The Bangladeshi population in the UK has grown rapidly, from 6″,000 in 1961 to 162″,835 in 1991 (Eade and Garbin, 2002), and is now estimated to be over double that figure. According to the 2001 Census, there were 275″,395 Bangladeshis living in England of which 254″,704 reported their religion as Muslim, 17 per cent of England’s Muslim population (Gardner, 2002). The Bangladeshi Muslim community is the most concentrated and ethnically segregated Muslim community in England (Mental health stigma in the Muslim community, 2012) with 24 per cent of the total Bangladeshi Muslim population living in the London Borough of Tower Hamlets and a further 19 per cent of the total population living in surrounding boroughs (Gardner, 2002).
Despite the growing size of the Islamic community in the western countries, most western practitioners appear not to have been very well exposed to Islamic values and teachings during their educational careers (Sabry and Vohra, 2013). Researchers found that many Bangladeshi Muslims are hesitant to seek help from the mental health professionals in Western countries due to the differences in their beliefs and lack of understating of the helping professionals about Islamic values in their treatment modalities (Mental health stigma in the Muslim community, 2012). Consequently, Muslims might feel uncomfortable in seeking psychiatric help to avoid being in conflict with their religious beliefs (Sabry and Vohra, 2013).
According to the Mental Health Survey (2013), community survey found that there was an under-representation of British Asians in psychiatric statistics, particularly for affective disorders such as depression. Research showed that there were lower rates of depression amongst Asian migrants (Karasz, 2005), including British Bangladeshis, compared with their British White counterparts (McClelland et al, 2014). Nevertheless, this may simply be due to a failure to recognize depression by both the health professional and the Asian sufferers themselves (Sheikh and Furnham, 2000).
Bangladeshis are known to frequently present in primary care, but not with mental illness (Dein et al, 2008). Furthermore, primary care research in the UK reveals that although Bangladeshis are found to make more frequent visits to their general practitioners than the British Whites (Mcclelland et al, 2014), they are less likely to have their psychological difficulties (and particularly depression) identified ( Littlewood and dein, 2016; McClelland et al, 2014). They also provided several possible explanations for this under- representation. Firstly, it could imply that depression is a Western phenomenon and that Bangladeshis are psychologically healthier. Secondly, the somatisation hypothesis may explain the under-representation of mental illness amongst British Bangladeshis (McClelland et al, 2014). It has been suggested that Bangladeshis living in the UK are reluctant to dis- close psychological problems to health professionals (Sheikh & Furnham, 2000). Thirdly, there is clinical evidence for Bangladeshis who become depressed to commonly present with somatic problems; usually complaints of widespread pain, headaches, and difficulty in breathing (McClelland et al, 2014).
In non-Western cultures, there is a tendency to attribute a supernatural force, such as black magic and possession by evil spirits as the underlying cause for mental illness (Weatherhead and Daiche, 2010). The use of religious or spiritual healers, who offer culture- specific approaches to mental
illness and treatment, is an established form of treatment within the Bangladeshi community (Dein et al, 2008). Bangladeshis living in the UK are known to use such traditional healers (Hussain & Cochrane, 2004). More specifically, there is a strong belief in the existence of Jinn (beings who cannot be seen but are able to cause harm to humans through possession) and the “evil eye” (the power of envy which can cause both mental and physical ill-health) in the Bangladeshi Muslim community (Dein et al, 2008). Non-medical practitioners (faith healers) can be helpful in some circumstances. For instance, faith healers within the Bangladeshi culture also act as community counsellors (Littlewood and dein, 2016), helping their followers with a number of issues, health or non-health related
(Mental health stigma in the Muslim community, 2012). It is in these circumstances that non-medical professionals may prove beneficial. However, Weatherhead and Daiches, (2010) argues that non-medical help can hinder recovery. According to their research they found that 44.8% of the 106 patients who participated, consulted a faith healer before attending the psychiatric service, and of those 44.8%, 47% reported no improvement after seeing the faith healer, and 7% reported a worsened condition. Furthermore, cognitive factors (particularly religion and prayer) have been reported as important in managing depression by Bangladeshi Muslim women (McClelland et al, 2014). Hussain & Cochrane (2004) suggested that one reason for this is that in the South Asian cultures, the disclosure of mental illness in the family reduces the prospects of an arranged marriage (Dein et al, 2008). Thus the interest of the family replaces individual interests. This may lead to a preference for private coping strategies (Tsai and Chentsove-Dutton, 2002).
