The-Inquiry by sdaferv

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									Mental Health & Well-being (2)                       Insaaf Consultants




                    The Inquiry into
        Mental Health and Well-Being in Later Life

                                  Phase I


                         Views of
            African-Caribbean older people
                            &
           Social care and health professionals

                    Workshop on 31 March 2005
                         At Age Concern
                           Birmingham
                       1.00p.m. – 4.30p.m.

                                 Sue Vahid
               Insaaf - Management & Training Consultants
                     suevahid@insaaf.net




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Mental Health & Well-being (2)                                        Insaaf Consultants



             Views of African-Caribbean older people,
                                         &
                social care and health professionals on
             Mental Health and Well-being in later life

1 Introduction: This report presents the views of a group of African-Caribbean older
people, and of younger social care and health professionals, on the promotion of
positive mental health and well-being in later life. The group was convened by Age
Concern, Birmingham, to contribute to the national Inquiry into Mental Health and
Well-being in Later Life, a three-year project led by Age Concern and the Mental
Health Foundation.
2 Composition of the group: The four older people in the group were African-
Caribbean women, over the age of 60 years (by African-Caribbean, we are referring to
people from the West-Indies and Guyana). As active members of their local
communities and churches, they were particularly interested in strategies to minimise
the isolation of the elderly people they knew. The seven, younger participants were
professionals from the voluntary and statutory sectors, four of whom were Asian, two
were white British and one was African-Caribbean. The meeting lasted three hours
and the older people were prominent in the discussion.

3 Method of consultation: Invitation letters to groups and individuals were sent with
a questionnaire, to indicate the sort of issues that would be discussed. The group was
welcomed by the convenor, Nilam Chauhan, and the meeting started with an
introduction, from Claire Ball, about the Inquiry. People were made aware that this
workshop was not about mental illness and that the Inquiry is interested in what
promotes mental health and well-being. Sue Vahid, an independent consultant,
facilitated the discussion. Four questions were put to the group:

1    What are the factors that promote a sense of wellbeing and positive mental
     health in older people?

2    What are some of the issues specific to African-Caribbean / Asian older people
     that affect their sense of well-being and positive mental health?

3    Can we distinguish between the needs of people aged up to 65 years from those
     who are older, in relation to the promotion of mental health and well-being?

4    What can be done to ensure that the beneficial factors identified previously are
     effective and present? Who should be responsible for ensuring this?

Questions and 1 and 2 were discussed in the large group setting. Later, people worked
in smaller groups, to come up with suggestions about what would help promote
positive mental health and well-being. The ideas were shared in a final plenary
session. Everyone wanted a copy of the report and the evaluations were positive.


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4 What promotes mental health and well-being?

4.1 Companionship, respect & understanding : “People need people around them.”
During an assessment, an elderly gentleman who had a number of serious medical
conditions said, “my main illness that is the most painful is loneliness.”
Older people need people who “understand the person‟s situation.” Understanding
must come from the carer and the family. „Respect‟ means that “they don‟t look at
people as a liability.”

4.2. Good health and control over health issues: Older people enjoying good health
will have a greater sense of well-being. However, the mental health of those who have
medical problems can be positive if there are people around them who “fully
understand what they are going through and even what medication they should be
taking.” Some people who are unable to do things for themselves need to be treated
with understanding and respect. For example, the attendant who goes to pick them up
should “have patience and not hurry people who are not very mobile any more.”

Older people would feel more confident about their GP and other carers if they were
allowed to “have control of their own health issues” and their health care traditions
respected. Medical interventions need to allow for traditional diets and health care
conventions. “If people want to use their own kinds of treatments, that should be
allowed.” There are complementary treatments that can help and these should be
made available.

4.3 Independence and Choice: People take a pride in doing things for themselves.
“You feel proud of yourself that you can manage.” Those who can‟t, “it bothers them
to have to ask for help.” “You feel so embarrassed if other people have to do things
for you.”

Mobility affects people‟s sense of independence. “You feel good about yourself if you
can get around.”

As people become dependent, it is even more important to ensure that they have a
choice in what happens to them, what help they take and what treatments they accept.
People should be able to “make independent decisions about whether to seek help or
not”; they “should have choice and independence to make their own decisions.”

