The following are the winners and highly commended for the BME Award:-
The Football and Music Project – Key Changes, London, and Arsenal FC in the Community. The FAM (Football and Music) project is targeted at young BAME males using mental health services in Islington, North London. It promotes both physical and mental health through weekly football practice led by trained Arsenal FC coaches, followed by music sessions led by professional musicians and producers in fully-equipped rehearsal and recording studios. The participants have recently written and produced a team song to promote the project and reflect their footballing experiences and aspirations which has a video that can be viewed on You Tube (youtube.com/keychanges) and the Key Changes website (www.keychanges.org.uk).
The project has made a real difference to participants on a number of levels. It has promoted physical fitness and wellbeing to over 30 young men experiencing severe and enduring mental illnesses through engaging them in culturally relevant leisure interests which are common to them as a group, namely football and music. It has brought together a group of people who are normally isolated from mainstream life and has united both service users and sport and music professionals in positive activities. The benefits of social inclusion, and physical and creative endeavour, have aided service users’ recovery, through enhancement of their social, emotional and technical skills and facilitated positive changes in behaviour and wellbeing. The distance travelled by project participants is clear: from standing unconfidently on the touchline, group members have gone on to play in a football team, returning weekly to repeat the experience. Those who faced challenges in verbal communication and expression have collaborated on a professionally produced track that celebrates their experiences and have performed it live to audiences at concerts and events.
The service is a partnership of two mental health organisations in Islington. It has brought together Arsenal in the Community’s mental health football project with the Key Changes mental health music charity. Arsenal’s football project encourages and promotes physical well being in service users, through weekly football practice, led by professional coaches with support from specialist mental health services. Key Changes provides music engagement and recovery services for young people and adults experiencing serious mental health problems.
The project is funded by NHS Islington Clinical Commissioning Group. It addresses the wider national Adult Joint Commissioning Strategy, which is concerned with improving physical health for people with mental health problems and reducing stigma and discrimination.;
HIGHLY COMMENDED –
Substance Misuse Clinic for Eastern European Service Users – Derbyshire Healthcare NHS Foundation Trust. We provide a dedicated substance misuse clinic for East European service users within Derby. The initiative was our proactive response to twin drivers – a higher-than-average rate of substance misuse among Eastern European migrants living in Derby and approaching treatment for help, coupled with a lower-than-average awareness and understanding of health risks associated with misuse. Heroin and crack cocaine use is particularly prevalent (with established links with poverty) within new and emerging communities and has significant health impact as well as detrimental impact around involvement in the criminal justice system. Due to their limited English speaking skills, their needs are not met holistically. For example, at the start, one of the service user from this cohort did not understand that buprenorphine (opioid substitute medication to treat heroin dependence) needs to be kept under the tongue and that it should not be swallowed for it to work properly. We also found it difficult to explain all the health care and social implications of substance misuse due to the language barrier including some of the medical problems.
One of the key factors in doing something proactive to encourage engagement and remove barriers to treatment was around increased incidents of positive test results for Blood Borne Viruses (in particular Hepatitis C and Human Immunodeficiency Virus) amongst service users who injected heroin or crack within the East European cohort. Whilst exploring this, Harm Reduction nursing staff came across misconceptions around intravenous drug use that had significant repercussions on health. A key example would be the belief shared by several intravenous drug users that it is OK to share injecting equipment and associated paraphernalia with extended family members due to the belief that we are related and therefore “we’ve got the same blood”. Such misconceptions about substance misuse, and a lack of knowledge around the risks of contracting HIV and hepatitis, were held by drug users (and likely others) within the emerging Eastern European migrant community.
This concern around the lack of knowledge, impact on individual and public health, as well as a desire to increase engagement within treatment spurred the substance misuse service in Derby to create a unique, purpose-designed service for this hard-to-reach group. Despite a significantly higher-than-average rate of substance misuse in this community, we identified a gap between the numbers who would benefit from our established clinic and those who would actually access it. It was a growing cause for concern for the Public Health commissioners, who tasked the service with trailblazing a new approach that would better meet the needs of these clients.
