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• Commentary Response
  Lisa X Liu
  Published on: 30 January 2017
• Response to "Perceived barriers to accessing mental health services among black and minority ethnic (BME) communities: a qualitative study in Southeast England"
  Chelsea M. Ilagan
  Published on: 30 January 2017

• Published on: 30 January 2017

  Commentary Response

  • Lisa X Liu, MSc(A) Nursing Candidate

  Dear Editors,

  I write in reference to the article "Perceived barriers to accessing mental health services among black and minority ethnic (BME) communities: a qualitative study in Southeast England" (2016), which explored the perceived barriers to accessing mental health services from the perspective of racial minorities. Through focused group discussions and thematic analysis of the data, this study was able...

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  Dear Editors,

  I write in reference to the article "Perceived barriers to accessing mental health services among black and minority ethnic (BME) communities: a qualitative study in Southeast England" (2016), which explored the perceived barriers to accessing mental health services from the perspective of racial minorities. Through focused group discussions and thematic analysis of the data, this study was able to capture the multifaceted nature of this issue, illustrating that minority ethnic groups encountered barriers to access both in their own community as well as within the current healthcare system. What I liked particularly was the inclusion of participants from different age groups and the use of abundant and relevant quotations in support of the major themes; it lent direct insight into the experiences of BME patients across a wide age and racial spectra. To further enhance the trustworthiness of the study, one suggestion would be to include the process through which investigators reflected on their own preconceived beliefs and how it could potentially impact the study.

  The current study proposed several important policy recommendations, including antistigma programmes, increasing the role of BME staff within mental health services, and formal training for healthcare providers to improve their understanding of cultural issues. While I agree that it is essential for practitioners to recognize and appreciate the influence of culture, I would also caution against overemphasizing cultural identity for the risk of underappreciating variations in the experience of persons within a specific race. As one of the key issues arising from this study was physician's "perceived inability to listen to the concerns and needs of service users", perhaps future efforts could be directed towards bettering personalized care, where attention is granted not only to patients' cultural needs but their needs as individuals.

  Even though this study was done in England, it has rich implications for other ethnically diverse countries. An example of such country is Canada, which has significant immigrant presence in many of its major cities (Statistics Canada, 2016). Given the current political atmosphere and the growth in numbers of refugees, it is imperative for healthcare workers to be sensitive to the mental health needs of those who have been through a traumatic migration process. This paper examined the perspective of adult immigrants (+18 y.o.), but the wellbeing of parents in immigrant families may be directly affected by the wellbeing of their children (Pitt, Sherman & MacDonald, 2015). An interesting next step would be to look at the mental health experience of immigrant youths growing up under the competing influence of their local culture and their ethnic culture. Overall, this was a very informative read.

  Statistics Canada. (2016). Immigration and Ethnocultural Diversity in Canada. Retrieved November 21, 2016, from https://www12.statcan.gc.ca/nhs -enm/2011/as-sa/99-010-x/99-010-x2011001-eng.cfm

  Pitt, R. S., Sherman, J., & Macdonald, M. E. (2016). Low-income working immigrant families in Quebec: Exploring their challenges to well- being. Can J Public Health, 106(8), 539-545.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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• Published on: 30 January 2017

  Response to "Perceived barriers to accessing mental health services among black and minority ethnic (BME) communities: a qualitative study in Southeast England"

  • Chelsea M. Ilagan, RN

  Dear editor, I am commenting in reference to article: "Perceived barriers to accessing mental health services among black and minority ethnic (BME) communities: a qualitative study in Southeast England"

  The article openly examines the views of the black minority ethnic (BME) individuals on the perceived barriers to accessing mental health. The data was collected from focus groups, analyzed and separated into t...

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  Dear editor, I am commenting in reference to article: "Perceived barriers to accessing mental health services among black and minority ethnic (BME) communities: a qualitative study in Southeast England"

  The article openly examines the views of the black minority ethnic (BME) individuals on the perceived barriers to accessing mental health. The data was collected from focus groups, analyzed and separated into two main themes: (1) personal and environmental factors and (2) relationship between service user and health care provider.

  I felt the two themes and their subthemes presented were particularly intriguing and the article had a lot of strengths. It did, however, have some areas that would require further clarification.

  I appreciated the emphasis on culture and communication. Nursing research has demonstrated that effective communication is essential for working relationships to improve outcomes for clients with mental illness (Ennis et al., 2013). Furthermore, the participants of this study highlighted the need of minority-based practitioners, who know and understand the language and culture. This would facilitate their discussion and fully grasp the client's interpretations of their experience. This was repeated consistently throughout the article in the focus group quotes.

  To add, I commend the researcher's transparency and analysis on the impact of mental health access in black minority ethnic groups. There were several instances where the views of their white majority counterparts were not dissimilar to those implicated in the study. This was not only discussed by participants but also reiterated in the discussion section. The researcher even goes as far as saying that only half the participants completed the ethnicity question in the questionnaire. Unfortunately, this failure to respond is reflective on the fact that the study was unable to capture an analysis of ethnic specific barriers to accessing service.

  Conversely, one critique was when the article stated: "Also, the majority of our participants were university educated and therefore may not represent the views/perceptions of all strata of the BME population." There was no concrete literature to support the claim that the majority of BME population in Southeast England was not university educated and in fact the sample was representative of the population.

  Another area that requires clarification, is that the researchers did not explicitly highlight the theory supporting their qualitative analysis. On the other hand, the authors increased the credibility and trustworthiness of the article with a detailed coding process and investigator triangulation. It was also coherent and easy to read.

  Overall, I found the article findings not limited to BME culture. Perceptions regarding stigma, gender and inability for health practitioners to respond needs are concerns that reach all cultures. This shows that there are many perceived barriers to mental illness as whole. I reward the researchers for their intention of exploring the views of ethnic minorities because often they are not given that voice.

  Ennis, G., Happell, B., Broadbent, M., & Reid-Searl, K. (2013). The Importance of Communication for Clinical Leaders in Mental Health Nursing: The Perspective of Nurses Working in Mental Health. Issues in Mental Health Nursing, 34(11), 814-819. doi:10.3109/01612840.2013.829539

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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