Furthermore, Bangladeshi women in the UK have been found to suffer from a medical condition termed “Begum Syndrome” (Hussain and Chochrane, 2004). They go on to state it has been argued that many of these women visit their doctor for symptoms which to them relate to physical pain inside the body. In fact, these symptoms are caused by the need to express their feelings towards their environment while holding back their emotions (Weatherhead and Daiche, 2010).
According to McClelland et al (2014) it is hypothesised that overall, the British Bangladeshis will have more conservative and negative attitudes towards depression than British Whites but this effect will be moderated by age; the younger British Bangladeshis will have similar beliefs and attitudes towards depression as British Whites (McClelland et al, 2014).
Furthermore, the older British Bangladeshis generally tended to show more negative attitudes towards depression than younger British Bangladeshis ( Littlewood and Dein, 2016). With respect to general beliefs about depression, and unlike younger British Bangladeshis and British Whites, older British Bangladeshis associate depression with personal shame, and loss of respect and dignity for the family (McClelland et al, 2014)). With respect to treatment of depression, British Bangladeshis place greater importance on the role of religion, family and friends, and have less faith in the effectiveness of counselling and therapy than British Whites (Dein et al, 2008; Mental health in the Muslim community, 2012; McClelland et al, 2014). McClelland et al (2014) go on to claim that this highlights the importance of the family in the British Bangladeshi culture and supports the notion that Asians are more likely to use a lay referral system rather than seeking professional help. This may imply that the British Bangladeshis do not view depression to be such a serious illness (Dein et al, 2008), and the depressed individual can get help from the family rather than a health professional (Islam et al 2015), but alternatively, it may indicate a fear of being stigmatised.
The fear of social stigma and shame delayed help-seeking in all focus groups, particularly in the South Asian communities (Islam et al 2014). Voluntary and community organization representatives and spiritual care representatives emphasized that the label of mental illness held repercussions for carers and family members affecting marriage prospects and positions within South Asian communities (Bhui and Bhugra, 2002).
According to (Bhui and Bhugra (2002), lack of knowledge and understanding was perceived to be a key barrier to delay appropriate help-seeking by commissioners, voluntary and community organization representatives (Greenwood et al 2014).
Ferbnando and Keating (2008) emphasizes, good practice is underpinned by good principles. A person centred planning is the foundation for truly personalised services. Lie ́geois, and Van Audenhove (2005) agree and state, social care service providers must follow the eight fundamental values of the social care model. These values are: autonomy, privacy, safety, trust, participation, solidarity, and justice. Autonomy gives the freedom to make choices. Those involved in mental health care must endeavour to the best of their ability to restore this capacity to choose so that the person concerned can make free choices (Claire, 2012; Fernando, 2010). The value of privacy means the personal life or intimacy of a person. Physical privacy refers to the intimacy of one’s own body. Psychological privacy concerns one’s emotions and life (Fernando and Keating, 2008). It is important, therefore, to distinguish between desirable and undesirable psychological and physical contact. Safety, the protection of physical and psychological integrity, and the protection of the physical and psychological health of a person (Claire”,2012; Fernando, 2010). The fundamental value underpinning any form of relationship is trust. It is the basis of cooperation. Good care will succeed only if people commit themselves to cooperation (Lie ́geois, and Van Audenhove, 2005; Mental health stigma in the Muslim community, 2012). Participation implies a genuine desire on the part of the person in care to integrate with other citizens in the community (Karasz, 2005; Greenwood et al, 2014). At the same time, it also implies a genuine desire on the part of other citizens to actively include the person in care within the community (Greenwood et al 2014). Solidarity represents the encouragement and help of one individual or group for another, rooted in shared aims, opinions or feelings. Finally, Justice amounts to the right distribution of goods and services in society (Lie ́geois, and Van Audenhove, 2005).
For people who lack capacity to make decisions about their mental health, The Mental Capacity Act 2005 (MCA) may provide the protection that is needed. For most adults who need help with their mental health problems, but refuse intervention, The Mental Health Act 1983 (MHA) provides the legal framework to detain access and treat someone against their will. For children and young people, it is more complex, with parental authority providing additional sources of authority upon which professionals may rely (Claire, 2012).
Social care settings must follow The Human Rights Act 1998 (HRA). It works by imposing a duty on public authorities to only act in way that is compatible with the European Convention of Human Rights (ECHR). This means not doing things that infringe people’s rights and positively intervening to ensure people have access to these rights (Gov.UK, 2015).
Under the Equality Act 2010, people are protected from discrimination and harassment in different context based on their protected characteristics such as disability, gender reassignment, pregnancy, race, religion, sex and sexual orientation (Gov.UK, 2015).