Improving access to mental health care in an Orthodox Jewish community: a critical reflection upon the accommodation of otherness
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Abstract
Background: The English National Health Service (NHS) has significantly extended the supply of evidence based
psychological interventions in primary care for people experiencing common mental health problems. Yet despite
the extra resources, the accessibility of services for ‘under-served’ ethnic and religious minority groups, is considerably
short of the levels of access that may be necessary to offset the health inequalities created by their different exposure
to services, resulting in negative health outcomes. This paper offers a critical reflection upon an initiative that sought
to improve access to an NHS funded primary care mental health service to one ‘under-served’ population, an
Orthodox Jewish community in the North West of England.
Methods: A combination of qualitative and quantitative data were drawn upon including naturally occurring data,
observational notes, e-mail correspondence, routinely collected demographic data and clinical outcomes measures, as
well as written feedback and recorded discussions with 12 key informants.
Results: Improvements in access to mental health care for some people from the Orthodox Jewish community were
achieved through the collaborative efforts of a distributed leadership team. The members of this leadership team
were a self-selecting group of stakeholders which had a combination of local knowledge, cultural understanding,
power to negotiate on behalf of their respective constituencies and expertise in mental health care. Through a process
of dialogic engagement the team was able to work with the community to develop a bespoke service that
accommodated its wish to maintain a distinct sense of cultural otherness.
Conclusions: This critical reflection illustrates how dialogic engagement can further the mechanisms of candidacy,
concordance and recursivity that are associated with improvements in access to care in under-served sections of the
population, whilst simultaneously recognising the limits of constructive dialogue. Dialogue can change the dynamic of
community engagement. However, the full alignment of the goals of differing constituencies may not always be
possible, due the complex interaction between the multiple positions and understandings of stakeholders that are
involved and the need to respect the other’-s’ autonomy.
psychological interventions in primary care for people experiencing common mental health problems. Yet despite
the extra resources, the accessibility of services for ‘under-served’ ethnic and religious minority groups, is considerably
short of the levels of access that may be necessary to offset the health inequalities created by their different exposure
to services, resulting in negative health outcomes. This paper offers a critical reflection upon an initiative that sought
to improve access to an NHS funded primary care mental health service to one ‘under-served’ population, an
Orthodox Jewish community in the North West of England.
Methods: A combination of qualitative and quantitative data were drawn upon including naturally occurring data,
observational notes, e-mail correspondence, routinely collected demographic data and clinical outcomes measures, as
well as written feedback and recorded discussions with 12 key informants.
Results: Improvements in access to mental health care for some people from the Orthodox Jewish community were
achieved through the collaborative efforts of a distributed leadership team. The members of this leadership team
were a self-selecting group of stakeholders which had a combination of local knowledge, cultural understanding,
power to negotiate on behalf of their respective constituencies and expertise in mental health care. Through a process
of dialogic engagement the team was able to work with the community to develop a bespoke service that
accommodated its wish to maintain a distinct sense of cultural otherness.
Conclusions: This critical reflection illustrates how dialogic engagement can further the mechanisms of candidacy,
concordance and recursivity that are associated with improvements in access to care in under-served sections of the
population, whilst simultaneously recognising the limits of constructive dialogue. Dialogue can change the dynamic of
community engagement. However, the full alignment of the goals of differing constituencies may not always be
possible, due the complex interaction between the multiple positions and understandings of stakeholders that are
involved and the need to respect the other’-s’ autonomy.
Topics
Main Topic: Other Health Education Mental Health Haredi / Strictly Orthodox Jews Jewish - Non - Jewish Relations
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s This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made
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17(557)
DOI
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Link to article, Improving access to mental health care in an Orthodox Jewish community: a critical reflection upon the accommodation of otherness
Bibliographic Information
Improving access to mental health care in an Orthodox Jewish community: a critical reflection upon the accommodation of otherness. 2017: https://archive.jpr.org.uk/10.1186/s12913-017-2509-4