It is already achieving its aims of bringing more users into drug treatment and encouraging them to enter an individually structured programme of 1-to-1 care planned treatment and health promotion. Almost five times as many people from this community (Slovakia/Slovenia; Poland; Lithuania; Latvia; Czech Republic) access the clinic now than before the clinic was in operation.;
HIGHLY COMMENDED –
Six Degrees – Salford. Eis Lebadar means ‘time to talk’ in Hebrew. The Eis Lebadar Project was set up by Six Degrees Social Enterprise in October 2011 to improve access to mental health care within the Jewish Haredi community in Salford. Six Degrees runs the Step 2 IAPT services (Improving Access to Psychological Therapies) in Salford as well as a range of projects that are targeted at under-represented groups. Through this work, Six Degrees was approached by Salford Council for help in approaching the Haredi community that was not accessing NHS funded mental health services.
5% of the Salford population is Jewish and the Jewish population has increased by nearly 50% over the past decade, due to the rapid ex-pansion of the strictly orthodox Haredi community. The people of Haredi community belong to kehillas. These are groups of likeminded people who share their theological outlook, culture, and traditional attitudes towards religious observance. They follow the guidance of their Rebbes (religious leaders, who act as spiritual guides and educators) and their religious ideology regulates the observance of the Sabbath, the preparation of kosher foods, social interaction between men and women and other aspects of their day to day lives. Cultural boundaries are symbolically manifested in their distinctive dress code which gives them a clear visible presence. Haredi men are often bearded and they tend to wear a wide brimmed black hat and suit. Haredi women dress modestly, wearing mid to long length skirts and they tend to keep their head covered. Married men devote their time to religious studies and stay in religious seminaries called yeshivas until their mid to late 20s. Their wives accept responsibility for the running of the family households and in many cases they are also the family breadwinners. Levels of debt and poverty within the Haredi community are high. Couples marry young, have large families and the levels of participation in the labour market outside the internal economy of the community are low. High levels of morbidity due to poverty, unemployment, the housing of large families in cramped accommodation, pressure to conform and live according to challenging spiritual ideals increase vulnerability to poor mental health. The stigma and shame associated with mental health issues is acute and there is a strong fear that marriage prospects will be harmed if it becomes known that a potential partner or family member has had a mental health problem.
For many Haredi people engagement with mental health service providers entails the crossing of a social boundary that they would not normally transgress without the blessing and permission of their Rebbe . The Rebbes can be ambivalent about secular mental health services. On the one hand, they accept that it is necessary in certain circumstances for people to gain access to vital resources and expert knowledge from outside the community in order to meet their needs. On the other hand they are very wary of the influence of secular humanistic ideologies that present radical challenges to their cultural order. Most have strong reservations about referring people to non-Jewish mental health workers and most would prefer to recommend a worker from the Haredi or Orthodox community who is of the same gender.
The work with the Haredi community has been informed by the work of the Access to Mental Health in Primary Care (AMP) Study Group based at the University of Manchester. The AMP Study Group are seeking to develop a better understanding of the social processes through which people from minority communities identify the need for and make use of primary care based mental health services. The modelling of the Study Group suggests that in order to deliver effective interventions it is necessary to focus on community engagement, the quality of interactions in primary care and the development and delivery of tailored psychosocial interventions.
It has been necessary for all those that have been involved, to allow the project time to develop. Building up the relationships and trust that was needed to overcome the suspicions that people within the Haredi community previously had of the mental health services could not be done quickly or easily. Access to talking therapies had been restricted to those within the community who could afford to see a private therapist. However, since the project began there has been a marked improvement in uptake of NHS mental health services. Prior to 2011 an average of less than 5 Jewish residents were accessing support from the NHS funded talking therapy services per year, but the numbers has now grown to over 50 per year.;