Skip to main content

Mental health services for black and minority ethnic elders in the United Kingdom: a systematic review of innovative practice with service provision and policy implications

  • Sarmishtha Bhattacharyya (a1) (a2) and Susan Mary Benbow (a2) (a3)

Background: The proportion of older people from black and minority ethnic (BME) groups in the United Kingdom (UK) is increasing steadily as the population ages. The numbers with dementia, depression, and other mental health problems are predicted to increase. Government policy documents have highlighted gaps in services for BME elders and/or the need to develop culturally appropriate services, in order to prevent people from BME communities from becoming socially excluded and finding services hard to access. This paper reviews published examples of innovative services and key learning points from them.

Method: A search was carried out on Pubmed, Medline, and Google Scholar for service developments aimed at BME elders in the UK. Sixteen relevant papers and reports were identified and were analysed to identify learning points and implications for clinical practice and policy.

Results: Commissioning issues included were forward planning for continuing funding and mainstreaming versus specialist services. Provider management issues included were employing staff from the communities of interest, partnership, and removing language barriers. Provider service issues included were education for service provider staff on the needs of BME elders, making available information in relevant languages, building on carers’ and users’ experiences, and addressing the needs of both groups.

Conclusion: A model for structuring understanding of the underutilisation of services by BME elders is suggested. The main emphasis in future should be to ensure that learning is shared, disseminated, and applied to the benefit of all communities across the whole of the UK and elsewhere. Person-centred care is beneficial to all service users.