4.4 Acceptance: Those who do not accept their fate are survivors because if you
accept your circumstances then “you give up on yourself; so you lose your respect and
integrity.”
However, not everyone agreed with this view: some thought older people can help
themselves by being more philosophical about their situation. Some older people do
not want to accept that they are in difficulty, or even that they can‟t look after
themselves. “Some people will never accept what happens to them and it makes them
feel worse if they don‟t accept it.”
“A lot of people are in denial and when they are in denial they can come across
aggressively,” which may not help if they need help.



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And there is the question of death. “Some people will never accept that their time is
cut.”


4.5 Having a Purpose & a Sense of Belonging: these two factors go together. People
need a sense of purpose to want to get out of bed and face another day. You need
respect and acknowledgement and this happens when you have a role, you know you
have something to contribute. Older people want to be consulted by the family, by
relatives and the community, especially around festivals and celebrations. But the
purpose is related to people: “it‟s what you do with other people and what you do for
them.”


Social networks: People spoke about the importance of having a group to belong to, a
group of friends to look forward to, a church in which to be active. Belonging to a
group gives you a sense of purpose -“even if you can‟t get to the group or do the
activity.” It gives you your identity.
“On Mondays I go to coffee morning; Tuesdays I go to college to a computer class;
Wednesdays I go swimming or go for a walk; Thursdays I run a club.” Things “only
become worse when there is nothing to engage in each day, not meeting people or
making new friends.”


4.6 Being involved in the household: Those who live with their families, even those
who don‟t, want a role in it. They want to be involved, as an elder. “To feel part of it
and not excluded.” They want to be consulted and get involved in the planning of
important family events such as weddings. They want to be invited to go along when
the family visits friends or attends functions. They want to be asked if they would like
to go on holiday with the family – “even if they decide not to go.”
There is also a role for grandparents. They can play with the grandchildren and,
especially if there is respect shown in the household towards older people, they find
that younger people will grow up to listen to them - even if they don‟t do what they
say. Grandparents can talk to them more easily about the consequences of crossing
boundaries. Sometimes they are more likely to listen to the grandparents, especially
when there is tension between parents and teenagers. “My father can talk to my
teenage boy. He can tell him how they used to do things (in Jamaica).”
“I grew up old-fashioned: to have manners and respect for older people. I have 21
grandchildren and I take them to Sunday School. At a certain age when they don‟t
want to go, [at least] they have had that experience when young.”


4.7 Volunteering: People want to do whatever they can. “I move about with God‟s
help, to help others less fortunate than myself. Give someone a word of
encouragement – or whatever I can do.” Older people in the group gave examples of
what they like to do: visit friends or someone from the church who is in hospital; visit
house-bound people, do their shopping, cooking, cleaning, ironing. There should be
opportunities for volunteering.




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Mental Health & Well-being (2)                                       Insaaf Consultants


4.8 Comfortable, physical environment: The house needs to be warm and
comfortable. Older people need surroundings that are homely and lived in, with
people coming and going.
4.9 Sense of Security: This was considered to be very important yet older people do
not always feel secure.
a) Locality issues: the fear of crime in the locality, especially if one‟s home is not in
   a safe or „good‟ area; fear of the physical environment such as uneven pavements
   which are a hazard; problems with the property they are living in, all these affect
   the sense of well-being.
b) Financial issues: the need to be independent; to know that they can make
   arrangements such as for their funeral.
c) Trust in carers: whether they will be treated well and if they can negotiate their
   own requirements. There is a power imbalance between social workers and the
   older persons and the latter need to feel that they are not dictated to.


4.10 A broader philosophical approach: Those who have spiritual faith, believe in
God, belong to a religion or espouse a positive philosophy of life have a greater sense
of well-being. “If I am worried and have a friend who I can talk to, he will see me
through. This friend is Jesus. He will take me through.”


5 What are some of the issues specific to African-Caribbean / Asian
older people that affect their sense of well-being and positive mental
health?
African-Caribbean older people:

Sense of privacy: “We don‟t open up easily to strangers and outsiders as another
nation would do.” This can be a problem if people are not able to come forward and
ask for help.

