Older people from black and minority ethnic groups: mental wellbeing

Jill Manthorpe, Jo Moriarty, Martin Stevens,

Nadira Sharif, Shereen Hussein

King’s College London

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Outline

Importance of looking at mental well being, ageing and ethnicity

Demographic picture in the UK

Evidence from primary research

Own research and that of others

Issues for the future

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Barriers to knowledge

Still neglected issue in mainstream research

Just eight per cent of articles in two old age psychiatry journals included people form a minority ethnic group (Shah et al., 2008, 20(5) 1041-5)

Complexities of separating out multiple factors

e.g. socio-economic status

International comparisons

UK only country to routinely collect ethnicity data (Finney and Simpson, 2009)

Important to consider impact of immigration policies, histories of colonialism, impact of EU

Small scale studies exist (e.g. Lorent et al., 2008) but often descriptive and practice free…

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Difficulties in definitions…

Measurements confusing and contentious

Ethnicity – can’t be separated from (political) purposes for which information is collected (Finney and Simpson, 2009)

Longstanding debates about how it should be measured

Widespread differences between studies

Imprecise terms can cloud issues of causation and attribution (Bhopal et al., 1991)

Definitions of wellbeing (Opposite to ill-being? Everything? Aspiration? At end of life?)

Definitions of depression – clinical or commonplace

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Why focus on mental wellbeing ?

Change practice, provision and advocacyAffects physical wellbeingEffect on quality of lifeEffects on others (carers, wider social networks, communities)Promote equalitiesCostDominance of dementiaBecoming more frequent as professional term and policy goal

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Picture from Westminster City Council

Changing demographic picture

By 2051 estimates of 7.4 million Black and minority ethnic older people aged 50+, living in England & Wales, with 3.8 million 65+.

Age distribution among different ethnic groups varies

Many but not all minority groups have younger age structures

But in future…

Anticipated increase in the proportion of (users and carers) older people among minority ethnic groups due to the ageing of people arriving in the 1970s

Differing age structures means that changes will not be uniform

Different localities will be affected differently

Large groups will be ‘White other’

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Impact of regional/local variations

Different localities have differing proportions of BME older people

Projections influenced by migration history & settlement

Currently:

30 per cent people aged 65 and over in Brent

20 per cent in Lambeth and Hackney

More areas are likely to have BME older people (movement inside the UK and longer life spans) (Lievesley, Centre for Policy & Ageing 2010)

SCIE practice enquiry

Targeted areas with low BME populations

Investigated accounts of practice in social care (including housing with care) in visits and interviews

Focus on promotion of mental wellbeing

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Three themes in practice: (1) Language matters but not for all..

Relationships with ‘link’ people and/interpreters

May be ambivalent (Chau, 2007)

Over reliance upon family members questioned

Good quality interpreting can raise quality of care to same levels as those proficient in English (Karliner et al, 2007)

Importance of recruiting bilingual workers

BUT services few and far between (and many languages) so practitioners manage:

Wish to use family among some older people

Alert to isolation of the minority…use of new media

Keep eyes open eg family visits falling off…

Potential of personalisation (if eligible)

(2) Managing relationships

Direct and indirect racismTensions, misunderstandings and lack of knowledge between older people and familiesLittle guidance and support for staffPart of social care workZero tolerance to mediation…Training often ‘food and faith’ basedDiversity of BME older groups being addressed in some social care provision

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(3) Specialist or integrated?

Specialist along which lines? examples – Day care, Care Homes, Community groups…cost-effectiveness?But also intergenerational and also by interest groupsNeed for sensitivity & flexibility as groups/communities change and bills have to be paidPotential of personalisation, housing wealth…

Barriers to knowledge

Studies of older people still have low numbers of older people from minority ethnic groups

e.g. English Longitudinal Study of AgeingDifferent sampling strategies may be necessary (Manthorpe et al., 2009)

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Photograph from 3YO event

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Discussion

Limited nature of much current researchMost evidence on clinical practice in healthVery little on social careTends to be deficit focusedTends to look at easily identifiable groupsHow comparable are concepts such as ‘successful ageing’, wellbeing, isolation, across different ethnic/migrant groups?

Differences within and between groupsAre the issues the same for carers? And paid care workers?

See…

Practice enquiry: Supporting black and minority ethnic older people’s mental wellbeing: accounts of social care practice

scie.org.uk