. However, there is no evidence that BME groups have a higher biological disposition to serious mental illness.

According to the Race Disparity Audit, a significantly higher percentage of black men (3.2%) experienced a psychotic disorder in the past year than white men (0.3%), and black women (29%) were more likely to have experienced a common mental health problem, such as anxiety or depression than white women (21%) and women of other ethnicity (16%). White British adults were more likely to be receiving treatment for a mental or emotional problem than adults in other ethnic groups. Of those receiving psychological therapies, white adults experienced better outcomes than those in other ethnic groups.

Contributing factors

There are a number of factors contributing to the lack of use of mental health services at an early stage by BME groups. These include a lack of knowledge about how to navigate mental health services and/or access support, reluctance to seek help until the last minute, mental health services not being seen as helpful, the stigma attached to mental illness, a lack of trust in healthcare because of poor communication between service users and providers, and staff’s cultural insensitivity.

'Cultural competence is about applying principles of patient-centred care and asking patients about the effect of their culture on their health'

In healthcare, we work with people from diverse backgrounds and we should have knowledge of the role culture plays in the development and maintenance of an individual’s mental well-being. Cultural competence offers a framework to improve services for patients from culturally diverse backgrounds, to ensure better health outcomes and experience of care.

Cultural competence requires commitment on the part of mental health professionals to be aware of their own attitudes and behaviours, and how these affect their interaction with BME patients. Culture affects all aspects of our lives and comprises of a number of variables including values, beliefs, language, race, politics, religion, gender and social class. Cultural competence is about applying principles of patient-centred care and asking patients about the effect of their culture on their health, rather than making assumptions based on the patient’s ethnic group.

I am delighted to be a Mary Seacole awardee and I intend to use this opportunity to assess my organisation’s cross-cultural strengths and weaknesses in order to design an action plan promoting greater cultural competence across the organisation.


About the author

Saeideh Saeidi is interim head of clinical audit and service evaluation, clinical audit and effectiveness team at Leeds and York Partnership NHS Foundation Trust

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