Not everyone has a family: “Not everyone has children. Will anyone be there for
people who live on their own?” Often the community doesn‟t know that they are
there or what their situation is. “You don‟t know where they are are unless you seek
them out. I stop and talk to people even if I don‟t know them and they feel good –
even if it‟s just for a few minutes. They give you a card at X‟mas.”

Teaching social responsibility at an early age: It is difficult for older people whose
children weren‟t brought up in the Caribbean. The culture is changing and there isn‟t
the extent of inter-generational support in the Caribbean community here. There, in
the Caribbean, you were taught to visit the elderly in the neighbourhood “before we
go to school or you would go and look after them in the evenings. You would look
after the elderly people until they died.”

“Children were taught to look after the elderly instead of putting them into a home –
would be nice if it [the practice] come around again.”



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Mental Health & Well-being (2)                                        Insaaf Consultants


Visiting home: “My father spends 6 months in Jamaica and 6 months in England. He
is happy and very excited when he‟s going to Jamaica. And then he‟s excited about
coming back.”

People said they visited „home‟ frequently. They were attached to the home country
and wanted to visit regularly. “But most of my children and grandchildren are here. I
was married here. So my home is where my family is.”

Language: Most people speak patois and their language needs are often overlooked.
When seen by GPs and other professionals, they will try and speak in the „Queen‟s
English‟ and that means they will not be communicating freely or easily. So their
„needs assessment‟ may not be accurate.

Cultural issues: Older people have maintained their ideas of cleanliness and hygiene,
both personal and in relation to food preparation, washing up etc. They have culturally
specific needs in this area which are not recognised in mainstream homes and day
centres. They also have traditional remedies and diets that should be respected.

Asian older people:

Not going into a home: This group of professionals felt that since it is a very
important cultural value that children should look after their parents, those who are
cared for in their family homes feel respected and valued. Elders feel disrespected and
disowned if they are put into a residential home. It is therefore vital that older people
are helped to remain in their own homes and/or their families are helped to take care
of them. However, the concept of the extended family is being eroded and perhaps
what is now vital is to reassure elders that their families are there for them - when they
are needed, eg. when visiting the GP, dentist or hospital.

Not being isolated in the home: Even those who live with their families can feel very
isolated during the day when their sons and daughters are at work and the children are
at school. They need to go out and be involved with others. However, there is a
misconception about Day Care Centres which are seen as places for people with
dementia or mental illness. This view is strengthened if no provision is made for those
who are mentally active and just need to go out and socialise at a centre. If everyone
is put together, the Centre may not be attractive to some older people who do not need
personal care.

Culturally specific Centres: More drop-in centres are needed for Asian elders as
well as culturally specific day care centres that cater for a variety of needs. The Asian
community is diverse and some felt that they should not be lumped together. When
this happens, social groups form on the basis of language and ethnicity, e.g. Gujarati,
Punjabi. There was a difference of views here. One organisation, Shakti, had
canvassed their members to see if they minded being together and they said that they
were content as long as their needs were being met.

Language: Appropriate assessment of needs requires cultural understanding and
communication in the older person‟s mother-tongue.




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Gender issues: There should be “same gender support for personal care.” Older
people need to have their preference respected in relation to the gender of care
workers.


6 Can we distinguish between the needs of people aged up to 65
years from those who are older, in relation to the promotion of
mental health and well-being?

6.1 Under-65s: Those between 50 – 65 years of age are generally fit and their needs
are not as great as those of older people unless they have suffered a stroke or have an
illness. Most are still working. Many were brought up here and have different
expectations of services. Their outlook on life is probably very different from the
earlier generation because they would have adjusted to the majority culture and have
modified their expectations regarding mutual support and help in later life.
6.2 Over-65s: They have greater physical needs. They are entirely first generation
settlers in the UK and feel the gap, acutely, in terms of values and expectations. They
may feel more disappointed in later life and suffer from that experience. They are also
less likely to have had an advanced formal education and may not be able to
understand what is happening to them around mental health issues, depression.
6.3 Impact of racism: The participants were asked about the impact of racism and
why this was not mentioned at all during the day. The reaction was interesting:

a) That racism was just there in the wider society – endemic - something they took for
granted, “something that happens to us anyway.” So they were simply taking it in
their stride. “If you take these things into your head, it will affect you too much.” The
older members of the group gave examples of the prejudice and discrimination they
and their partners had encountered, especially in the early days of migration. They
didn‟t want to make it a key issue: racism was there but they were getting on with
their lives.

