A co-produced service evaluation of ethnic minority community service user experiences of a specialist mental health service during the COVID-19 pandemic.

BACKGROUND: For ethnic minority communities in the UK, the COVID-19 pandemic amplified existing health inequalities and created other consequential disadvantages like increased vulnerability to COVID-19, higher rates of hospital admissions, increased mortality and poorer mental health outcomes. While longer-term impacts of COVID-19 are considered, it is crucial for NHS mental health services to understand the specific barriers and needs of ethnic minority communities to provide consistent and equitable access to mental health services. These aspects were the focus of a service evaluation of a Sussex-wide mental health service conducted in co-production with experts-by-experience, public members, health professionals and researchers from ethnic minority communities. METHODS: Co-designed creative workshops (n = 13) and semi-structured qualitative interviews (n = 13) were used to explore experiences of accessing specialist mental health services during the COVID-19 pandemic. Participants were: Sussex Partnership NHS Foundation Trust (SPFT) service users recruited between October 2021 and January 2022; aged 16+; from ethnic minority community backgrounds. Data was analysed using Thematic Analysis. RESULTS: The analysis yielded five overarching themes contextualising service users' experiences: (1) limited awareness of SPFT mental health services; (2) effects of COVID-19 in gaining access to SPFT; (3) SPFT reaching out to ethnic minorities; (4) being supported, 4a) hiding my mental health status from friends and families, 4b) lack of ethnic diversity in services, and 4c) better provision of information and support services, (5) relationship between childhood experiences and current mental health. These findings led to seven key recommendations for future service developments within SPFT. CONCLUSIONS: Although this evaluation was set in the context of COVID-19, findings have highlighted specific mental health service needs for ethnic minorities that are applicable beyond the confines of the pandemic. Many benefited from online sessions seen as more inclusive. Mental health advocates, outreach and joint working with communities could help further reduce stigmatising attitudes and improve engagement with mental health services. Improved service awareness of the impact of childhood or historical traumas experienced by ethnic minority communities on current mental health, the role of cultural awareness training and availability of culturally adapted therapies is also needed. Many service improvement recommendations provided could impact all service users.

Are trainee teachers being adequately prepared to promote the health and well-being of school children? A survey of current practice.

BACKGROUND: Teachers are a key part of the wider public health workforce in England. We conducted a survey to find out how they are trained for this role during their initial teacher education (ITE). METHODS: Between 2011 and 2012, we sent an online questionnaire to 220 ITE course managers and conducted semi-structured interviews with a purposive sample of 19 course managers to explore issues in more depth. RESULTS: The response rate to the questionnaire was 34% (n = 74). Although most of the course managers felt inclusion of health and well-being training in ITE was important, provision across courses was variable. Topics which are public health priorities [e.g. sex and relationships education (SRE) and drugs, alcohol and tobacco] were covered by fewer courses than other topics (e.g. child protection, emotional health and anti-bullying). Perceived barriers to training included lack of time and a belief that health and well-being were low priorities in educational policy. CONCLUSIONS: Not all of tomorrow's teachers are being adequately prepared for their role in helping to address public health priorities. Educational policy does not appear to be supporting the priorities of public health policy, and this is a key barrier to health promotion training in ITE. Keywords children, educational settings, health promotion.

Inequity in provision of and access to health visiting postnatal depression services.

AIM: This paper is a report of a study of equity in the provision of a public health nursing postnatal depression service. BACKGROUND: Postnatal depression is a global public health concern. Health visitors are nurses involved in the early detection and treatment of postnatal depression. However, research has revealed that all women are not assessed for postnatal depression particularly women in minority ethnic groups. METHODS: A case study was conducted involving 21 observations of health visitors visiting postnatal women, interviews with 20 health visitors, 6 managers, 12 English women, 9 Bangladeshi women and 3 other personnel. Data were collected between 2003 and 2005 and analysis was completed in 2008. FINDINGS: The organization had a policy to create equitable postnatal depression services, but practitioners were not clear whether it was to be implemented, and it did not address the needs of a diverse population. All health visitors received specialized training and were consequently expected to assess and treat all women. The training based on the policy had not equipped health visitors with knowledge and skills to assess and treat women in minority ethnic groups. CONCLUSION: While a policy was in place, equity in care was not achieved. An analysis of women's needs is recommended prior to policy development and policy implementation should be planned. To achieve equity, training should include knowledge and skills for cultural competency. Research is needed to illuminate the characteristics of equitable nursing services.

Postnatal depression: a global public health perspective.

The aim of this paper is to discuss whether or not postnatal depression is a global public health concern. Public health is the study of the morbidity, mortality and the cause and course of disease, at a population rather than an individual level. Public health is also concerned with examining factors that cause health inequalities. Postnatal depression is a mental and emotional condition that can affect women during the first postnatal year. Since the effects of postnatal depression are known to go beyond the mother in that it also affects the partner and the child, it can be deemed a public health problem. Additionally, severe postnatal depression can lead to infanticide as well as maternal death, often by suicide. Furthermore, evidence demonstrates that all countries are faced with the challenge of postnatal depression, but low- to middle-income countries face the greatest burden. The literature revealed various treatment options for this complex condition. However, it also uncovered that not all women are assessed for postnatal depression, nor do all women receive treatment. The emerging picture is that postnatal depression is indeed a public health problem, particularly as the incidence is much higher than the quoted rate of 10%-15%. This paper recommends direction for public health-orientated perinatal mental health research and suggests that service providers should consider the routine assessment of all postnatal women.

An analysis of the concept of equity and its application to health visiting.

AIMS: The aim of this paper is to provide an in-depth analysis of the concept of equity in the British health visiting service and thus facilitate understanding of the term. An attempt has been made to apply the analytical process to the context of health visiting. BACKGROUND: Equity has been discussed at some length in the health literature. Much of this including the health visiting literature discusses inequality and inequalities in health at the same time as discussing equity. Increasingly, poverty and inequalities have become accepted as determinants in poor health. It seemed appropriate therefore to analyse these topical and seemingly related concepts. METHODS: A well established method of concept analysis has been utilized to facilitate the process of analysis. RESULTS: Confusion between the meaning and application of the concepts of equity and equality was found. Much of the health visiting and health care literature related to addressing the needs of groups who experience inequality in terms of service provision, and access to services. Following an in-depth critical analysis of the literature three critical attributes of the concept were identified: equal opportunity of access to services; a high standard of service for everyone; and unequal distribution of services to meet unequal need. These relate to two distinct forms of equity: horizontal and vertical equity. A definition of equity has been proposed. Maxwell's (1992) framework is suggested as a means to evaluate equity in service provision and uptake. CONCLUSIONS: Most of the literature examines equity at a macro level, that is service level. Nurses and health visitors are urged to examine the services that they are involved in to determine the level of equity that is achieved or not attained. Suggestions have been offered as to how this task may be undertaken. A definition has been proposed to stimulate debate and discussion about the concept within nursing contexts.