Philip Thomas

Patience Seebohm

Salma Yasmeen

Patrick Bracken

With thanks to Jennifer Davis, Sasha Bhatt, Kulvinder Kaur and

Shabana Kauser

1. Why public / user / community participation

in health is important – demographic and

policy contexts

2. What is community development? The work

of Sharing Voices Bradford

3. Community participation in outcomes and

commissioning – pitfalls and opportunities

4. Conclusions: bottom up vs. top down

Community and identity A community is a group that has a common

identity through: • living in a geographical area or neighbourhood

• sharing faith/religious/linguistic features in common

• sharing national, ethnic, social class or political identity

• having a shared history, for example, colonialism (hence South Asian, African-Caribbean)

• stigmatisation (e.g. the service user community)

Or any combination of these

Globalisation and increasing complexity of all our identities (Bibeau, 1997)

Multiculturalism, liberal democracies and autonomy (Kymlicka, 1995)

Multiculturalism and social cohesion – 9/11 and 7/7

The problem of autonomy (Modood, 2007) Multiculturalism – integration and cohesion vs

recognising and respecting difference

0

1

2

3

4

5

6

7

8

9

10 White (92.1%)

Asian / BritishAsian (4%)

Black / BlackBritish (2%)

Mixed (1.2%)

Chinese (0.4%)

Other (0.4%)

Rate of detection of significant mental health problems in

Black and South Asian people about half that of White people

in primary care.

Higher rates for admission to psychiatric hospital for African-

Caribbean than White patients (South Asians catching up)

Rates of admission for African-Caribbean men are 3 to 13

times higher than White men

Black & Asian mentally disordered offenders have higher rates

of schizophrenia

African-Caribbean men and women over-represented in

forensic units, on remand and in prison

National Contexts: Stephen Lawrence

September 13, 1974 – April 22, 1993

to eliminate unlawful racial discrimination to promote equality of opportunity between

persons of different racial groups to promote good relations between persons of different racial groups Places public authorities under an obligation to

engage positively with BME communities, and to tackle social exclusion and discrimination.

Race Equality Impact Assessments

NSC NHS Strategic Health

Authority (2003)

Independent Inquiry into the

death of David Bennett: An

Independent Inquiry set up

under HSG (94)27.

http://www.nscha.nhs.uk/scr

ipts/default.asp?site_id=117

&id=11516

Delivering Race Equality, 2005. Four elements:

• More appropriate and responsive services

• A more culturally diverse workforce

• Better information (Count me in)

• Community Engagement/Development, supported by 500

new community development workers

Foundation Trusts – recruit up to 1% of the

communities they serve as members / governors

World Class Commissioning

In UK – Quaker movement (18th century), socialism

and humanism (19th century), community

development and social work (20th century)

International

• Ghandi‟s South African Ashram

• Utopian communities, Oneida (US) John Humphrey Noyes

1848 , New Australia movement Paraguay William Lane,

1892)

• Tanzania, Julius Nyerere and Ujamaa (familyhood)

• Paulo Freire – Pedagogy of the Oppressed

Community development and social capital

Understanding community strengths, beliefs and values

Mapping needs and resources

Working in partnership with local groups / organisations

Community empowerment, increased participation in

decision making forums, facilitating community

enterprise

Community involvement in service delivery

Working inside, alongside and outside statutory services

CD and communicative space (Habermas)

0

10

20

30

40

50

60

Per-cent

Bradford - main religious groups 2001

Christian

Muslim

Other (Sikh, Hindu,

Jewsih, Buddhist)

None / none stated

Inner-city Bradford; 60% of community from

BME communities; Largely South Asian

1999 – closure of TCPU

2000 – NHS reorganisation; Bradford City

tPCT

How do services meet the needs of the city‟s

BME communities?

The role of Community Development

2002 project funded by PCT Manager and 2.5 full-time equivalent CDWs (S Asian women, S

Asian men, A/C people)

Project based in the community, managed independently of statutory services

Community mapping and community networking

2004 becomes independent charity

2004-2005 evaluation

2007 (DRE/FIS) 4 more CDWs (young people, older people, Refugees and Asylum Seekers, Eastern European)

Outcomes & Commissioning Project: Aims

1. To involve people from BME communities in

developing an outcomes-focused commissioning

framework for mental health.

