Effective involvement in mental health services: the role of assertive outreach and the

voluntary sector

Bristol Mind

Aim of the study

To explore in depth how voluntary and statutory services can best work to promote effective access to services for people with severe mental illness who are perceived as being ‘hard to engage’ by those services.

• Black and minority ethnic groups• Gypsies and Travellers

• 73 participants in all

• Gypsies and Travellers - 9

Sample GroupsNumber of participants

Staffing and Management

• The study is based at Bristol Mind, funded by the Big Lottery Fund

• Steering Group

• Advisory Group

• Three research staff – all mental health service users

Staff participation in the study

• Mapping exercise

• 5 staff focus groups

Problems of Language

• ‘Nerves’, depression, stress

• Serious mental health issues

Attitudes Towards Mental Health

• Keeping it private

• Protecting the family

• Gods will

• Varied views of medication

• Stigma around ‘mental health’ language and

services

Experiences with GPs

• Main point of contact

• Some positive experiences

• Flexibility and consideration (+ve and –ve)

• Access

• Mental health issues hidden

What Puts People Off

• Fear of discrimination

• Discrimination from GPs and psychiatrists

• Issues of hygiene

• Carer issues

• Referral procedures

Problems Related To Housing

• Surrounding environment• Frequent moves• Too remote• Poor conditions• Pressures linked to legal issues• Stress about the future• Not enough space• No privacy• Problems of moving into a house

What People Want - Services

• Counselling

• Support at home

• Support with children

• ‘Intensive support’

• Paperwork

• Furniture

• Adult education/literacy

Medication & Talking Therapies

• Don’t want to rely on tablets but sometimes helpful

• Suppressing not solving problems• Not responsive enough• Didn’t work• Costs• Talking therapies• Some people wanted medication and were not

getting it

Staff focus groups

• Hardly any Gypsies and Travellers seen by either statutory Assertive Outreach teams or voluntary outreach services

• Yet a Travellers Service knew of many people with problems right across the mental health spectrum

Staff focus group

To improve mental health services need to:

• Be proactive, going out to meet people• Be holistic, open and flexible• Enable relationships and trust to be built• Be linked into other specialist services

(especially GPs)• Consider needs of the whole family

One participant came from a specialist mental health service for the deaf

Positive features were– People can self refer, families and friends can refer– Service was flexible working with all kinds of problem– Staff worked to connect to the deaf community – Flexible, outreach style service

Communities need to have a strong voice and lobby

Staff focus group

• Diversity training had not covered Gypsy and Traveller issues

• Specialist resources were available from specialist services but this was not widely known about

• Monitoring forms do not include categories for Gypsies, Travellers or Showmen

Staff focus group

Key Issues

• People are not looking for ‘mental health services’ they want help with a whole range of different issues

• Some issues, like housing, may have big impact on people’s mental health

• Improving education and awareness in all relevant services, particularly GPs

More Accessible Support

Things that are likely to help are

• Staff who actively go out to visit people and build ongoing relationships and trust

• Services that are culturally sensitive

• Services that offer a range of help, are holistic and flexible

• Services that consider the whole family

• Services that link (GPs)

Thank you very much!

For further information contact:

Rosie Davies, Bristol Mind,

35 Old Market Street, Bristol BS2 0EZ

O117 980 0382

assertiveoutreach@bristolmind.org.uk