1. Effective involvement in mental health services: the role of assertive outreach and the voluntary sector Bristol Mind

2. 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

3. 73 participants in all Gypsies and Travellers - 9 Sample Groups Number of participants

4. 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

5. Staff participation in the study Mapping exercise 5 staff focus groups

6. Problems of Language ‘Nerves’, depression, stress Serious mental health issues

7. Attitudes Towards Mental Health Keeping it private Protecting the family Gods will Varied views of medication Stigma around ‘mental health’ language and services

8. Experiences with GPs Main point of contact Some positive experiences Flexibility and consideration (+ve and –ve) Access Mental health issues hidden

9. What Puts People Off Fear of discrimination Discrimination from GPs and psychiatrists Issues of hygiene Carer issues Referral procedures

10. 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

11. What People Want - Services Counselling Support at home Support with children ‘Intensive support’ Paperwork Furniture Adult education/literacy

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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)

19. 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