Corresponding author
Correspondence should be addressed to: Dr. Susan Mary Benbow, Professor of Mental Health and Ageing, Centre for Ageing and Mental Health, BL 167 Staffordshire University, Blackheath Lane, Stafford ST18 0AD, UK. Phone: +44 (0)1785 353742; Mobile: +44 (0)7789 485435. Email:
Hide All
Adamson, J. (2001). Awareness and understanding of dementia in African/Caribbean and South Asian families. Health and Social Care in the Community, 9, 391396. doi:10.1046/j.0966-0410.2001.00321.x.
Aday, L. A. and Andersen, R. (1975). Development of Indices of Access to Medical Care. Ann Arbor, MI: Health Administration Press.
Adelman, S. (2010). Prevalence and recognition of dementia in primary care: a comparison of older African–Caribbean and white British residents of Haringey. PhD thesis, University College London. Available at:; last accessed 3 August 2012.
Age Concern London (2002). Age Concern Information and Advice Services for black and minority ethnic older people: a strategy for London.
Alzheimer's Society (2007). Dementia UK. The full report (165 pp). London: Alzheimer's Society.
Andersen, J. G. (1973). Health services utilization: framework and review. Health Service Research, 8, 184199.
Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: does it matter? Journal of Health and Social Behavior, 36, 110.
Andersen, R. and Newman, J. F. (1973). Societal and individual determinants of medical care utilization in the United States. The Milbank Memorial Fund Quarterly: Health and Society, 51, 95124.
Barker, J. (1984). Research Perspectives on Ageing: Black and Asian Old People in Britain, 1st ed. London: Age Concern Research Unit.
Benbow, S. M. (2012). Patient and carer participation in old age psychiatry in England. Part II: models of participation. International Psychogeriatrics, 24, 185196. doi:10.1017/S1041610211001876.
Bice, T. W., Eichhorn, R. L. and Fox, P. D. (1972). Socioeconomic status and use of physician services: a reconsideration. Medical Care, 10, 261271.
Blais, R. and Maïga, A. (1999). Do ethnic groups use health services like the majority of the population? A study from Quebec, Canada. Social Science and Medicine, 48, 12371245. doi:10.1016/s0277-9536(98)00423-7.
Blakey, H., Pearce, J. and Chesters, G. (2006). Minorities Within Minorities: Beneath the Surface of South Asian Participation. York: Joseph Rowntree Foundation.
Butt, J. and O'Neil, A. (2004). “Let's Move on.” Black and Minority Ethnic Older People's Views on Research Findings. York: Joseph Rowntree Foundation.
Cambridge, J., Singh, S. P. and Johnson, M. (2012). The need for measurable standards in mental health interpreting: a neglected area. The Psychiatrist, 36, 121124. doi:10.1192/pb.bp.110.031211.
Centre for Community Mental Health (2008). Irish Mental Health in Birmingham: What is Appropriate and Culturally Competent Primary Care? Available at:; last accessed 4 October 2012.
Chau, R. C. M. (2007). The Involvement of Chinese Older People in Policy and Practice. Aspirations and Expectations. York: Joseph Rowntree Foundation.
Cooper, C., Tandy, A. R., Balamurali, T. B. S. and Livingston, G. (2010). A systematic review and meta-analysis of ethnic differences in use of dementia treatment, care, and research. American Journal of Geriatric Psychiatry, 18, 193203.
Dementia Plus (2001). Twice a Child. Available at:; last accessed 19 January 2012.
Dementia Plus (2003). Twice a Child II. Available at:; last accessed 19 January 2012.
Department of Health (1999). National Service Framework for Mental Health. Modern Standards and Service Models. Available at:; last accessed 6 February 2012.
Department of Health (2001). National Service Framework for Older People. Available at:; last accessed 6 February 2012.
Department of Health (2005). Delivering Race Equality in Mental Health Care: An Action Plan for Reform Inside and Outside Services and the Government's Response to the Independent Inquiry into the Death of David Bennett. Available at:; last accessed 6 February 2012.
Department of Health/Care Services Improvement Partnership (2005). Everybody's Business. Integrated Mental Health Services for Older Adults: A Service Development Guide. Available at:; last accessed 26 July 2012.
El Ansari, W., Newbigging, K., Roth, C. and Malik, F. (2009). The role of advocacy and interpretation services in the delivery of quality healthcare to diverse minority communities in London, United Kingdom. Health and Social Care in the Community, 17, 636646.
Faculty of the Psychiatry of Learning Disability Working Group (2011). Minority Ethnic Communities and Specialist Learning Disability Services. Available at:; last accessed 1 August 2012.
Ferri, C. al. (2005). Global prevalence of dementia: a Delphi consensus study. The Lancet, 366, 21122117. doi:10.1016/s0140-6736(05)67889-0.
Gibson, G. (1972). Explanatory models and strategies for social change in health care behavior. Social Science and Medicine, 6, 635.
Hipwell, A., Hicks, L., Juttla, H., Pearson, L. and Benbow, S. M. (2006). Meeting the needs of Asian elders with dementia. Journal of Dementia Care, 14, 14, 16.
