Attitudes and understanding of mental health among Afro-Caribbean communities in Islington: Qualitative research.

Summary of Findings

Both mental health professionals and the community agree that mental health is inextricably linked to the social issues faced by the African-Caribbean community in Islington (and in Britain as a whole). In other words, the effects of social disadvantage, such as high unemployment, poor housing, and experiences of racial discrimination, are considered to negatively impact the mental health of African-Caribbeans. Therefore, while there is a definite need to raise awareness of mental health issues from its current low base, there is also a need to link mental health services with organizations who can offer practical help with finding work, rehousing, and managing debt.

The NHS Stressline (which tested well in the research) could provide a template for how such signposting might work. The research indicates that awareness of mental health issues is low within the African-Caribbean community and largely confined to negative stereotypes around the idea of ‘madness’. While the over 25s were more likely than younger audiences to see mental health as a key issue for the community spontaneously, they were no more knowledgeable about specific conditions, treatments, or risk factors. If anything, older audiences were more resistant towards the idea of seeking help since they were much more distrustful of the medical profession than younger people. Across the board, respondents equated ‘mental health’ with ‘madness’.

Respondents did not see common mental health disorders as mental illness. As a result, the terms ‘depressed’ and ‘depression’ were commonly used and did not alienate non-service users. However, there is a need for the community to recognize the individual’s role and responsibility in looking after their own mental health. Currently, mental health problems are mainly seen as out of the individual’s control, occurring as a result of external factors such as racism or life events such as bereavement. Mental health services were primarily associated with being ‘locked up’ and ‘pumped with drugs’. There was very little awareness of talking therapies (only among the very small number of non-service users who reported having had counseling) and there was virtually no knowledge of community-based services. Respondents’ preferred terminology reflected their attitudes towards and lack of knowledge of mental health services. For example, they responded best to words like ‘stressed’ and ‘worried’ rather than ‘mentally ill’, and to the idea of ‘support’ rather than ‘treatment’. Women, in particular, also liked the idea of replacing ‘mental’ with ‘emotional’ as in ‘emotional health’ and ‘emotional support services’.

Barriers to accessing mental health services (among non-service users) related to:

Lack of awareness of mental health disorders and of where to turn for help
Lack of trust in the system
Cultural norms e.g. that African-Caribbeans are brought up to ‘soldier on’ and not to share their problems
Fear e.g. of being labeled, of being stigmatized, of being reported to Social Services and losing one’s children as a result.

Service users experienced these same barriers initially, which may account for the range of pathways into services which we found among our sample and why most of them were ‘late presenting’. Having said this, service users had generally had positive experiences of using mental health services. They were complimentary about the individual services they had accessed, but they were critical of ‘the system’ as whole, particularly:

The lack of Caribbean mental health staff at senior levels
The lack of culturally appropriate therapies
The lack of specific provision for Caribbean people e.g. specific forums and groups, no Caribbean food on offer within most day centers and hospitals

All agreed that there is a need for specific communications and interventions aimed at the African-Caribbean community, although it was acknowledged that this would need to be delicately handled. In terms of communicating with the community going forward, several guiding principles have emerged from the range of communications materials tested in the research.

Key Learnings and Recommendations

Due to high levels of stigma around mental health, the language used on promotional materials needs to be selected carefully. For example, ‘mental health’ is associated with the extreme of the spectrum i.e. ‘madness’ and people would be less likely to pick up a flyer with this on. Words such as ‘stressed’, ‘worried’ and ‘depressed’ were more likely to prompt engagement.
Communications should use formal, standard English (e.g. replacing ‘mates’ with ‘friends’ on one of the ‘How are you feeling today?’ posters) and should speak to the audience in layman’s terms, with no medical jargon or ‘psycho babble’. Furthermore, respondents were very much against the idea of materials employing street slang or Caribbean patois as this was seen as inappropriate and patronizing.
Clever use of visuals would be a good way of targeting the community without having to be too direct on the materials themselves. For example, including an image of a Caribbean person looking stressed or neutral (to reflect the state of mind of the target audience) or better still, showing a Caribbean service user talking to a black psychologist. Alternatively, symbolic references to the Caribbean would work well, such as the use of red, green, and gold, or the inclusion of Caribbean flags.
Similarly, placing the communications materials in community gathering places would also be an effective way of reaching African-Caribbeans. Suggestions included barber’s/hairdresser’s, nail salons, betting shops, Caribbean restaurants and takeaways, Council buildings and benefits offices.
A key way to draw people in will be by referencing situations and scenarios which may be causing them stress. The most relevant of these for the African-Caribbean community are likely to be money worries, difficulty in finding employment, housing issues, family stress/relationship breakdown and lone parenthood.
Avoid detailed, complicated copy and long-winded leaflets as the respondents in this research seemed reluctant to read them. Posters were generally preferred over leaflets because they are more concise and also because they can be read discreetly, whereas it is often a more public act to pick up and read a leaflet.
All materials should highlight the confidentiality and privacy of the service as this is very important to the African-Caribbean community.
Where possible, the NHS should aim to reassure the target audience about who will be answering the helplines and what they can expect if they call. For example, saying something like ‘we have an ethnically diverse mix of staff’ or ‘our staff understand how difficult it can be to pick up the phone and ask for help’ etc.
There appears to be a good deal of support for involving African-Caribbean role models and celebrities in the promotion of mental health issues. Thus, we suggest that the NHS considers using Caribbean celebrities to put a face to the issue, ideally, including some who have experience of accessing mental health services, such as Frank Bruno and Trisha Goddard.

Quick Summary

The key learnings and recommendations arising from the research in terms of the future communications strategy are the following:

There is a great deal of stigma around mental health. The term ‘mental health’ is associated with the extreme of the spectrum i.e. ‘madness’. Careful use of language is required to engage the community.
Communications should use formal, standard English and should speak to the audience in layman’s terms, with no medical jargon or ‘psycho babble’.
Clever use of visuals is a good way of targeting the community without having to be too direct on the materials themselves.
Similarly, placing the communications materials in community gathering places would also be an effective way of reaching African-Caribbeans.
A key way to draw people in will be by referencing situations and scenarios which may be causing them stress, such as money worries, problem sleeping etc.
Avoid detailed, complicated copy and long-winded leaflets. Posters were generally preferred over leaflets.
All materials should highlight the confidentiality and privacy of the service as this is very important to the African-Caribbean community.
NHS should aim to reassure the target audience about who will be answering the helplines and what they can expect if they call.
There appears to be a good deal of support for involving African-Caribbean role models and celebrities in the promotion of mental health issues.

Attitudes and understanding of mental health among Afro-Caribbean communities in Islington: Qualitative research.

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