Research type 
Qualitative
Region 
Local
Year of report 
2010

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 organisations 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 recognise 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 counselling) 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 labelled, of being stigmatised, 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 daycentres 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. The two materials which tested best were the posters headed ‘How are you feeling today?’ and the NHS Stressline leaflet. These were liked because of their eye-catching headlines and titles, which people felt would inspire the viewer to continue reading. The short, punchy copy of the posters was much preferred to a wordy leaflet, and both the Stressline leaflet and the posters were felt to use the ‘right’ language, by which respondents meant clear, simple and non-medical. Both were also said to give a sense of the symptoms which people might be experiencing – symptoms which were brought to life by the service user quotes included on the posters and by the scenarios listed on the Stressline leaflet. Conversely, respondents were not keen on long detailed leaflets containing medical jargon or a great deal of information on therapy options (as witnessed by their reactions to the Icap, Women’s Therapy Centre and IAPT materials). It was also important to them for materials to be visually appealing. Thus, the Icap leaflet was criticised for not being visual enough (too much text), while the visuals on the Women’s Therapy Centre and IAPT leaflets were felt to be poorly chosen. Overall, respondents felt that targeting of African-Caribbeans would best be achieved visually and through placement of materials rather than explicit targeting in words on the materials themselves. The latter approach was considered more likely to offend. Throughout the research, it was evident that choosing the right language would be key. The key learnings and recommendations arising from the research in terms of the future communications strategy are the following: • Due to high levels of stigma around mental health, the language used on promotional materials needs to 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 be 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 patronising • 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 • The feedback suggests that 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. In terms of service delivery, the idea of providing mental health services in non-medical settings was very positively received. The research generated a list of possible locations/channels which included: • Community groups/community centres • Gyms/leisure centres • Social clubs • Via youth workers • Council buildings • Benefits offices/Jobcentres • Via well woman/GUM clinics (for younger people) As mentioned earlier, the research also supports the idea of linking mental health services with organisations who can offer practical help with the social issues that the community may be facing. We would recommend exploring whether this could also work in reverse i.e. could these organisations also become entry points into mental health services for people experiencing mental distress as a result of their financial or housing problems? Finally, we understand that efforts are being made to recruit more staff from ethnic minority backgrounds into mental health careers, but this will clearly take some time to achieve. In the meantime, we would recommend cultural awareness training for mental health staff to promote deeper understanding of issues such as how African-Caribbean people express themselves, cultural and religious norms within the community and typical family structures

Research objectives

 

This research was conducted to gain a deeper understanding of attitudes towards and knowledge of mental health among the African-Caribbean community in Islington Overall aims: • To understand attitudes towards and knowledge of mental health • To identify barriers to accessing mental health services • To assess existing and proposed interventions and their promotional materials The research objectives were to explore: • Awareness and understanding of mental health, including terminology • Stigma and discrimination • Awareness and use of services • Customer journeys • Reactions to possible interventions and communications

Background

 

Islington has a strong commitment to mental health promotion and early intervention and provides a range of interventions to support this aim, such as IAPT (Improving Access to Psychological Therapies), Mental Health First Aid Training, mental health champions, suicide prevention work and anti-stigma campaigning as well as many others. This research looked at how social marketing insight could be used to develop and improve these existing activities, in particular IAPT and the mental health champions, focussing specifically on the Caribbean community Statistics show that this community is: • More likely to experience mental illness • Over-represented as users of secondary mental health services but under-represented in primary care • More likely to be ‘late presenting’ than the white population This research gathered the views of service users, the wider community (non-service users) and health professionals

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.

Audience Summary

Gender

 
Male
Female

Ethnicity

 

African- Caribbean

Age

 

18-45+

Social Class

 

BC1C2DE

Methodology

Methodology

 

The research methods used were entirely qualitative and were designed to provide insight and understanding, rather than statistical or numerical data. A mix of qualitative methods was used, covering mental health service users, non-service users and professionals • Service user visits (over a 2hr period) were conducted with people who: ⇨ Have suffered with depression/anxiety ⇨ And who have experience of mental health services in Islington • 10 service users were interviewed: ⇨ 6 women, 4 men ⇨ 4 aged 25-44, 6 aged 45+ • 4 professional interviews were also conducted with: ⇨ 1 GP ⇨ 1 Church leader ⇨ 2 people who work within the IAPT service • Among the wider African-Caribbean community, six creative galleries lasting 2½ hrs each were held, combining: ⇨ Q&A ⇨ Artworks ⇨ Other exercises e.g. word sort, word association • These sessions were single-sex and divided by age/generational group • Around 15 respondents attended each session

Data collection methodology

 
Depth interviews
Focus groups
Workshops

Sample size

 

10 service user interviews, 4 professional interviews, 6 creative galleries with 15 respondents each

Detailed region

 

Islington, London

Fieldwork dates

 

Feb-March 2010

Contact Name

 
Baljinder Heer

Email

 
baljinder.heer@islingtonpct.nhs.uk

Agree to publish

 

Private

Research agency

 
Connect Research and Consultancy

COI Number

 
300606