Engaging diverse populations: moving beyond boxticking

A few weeks ago I attended the National Substance Misuse Conference in Birmingham and ran a workshop looking at our sector’s current response to the use of drugs and alcohol within black and minority ethnic (BME) communities. It was an interesting session: I gave an overview of the issues below and was delighted to showcase Aquarius’ ground-breaking Shanti service which supports Sikh alcohol users and their families. Below the issue is further probed.

What does the data say?

The NDTMS data shows that there are proportionately fewer people from BME populations in substance misuse treatment than in the general population. There is variation between different ethnic groups and across different substances. This doesn’t necessarily mean BME people are underrepresented in treatment; the figures may accurately reflect different prevalence rates.

What about wider evidence?

Due to the lack of prevalence estimates for substance misuse among BME populations, we often have to rely on anecdotal evidence from frontline workers/services in specific areas.

There have been some smaller pieces of research looking at specific ethnic groups, such as this research by the BBC finding that 27% of British Punjabi Sikhs have a family member with an alcohol problem despite alcohol being prohibited by the religion.

What does the policy and guidance say?

Reaching BME populations is not explicitly mentioned in the 2017 Drug Strategy or the 2012 Alcohol Strategy, although this may be because it is addressed in the clinical guidelines: “Services should consider the extent to which their services, and the way in which they are delivered, are accessible to all people who use drugs, how they address people’s vulnerabilities and whether they are culturally sensitive.”

What other tools do we have?

Joint Strategic Needs Assessments (JSNA) provide Health and Wellbeing Boards “with the opportunity to better understand the nature of public needs and demands on local services, which can in turn influence local commissioning strategies.” (2017 Drug Strategy) Each local area should publish a JSNA for substance misuse services, and this should address reaching BME populations.

In reality, JSNAs contain a very mixed level of detail. Haringey’s, for instance, has a detailed breakdown which reveals that the numbers of BME people in treatment is proportionate to the wider population. Gateshead’s makes no reference to ethnicity.

What other issues exist?

There are of course great cultural differences both between and within BME communities. Generation, gender, literacy and religion will all make a difference. It’s important to avoid generalisations.

Despite this there are undoubtedly other factors which may complicate the picture and constitute additional barriers to the delivery of effective and culturally sensitive services.

Problematic drug and alcohol use is stigmatised in almost all areas of society; this may happen to a greater degree in some BME communities. There is evidence that people from a BME background are more concerned about anonymity within the therapeutic support setting, and are reassured by support being delivered from a community or voluntary, rather than a statutory, service.

What next?

What do you think? At a time of austerity, does it make sense to fund standalone BME specific services, or is ensuring all practitioners are competent in dealing with their local population more appropriate? If you have experience of running, or indeed using, this kind of service then let us know.

If you want to read a bit more on this issue try:

• The Recovery Partnership’s Treatment and Recovery: Black and Minority Ethnic Communities (pdf)
• The UK Drug Policy Commission’s evidence review of the impact of drug use on BME communities (pdf) and its accompanying, much shorter, overview paper (pdf)