What are the mental health needs of the UK Central and Eastern European Community? A mixed-methods involvement and engagement strategy
UK resident Central and Eastern European nationals (UK-CEE) experience a higher prevalence of affective disorders, alcohol misuse, mental health stigma, and death through suicide. Community risk factors for poor mental health include home nation prevalence, in addition to migration, socioeconomic, and Brexit related marginalisation and psychological strain. Despite the significant community size (~2 million), little is known about community health beliefs and attitudes surrounding mental health presentation and management within UK primary care. Understanding variations in mental health presentations and morbidity is essential to culturally adapt GP management and improve outcomes. We are conducting a multi-stranded public, stakeholder, and clinician engagement and involvement strategy to evaluate the mental health primary care gap within this marginalised community.
Our approach incorporates:1) Public and Patient Involvement (PPI) health forums within Romanian and Lithuanian communities in line with INVOLVE and GRIPP2 criteria. 2) A researcher and stakeholder engagement forum (21/02/19) exploring the state of UK-CEE research. Formalised discussion topics relating to UK-CEE community well-being, mental health and primary care engagement; the research impact of Brexit; and cultural adaptation of self-harm and suicide prevention. Informed by an initial literature review, the forum is coordinating a scoping review on perceptions of mental health and primary care management within the UK CEE community. Rapidly mapping available evidence and core concepts will inform further translational mental health research within this field. 3) A cross-sectional survey to assess UK GP perceptions of CEE migrants’ mental health presentations and management. The survey intends to identify: the point of ‘drop off’ within the clinical pathway; barriers and facilitators to mental health presentation; steps to optimise mental health engagement with community members; and GP experience, knowledge, and confidence in addressing CEE mental health.
Outcomes to date include: 1) Discussion of PPI topics including community mental health perceptions and perceived needs; variation amongst CEE nationals; defining meaningful community involvement and outcomes; and potential research recruitment, design, and dissemination strategies for a in-depth exploration of community health beliefs. Themes expressed include: significant perceived mental health and suicide stigma; the importance of valued community leader or member endorsement; variable primary care satisfaction; and preference for one-on-one exploration of mental health beliefs, experience, and health service usage. 2) Defining a broad review search strategy to identify English and CEE language mental health publications and grey literature; 3) Development of the clinician survey and recruitment strategy. Interim findings expected by June 2019.
This complementary public/stakeholder, researcher, and clinician involvement and engagement strategy will inform development of a large scale mixed-method exploration and evaluation of UK-CEE mental health beliefs. Outcomes will direct development of community co-designed culturally adapted mental health management and risk stratification tools/resources for use within primary care.