1. MTETEZI Developing mental health advocacy with African and Caribbean men African and Caribbean mental health service, Manchester Equalities National Council for Black and Disabled People Lancashire Advocacy University of Central Lancashire

2. Knowledge Review Systematic review of published literature Systematic review of published literature Practice survey Practice survey –Telephone interviews –Case studies –Focus groups

3. Aims To find out what is already known about relevant advocacy provision from research reports and service descriptions. To find out what is already known about relevant advocacy provision from research reports and service descriptions. To find out what is already being provided and what is needed by asking people. To find out what is already being provided and what is needed by asking people.

4. Knowledge about mental health advocacy for African and Caribbean men Research literature – lack of evidence for effectiveness and evaluation Research literature – lack of evidence for effectiveness and evaluation Practice survey – the term ‘advocacy’ did not always make sense to people Practice survey – the term ‘advocacy’ did not always make sense to people Generic mental health advocacy services tended not have well developed strategies for providing advocacy with African and Caribbean men Generic mental health advocacy services tended not have well developed strategies for providing advocacy with African and Caribbean men

5. Three broad organisational forms African and Caribbean focused organisations African and Caribbean focused organisations Black and Minority Ethnic (BME) focused organisations Black and Minority Ethnic (BME) focused organisations Advocacy focused organisations Advocacy focused organisations

6. Expressed need for advocacy Clearly associated with patterns of anomalous treatment in mental health services Clearly associated with patterns of anomalous treatment in mental health services Medication especially highlighted Medication especially highlighted Masculinity and mental health Masculinity and mental health Cultural sensitivity Cultural sensitivity Racism Racism

7. Access to advocacy Location in community important Location in community important Association with other mental health services promotes personal development and empowerment Association with other mental health services promotes personal development and empowerment Relative lack of monitoring for ethnicity and gender Relative lack of monitoring for ethnicity and gender

8. Advocacy outcomes Weak evidence in research studies for outcomes Weak evidence in research studies for outcomes Few evaluative studies Few evaluative studies None have specifically looked at African and Caribbean men None have specifically looked at African and Caribbean men Also relative lack of routine data collection in advocacy services Also relative lack of routine data collection in advocacy services

9. Outcomes II Focus group participants framed outcomes in terms of: Focus group participants framed outcomes in terms of: –Having needs met –Helping to resolve problems –Upholding rights and entitlements

10. Outcomes III Advocacy organisations tended to see outcomes in terms of: Advocacy organisations tended to see outcomes in terms of: –Promoting empowerment & self-advocacy –Promoting autonomy and control in relationships with mental health services –Particularly in decision making about care and treatment BCVOs also framed outcomes in terms of: BCVOs also framed outcomes in terms of: –Meeting a broad range of social needs –Tackling social disadvantage

11. Shared cultural background An advocate ‘like me’ An advocate ‘like me’ Shared sense of identity and cultural background Shared sense of identity and cultural background Insider knowledge Insider knowledge Linked to issues of trust and mistrust Linked to issues of trust and mistrust Importance of choice Importance of choice

12. Relationships The quality of advocacy relationship The quality of advocacy relationship Connecting at the personal level Connecting at the personal level –Also can be linked to shared ethnicity but not necessarily Continuity of relationship Continuity of relationship Valued advocacy relationships set in contrast to experiences in mental health services Valued advocacy relationships set in contrast to experiences in mental health services

13. How best to organise advocacy services Proactive Proactive Ensuring access Ensuring access Delivering a high quality service Delivering a high quality service Developing a whole system of advocacy provision – emphasising choice Developing a whole system of advocacy provision – emphasising choice Urgent need to address capacity, resources and funding issues. Urgent need to address capacity, resources and funding issues. More thoughtful planning and commissioning More thoughtful planning and commissioning

14. Transforming mental health services Need for wider reform of mental health services Need for wider reform of mental health services Holistic and community oriented approaches of BCVOs Holistic and community oriented approaches of BCVOs In tune with current vogue for Recovery based approaches In tune with current vogue for Recovery based approaches And promotion of social inclusion And promotion of social inclusion

15. Conclusion African and Caribbean men require advocacy that is culturally sensitive African and Caribbean men require advocacy that is culturally sensitive This must address previous experiences of mental health services This must address previous experiences of mental health services Evidence for good examples of delivering high quality advocacy Evidence for good examples of delivering high quality advocacy However, reactive, rather than proactive services disadvantage African and Caribbean clients However, reactive, rather than proactive services disadvantage African and Caribbean clients A context of mistrust of mainstream services and confusion about the meaning of advocacy can get in the way of anticipating its value. A context of mistrust of mainstream services and confusion about the meaning of advocacy can get in the way of anticipating its value. Once people experience advocacy they are usually satisfied with its quality Once people experience advocacy they are usually satisfied with its quality

16. Inclusive research Range of partner organisations Range of partner organisations Thorough involvement in project design and development Thorough involvement in project design and development Construction of survey tools, interview schedules etc Construction of survey tools, interview schedules etc Support and training for focus group facilitators Support and training for focus group facilitators Approach to facilitation of focus groups Approach to facilitation of focus groups Interviewing in the case studies Interviewing in the case studies Commenting on emergent findings and drafts of reports Commenting on emergent findings and drafts of reports

17. Reflections on the Project Fairly unusual project Fairly unusual project Diverse partners Diverse partners The research process is of value in and of itself The research process is of value in and of itself –Finding ways of engaging with people on their own terms –Saw people growing in confidence –Felt it made people happy Report touched me as a survivor Report touched me as a survivor Recognise the participants stories in my own experiences Recognise the participants stories in my own experiences Action sustains hope. Hopeful it will make a difference. Action sustains hope. Hopeful it will make a difference.