1. To develop a model for participation which enables

people from BME communities and mental health

service commissioners/ providers to work together in

future.

1. Project manager DRE / FIS

2. Commissioners: led by mental health, involving others at the PCT, LA, GP alliances

3. Local people from BME communities

4. Providers: BDCT, LA, GPs, PCT, VCS (senior management and front line practitioners)

5. Academic support & facilitation: UCLAN

Policy & Participation

course with UCLAN:

24 BME participants

Community research:

9 participants, VCS

Develop framework:

2 commissioners,

2 participants &

UCLAN

Develop model of

participation:

UCLAN,

9 participants,

4 VCS staff/CDWs

Consultations

with partners &

stakeholders

UCLAN Training & review of

framework & model:

commissioners & 4 participants

24 research participants recruited from 9 BME

community groups

One third had used mental health services

One third were carers

One third asylum seekers / experience of

domestic abuse

9 research participants carried out focus groups

with > 100 people from diverse communities

„The study of a social situation carried out by

those involved in that situation in order to

improve both their practice and the quality of

their understanding‟

Richard Winter and Carol Munn-Giddings, 2001

PAR as a research style rather than a method

PAR and mixed methods

PAR and organisational change

Recognition of expertise of those involved: communities, commissioners, providers.

Regular reviews with participants to inform research process & contribute to learning of what works.

Reviews with wider interested groups to refine framework and model.

Outsider roles: facilitation & academic support (UCLan) for direction chosen from within.

“…in which people encounter each other reciprocally…

together seeking understanding and consensus…

speaking freely and opening themselves up to creative,

responsive, democratic approaches to problems”

(Kemmis, 2006)

1. Capacity issues

2. Divisions and hierarchies

3. Models of mental health & power issues

4. Pressures of family, health, work & time

1. Complexity of the topic(s) & ability to cope with the unfamiliar (all participants).

2. Statutory services unaccustomed to 2 way dialogue.

3. English language skills and jargon (trialogue)

4. Skills in meetings: listening, being effective, democratic and considerate.

5. Limited financial and administrative resources.

1. Gender, age, faith, ethnicity, class, and

language.

2. Community v community.

3. Community & VCS v statutory sector.

4. Statutory v statutory (LA, Trust, PCT).

5. Management v practitioner.

1. Medical dominance & focus on risk in statutory

services.

2. Social, spiritual, economic dominance & focus

on choice in community sector.

3. Commissioners‟ scope to increase choice limited

by the block grant – i.e. funding to statutory MH

services.

4. Practitioners scope to offer non-medical

approach limited by circumstances of job.

1. Senior staff fail to turn up due to pressures of

work

2. Participants fail to turn up due to pressures in

the home or health

3. Limited capacity to support participants and

organise reviews due to pressure of time for

project team.

1. Practical measures

2. Experiential learning

3. Tools for the future

1. Recruiting across many communities.

2. Recognition through pay for work done, childcare and travel.

3. Shared food, community venues.

4. Expert training in public speaking, opportunities to practice.

5. One to one support, group discussions.

1. Training together, with senior staff.

2. Learning about different groups through research.

3. Discovering commonalities across communities.

4. Gaining awareness of own and other‟s strengths and weaknesses during the project

1. The commissioning framework a. recognises similarities & caters for difference

b. Recognises the individual‟s right to choose the healthcare they want.

2. The model of participation a. promotes community cohesion

b. Potentially increases the influence of BME communities v provider organisations.

1. How much will be funded? 2. If the model of participation is not funded, can a

communicative space (Habermas) be sustained? 3. Without a communicative space, can the shared

commitment, community cohesion & community influence be sustained?

4. Multiculturalism in Mental Health Provision – integration and cohesion vs respecting diversity

(Seebohm, P. et al (2005) Together we will change. London,

SCMH.

Thomas, P., Seebohm, P., Henderson, P., Munn-

Giddings, C. & Yasmeen, S. (2006) Tackling Race

Inequalities: Community Development, Mental Health

and Diversity. Journal of Public Mental Health, 5, 13-19.

Bracken, P. & Thomas, P. (2005) Postpsychiatry: Mental

Health in a Postmodern World, in International

Perspectives on Philosophy and Psychiatry (Series

Editor Bill Fulford). Oxford, Oxford University Press.