“We need to slowly break down this barrier”: understanding the barriers and facilitators that Afro-Caribbean undergraduates perceive towards accessing mental health services in the UK
| Published date | 05 February 2020 |
| Date | 05 February 2020 |
| Pages | 63-81 |
| DOI | https://doi.org/10.1108/JPMH-12-2019-0099 |
| Author | Tamara Nadine Sancho,Michael Larkin |
| Subject Matter | Health & social care,Mental health,Public mental health |
“We need to slowly break down this
barrier”: understanding the barriers and
facilitators that Afro-Caribbean
undergraduates perceive towards
accessing mental health services in
the UK
Tamara Nadine Sancho and Michael Larkin
Abstract
Purpose –Undergraduatesare highly susceptible to the development of mental healthdifficulties. Afro-
Caribbean studentsare particularly vulnerable to the pressures of universityyet are less likely than other
ethnic groupsto receive early intervention. This paperaims to understand the barriers and facilitatorsthat
Afro-Caribbeanundergraduates perceivetowards accessing mental health services in the UK.
Design/methodology/approach –Critical Incident Technique was used as the qualitative method
because it exploresthe critical factors that contribute to or detractfrom a specific experience. Seventeen
Afro-Caribbean undergraduates participated in five focus groups. This involved engaging in a novel
psychosocial activity that incorporated vignettes to encourage the identification of barriers and
facilitators to service access. The data were analysed thematically to generate categories of critical
incidentsand wish-list items.
Findings –Analysis revealed rich data froma sub-group rarely researchedwithin UK literature. Fifteen
barriers, eleven facilitators and five wish-list items were identified. The importance of mental health
literacy, social networks, cultural sensitivity and concerns surrounding services underpinned many
categories.
Originality/value –Findings providea new perspective on barriers reportedin previous literature. Novel
facilitators were highlighted where, although psychological and sociocultural factors were deemed
valuable, structural changes were most desired. Recommended changes illustrate innovative
interventions that could make services accessible for young adult Afro-Caribbean populations. Future
researchshould explore the barriers and facilitators identifiedby Afro-Caribbean undergraduatesacross
various universities who have successfully accessed and engaged withservices. This could provide a
holisticperspective on viable facilitatorsenabling access despite the presenceof barriers.
Keywords Barriers, Facilitators, Ethnic disparity, Service-access, Student mental health
Paper type Research paper
Introduction
The past 10years has seen a fivefold increase in the number of students reporting severe
mental health problems to their institution (Thorley, 2017). One survey revealed that 95 per
cent of Higher Education Institutions (HEI) reported an increase in the demand for
counselling services (Thorley, 2017). Connell et al. (2007) found the self-harm ratesof those
Tamara Nadine Sancho
and Michael Larkin are both
based at Life and Health
Sciences, Aston University,
Birmingham, UK.
Received 5 December 2019
Revised 10 December 2019
Accepted 11 December 2019
The authors thank every single
participant who helped shed
light on this very important
matter. A special thanks also
goes to the field experts for
taking the time to provide their
invaluable opinions on the
research findings. Finally, they
would like to dedicate this study
to all the Afro-Caribbean
students who, within the
spectrum of what we call
mental health, may be
experiencing difficulties. It is
hoped that this piece of work
provides with some form of a
voice.
DOI 10.1108/JPMH-12-2019-0099 VOL. 19 NO. 1 2020, pp. 63-81, ©Emerald Publishing Limited, ISSN 1746-5729 jJOURNAL OF PUBLIC MENTAL HEALTH jPAGE 63
attending university counselling services to be just as high as those attending National
Health Service (NHS) primary care services. The Royal College of Psychiatrists (2011)
suggests that the growth in student numbers, cuts in university funding and larger teaching
groups might explain increasing decline in well-being amongst students. A recent
systematic review found that most students do not disclose or get the help needed (Storrie
et al., 2010). For students who access support, continuityof care can be difficult, especially
if they return home during academic holidays. Given the increasing incidence of mental
illness in students with few receiving professional support, more consideration should be
given to the accessibility of mental health services for vulnerable groups within a student
population. Examples of one suchgroup are students from Black and Minority Ethnic (BME)
backgrounds (Connell et al., 2007). Research shows a disparity between ethnic minority
students and ethnic majority students in the attainment of higher education degrees
(McDuff et al., 2018). Turner et al. (2007) found that although ethnic minority students
reported the most mental health-relateddifficulties, they were the least likely to seek help.
Compared to other ethnic groups, Black British service-users experience health-care
inequalities that result in more complex care pathways (Bhui and Bhugra, 2002). Services
are accessed at the point of crisis rather than in the early development of mental illness, for
instance referrals from general practitioners to mental health services are well below
average for black groups, whereas referrals by the police and courts are almost two times
higher (Suresh and Bhui, 2006). A recent race disparity audit (Cabinet Office, 2017)found
that black women were the most likely to have experienced a common mental disorder;
however, white women were more likely to be receiving treatment than any other ethnic
group. Of those receiving psychological therapies, white adults experienced better
outcomes than those in other ethnic groups. In the Ghanaian community, religious models
are often used to process emotional distress which leads people to faith-based support as
opposed to professional services (Ae-Ngibise et al.,2010). Keating and Robertson (2004)
report that fear often prevents Black British service-users from engaging with mental health
services because of the perception of services as inhumane, minimal primary care
involvement, stigma of mental illness, problematic care pathways and a lack of community-
based crisis care. It is unclear how barriers are perceived when explored within the
undergraduate population because HEIs provide additional stressors and structural
inequalities. One study highlighted that British BME groups perceive improving awareness
of mental health and reducing stigma, reducing waiting times and cost, raising awareness
of services and access pathways, expanding and enhancing the role of BME staff within
services and developing cultural awareness and sensitivity to facilitate access (Memon
et al., 2016). While these findings are beneficial in exploring the facilitators perceived by
BME groups, it is important that research recognises the unique perceptions each ethnic
group might hold towards facilitators for service access.
Research findings suggest that undergraduates from Black-African and Black-Caribbean
backgrounds are highly susceptible to the development of severe mental health difficulties
whilst also being vulnerable to the pressures of HEIs. Studies assert that their reluctance to
seek help might prolong and exacerbate mental health problems, and needs further
investigation (Turner et al.,2007). Research should aim to improve access for Black-African
and Black-Caribbean undergraduates by developing an understanding of the barriers and
facilitators that these students perceive towards accessing services in the UK. To the
author’s knowledge, this has not been investigated, to date, yet findings could prove
fundamental in the exploration of factors that might increase access for Black-African and
Black-Caribbean students. A qualitative approach to understanding the perspectives of
Black-African and Black-Caribbean undergraduates in the relation to UK mental health
service access is warranted given the limited literature on this sub-group to date. Critical
Incident Technique (CIT) is a framework that can be used to explore the experience of
accessing mental health services, and because of its inductive nature, it has been
described as an effective qualitative research method to use when a topic has been
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