2. How to reach and engage with young people from black and minority ethnic groups who may require help from mental health services What needs to happen to aid the development of effective service provision for young people from black and minority ethnic groups.

3. Minority ethnic population of the UK: 4.5 million (7.6%) Indians Pakistanis Black Caribbeans Black Africans Mixed ethnic backgrounds

4. Black Caribbean Pakistani Indian Bangladeshi Chinese Travellers

5. Iraqis Somalis Yemenis Iranians Kurds Bosnians Algerians Tamils Vietnamese

6. Ethnicity is… A process by which people create and maintain a sense of identity Something that we all have

7. Barriers to access

8. Determined by a variety of factors: Level of psychological distress Personal problem-solving skills Environmental factors Negative attitudes towards mental health professionals Preferences for informal sources of help (friends, family members) Religious coping strategies

9. Use of GP services Referrals for severe problems Misunderstandings about the structures of services

10. Exclusion from school Being looked after Homelessness Institutionalised racism Lower income Unemployed Overcrowding Bad housing Poverty

11. Communicational difficulties GP consultations not conducted Level of participation by the patient reduced

12. Discrimination Racial stereotyping

13. Shame-orientated Liable to adapt their behaviour to save face Reluctant to seek help outside the family Fearful of criticism and losing face in society Conflict between the service user and the family

14. Psychological problems not identified Nature of GP-patient interaction Poor communication Greater somatisation/presentation of physical illness to GPs Lack of trusts in services/professionals

15. Issues raised by young people in black and minority ethnic groups

16. Diversity of needs Education and employment Physical health Discrimination and racism Family relationships Inclusion in local community Money and finances

17. Past traumatic experiences Worries about legal status How long they might stay in UK Losses and grief

18. Fears of stigma and general reluctance to talk Difficulties in finding out where to go Long waiting times Having to travel some distance No interpreter Sense of being passed around Having to re-tell their story Service times not convenient

19. Stigma of being in contact with services Worried that friends and family would find out Concerns those in close-knit community would find out

20. Lack of knowledge of local area Lack of knowledge of transport system Not being able to self-refer Not able to get help promptly

21. Information sharing Trusting relationships Staff changes Constantly referred on Unfamiliar with how UK health system works

22. Having some choice in own care Choice of gender of staff member Cultural background of staff member Staff interested and aware of differences

23. Care through adult mental health services Inpatient care on adult wards Failure of inpatient CAMHS to meet dietary requirements Day-to-day social interaction

24. Different dynamics and roles within families Different attitudes towards being asked questions Worried about views of parents

25. Professionals making assumptions on basis of ethnic group Responding to questions about ethnicity Appreciate the diversity of needs and situations Why the question about ethnicity is being asked What information is actually required

26. Develop an understanding Take account of needs

27. Suggestions for improving access to and the delivery of services for the mental health of young people from black and minority ethnic groups

28. Greater range of settings including drop-in resources More flexible hours of operation Support from referring professional Services in other settings Choice about ethnicity of professional User involvement

29. Outreach work Work in schools Non-traditional routes

30. More awareness-raising Promotion through frontline professionals Use of audio-visual materials Changing referral structures Information for parents, family and community Open days

31. Interpreters to receive training about mental health Services to work with same interpreters to facilitate continuity Simultaneous translations and interpreting

32. Identified training needs: Cross-cultural communication of distress Engagement skills Challenging personal views and attitudes Information on adapting models and approaches Information about client contexts Information about local services

33. Having a diverse staff group able to communicate in a range of languages Neutral décor or reflecting local community through signs, posters and displays in different languages Interpreter support Reception staff from black and minority ethnic groups Celebrating religious and other cultural events Space to accommodate extended family members Translated materials in different languages (and ideally ansaphone not only available in English)

34. Need for different agencies to work in partnership Forge effective working links Services that can meet diverse needs

35. Frontline access Informal venues Support across different areas or social activities Less obviously mental health focused.