b) That it was institutional racism that was so pervasive. For example, according to
the health professionals present, Birmingham City Council‟s Strategy for Older
People doesn‟t include any reference to black and minority ethnic elders.

c) That the demand for culturally specific personal care and other services was also a
response to racism in the wider society. It was an attempt to create „safe havens‟.




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Mental Health & Well-being (2)                                    Insaaf Consultants


7 What can be done to ensure that the beneficial factors identified
previously are effective and present? Who should be responsible for
ensuring this?
Key solutions: People as key to social networks;
               Resources and better funding of voluntary organisations;
               Awareness and education for service providers, families and carers;
               Address institutional racism which ignores minority ethnic elderly.



           What needs to be done?                                             By whom?

 Venues outside the home

  Get people out of their homes by providing more
   day centres, drop-in sites, lunch clubs and other                     Local authority
   venues. All should be culturally appropriate.                         Housing
                                                                         Associations
                                                                         Government grants
 Culturally appropriate accommodation                                    Voluntary
                                                                         organisations
  More culturally based sheltered, residential and
   elderly care homes.
  Awareness of hygiene requirements and
   nutritional needs of different cultures.


 Social networks
                                                                         As above +
  Organise coffee mornings, social groups, clubs.                       Community groups
  Locate people living on their own. Befriend.
  Arrange visits to places of worship.                                  Role models within
                                                                         the community
  Increase people’s mobility by providing
   transport, especially for the over 65s.
  Persuade and empower people to try new things.
  Opportunities for voluntary work.




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             What needs to be done?                                   By whom?

   Health
                                                                 Statutory and
    Access to professionals who speak the same                  voluntary sectors
     language.
    Raise awareness of health needs, diet, fitness.             PCT
    Respect traditional remedies and provide
     complementary therapies.


   Role in the family

    Family mediation by someone within the
     community.
    More culturally knowledgeable support workers.              Community groups
    ‘Family listening’ with help from, for example,             Social Services
     community elders.
    Raising family awareness of the needs of older              Voluntary
     people.                                                     organisations
    Advocates for elders to negotiate finances, care,
     accommodation within the family or outside of it.
    Support for families who care for or even just,
     accommodate, older people. Information about
     what is available to help elders to continue living
     in the family home.
    Direct payment for services.




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  Mental Health & Well-being (2)                            Insaaf Consultants




                 What needs to be done?                                 By whom?

        Learning
        Security
         IT skills
         Gardening and access to allotments.
           Protection against fraudulent officers, cowboy           Statutory and
         workmen.
           Healthy diets.                                           voluntary sectors
         Help with security measures in the home.
         Cookery classes.                                          Community
         Maketo develop hobbies and new interests.                 groups
         Help environment safer and address crime.
         Help in understanding and managing finances.              Police
         Activities to keep brain active.                          Town Planning
         Direct payment for services. change; tolerance:
         Attitude: acceptance of                                   LEA, PCT
           limiting one’s expectations.
        Education & awareness
        Family support
         Training mediation by someone within and
         Family in cultural awareness for carers the               Community
          other service providers.
          community. Social services are not always                 groups
         Make institutions aware of how institutional
          appropriate.                                              Local Authority
          More works and what to do about it.
         racismculturally knowledgeable support workers.           Government
         Remove stigma of day care help providing
         Inter-generational listening with by from, for            Schools
          information, open days.
          example, community elders.                                Youth clubs
         Training for carers in to negotiate finances, care,
         Advocates for elders the family.
         accommodation within the family or outside of it.
          Inculcate values in young people of respect and
         care for the elderly. who care for or even just,
          Support for families
          accommodate, older people. Information about
          what is available to help elders to continue living
          in the family home.




Sue Vahid
April 2005




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