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VADM Centre for Ethnic Minority Mental Health

Advocacy is a process or intervention that ensures vulnerable people have a voice within services that are characterised by power inequalities between providers and users. Mental heath issues, and the social and statutory service response to them, can mean that individuals can find it difficult to speak up for themselves and be heard. This can impact on decision-making and the opportunities to exercise choice. It can also result in marginalisation and social exclusion and place an individual's rights in jeopardy.

In addition to this, people from minority ethnic communities may also experience racism and discrimination. For people from specific ethnic minorities, notably African and Caribbean communities, this means diversion to less restrictive services, reducing the risk of admission and detention under the Mental Health Act or via the criminal justice system. For other communities, for example Chinese communities, it means increased engagement and access to support, as people from these communities are typically under-served by mental health services.

There is a growing body of evidence for the negative relationship between mental health services and African and Caribbean men. This negative relationship can result in a reluctance to seek help or comply with treatment, leading to relapse and readmission and further social exclusion. The Better Health Briefing on African and Caribbean men and Mental Health from the Race Equality Foundation provides an overview of the key issues and examples of positive service developments. This evidence provides information on the role of advocacy and addresses:

● The failure of services to understand and meet needs, including misunderstanding of African and Caribbean modes of self-expression.

● Fear and expectation of negative treatment, including not having needs understood or met, being stereotyped or ignored, concerns about treatment (particularly medication), detention, leave arrangements, day-to-day living, access to appropriate treatment and practical support.

● Low uptake of services and less desirable pathways into care,

● Lack of awareness of mental health and service provision,

● Lack of choices in relation to treatment offered - for example more likely to receive physical treatments and less likely to get psychotherapy.

● Experiences of coercion, discrimination and racism in mental health services;

● Social disadvantage and exclusion, particularly homelessness, poor housing, unemployment and over-representation in prison.

Last revised: 14^th, October 2008.