Horn, C., Markey, H. and Bracher, M. (2007). Report of the Community Led Research Project Focussing on the Mental Health Needs of the Older Irish Adults Community in Birmingham. Available at:; last accessed 4 October 2012.
Iliffe, S. and Manthorpe, J. (2004). The debate on ethnicity and dementia: from category fallacy to person-centred care? Aging and Mental Health, 8, 283292. doi:10.1080/13607860410001709656.
Jang, Y., Chiriboga, D. A., Kim, G. and Phillips, K. (2008). Depressive symptoms in four racial and ethnic groups. Research on Aging, 30, 488502. doi: 10.1177/0164027508316617.
Jutlla, K. and Moreland, N. (2007). Twice a Child III. Available at:; last accessed 19 January 2012.
Katbamna, S. and Matthews, R. (2007). Ageing and Ethnicity in England. A Demographic Profile of BME Older People in England. Available at:; last accessed 3 August 2012.
Kaur, H., Jutlla, K., Read, K. and Moreland, N. (2010). How a link nurse ensured equal treatment for people of Asian origin with dementia. Nursing Times, 106, 1215.
Kendall, J. and Kohler, I. (2010). Bringing dementia out of the shadows for BME elders. Journal of Dementia Care, 18, 1617.
Koehn, S. (2009). Negotiating candidacy: ethnic minority seniors’ access to care. Ageing and Society, 29, 585608.
Lane, P. and Hearsum, S. (2007). The Mental Health and Well Being of Black and Minority Ethnic Elders: A Foundational Report on the Research Literature and a Mapping of National Resources. Available at:; last accessed 3 August 2012.
Lindesay, J., Jagger, C., Hibbett, M. J., Peet, S. M. and Moledina, F. (1997a). Knowledge, uptake and availability of health and social services among Asian Gujarati and white elderly persons. Ethnicity and Health, 2, 5969. doi:10.1080/13557858.1997.9961815.
Lindesay, J., Jagger, C., Mlynik-Szmid, A., Sinorwala, A., Peet, S. and Moledina, F. (1997b). The mini-mental state examination (MMSE) in an elderly immigrant Gujarati population in the United Kingdom. International Journal of Geriatric Psychiatry, 12, 11551167.
Livingston, G., Leavey, G., Kitchen, G., Manela, M., Sembhi, S. and Katona, C. (2001). Mental health of migrant elders – the Islington study. The British Journal of Psychiatry, 179, 361366. doi:10.1192/bjp.179.4.361.
Manthorpe, J. and Hettiaratchy, P. (1993). Ethnic Minority Elders in the UK. International Review of Psychiatry, 5, 171178. doi:10.3109/09540269309028308.
Matthews, Z. (2008). The health of Gypsies and Travellers in the UK. Better Health Briefing 12. London: Race Equality Foundation.
McCracken, C. al. (1997). Prevalence of dementia and depression among elderly people in black and ethnic minorities. The British Journal of Psychiatry, 171, 269273. doi:10.1192/bjp.171.3.269.
Mechanic, D. (1978). Medical Sociology: A Comprehensive Text, 2nd ed. New York: Free Press.
Meri Yaadain (2009). The Meri Yaadain Project. Available at:; last accessed 3 August 2012.
Mir, G., Nocon, A., Ahmad, W. and Jones, L. (2001). Learning Difficulties and Ethnicity Report to the Department of Health. London: Department of Health.
Mukadam, N., Cooper, C. and Livingston, G. (2011). A systematic review of ethnicity and pathways to care in dementia. International Journal of Geriatric Psychiatry, 26, 1220. doi:10.1002/gps.2484.
National Audit Office (2007). Improving Services and Support for People with Dementia. Available at:; last accessed 3 August 2012.
National Mental Health Development Unit (n/d). A National Mapping of Projects for BME Elders to Support Their Mental Health Well‐Being. Available at:; last accessed 3 August 2012.
Office for National Statistics (2011). Population Estimates by Ethnic Group (Experimental), Mid-2009. Statistical Bulletin. Available at:; last accessed 3 August 2012.
Parker, C. and Philp, I. (2004). Screening for cognitive impairment among older people in black and minority ethnic groups. Age and Ageing, 33, 447452.
Rait, G., Burns, A. and Chew, C. (1996). Age, ethnicity, and mental illness: a triple whammy. BMJ, 313, 13471348. doi: 10.1136/bmj.313.7069.1347.
Ramsey, V., Stevens, S., Bryan, K., Binder, J. and Cockle-Heame, J. (2009). Using the Barnes Language Assessment with older ethnic minority groups. International Journal of Geriatric Psychiatry, 24, 426431.
Redelinghuys, J. and Shah, A. (1997). The characteristics of ethnic elders from the Indian subcontinent using a geriatric psychiatry service in West London. Aging and Mental Health, 1, 243247. doi:10.1080/13607869757137.
Richards, al. (2000). Cognitive function in UK community-dwelling African Caribbean and white elders: a pilot study. International Journal of Geriatric Psychiatry, 15, 621630.
Royal College of Psychiatrists (2009). CR156. Psychiatric Services for Black and Minority Ethnic Older People. Available at:; last accessed 3 August 2012.
Royal College of Psychiatrists (2011). The Equality Act and Adult Mental Health Services: Achieving Non-Discriminatory, Age-Appropriate Services. Joint Guidance from the Royal College of Psychiatrists’ Faculties of Old Age and General and Community Psychiatry. Occasional Paper 82. Available at:; last accessed 3 August 2012.
Sayed, A. (2008). Good Practice Case Study “Are you really listening”? Available at: you really listening-case study.PDF; last accessed 3 August 2012.
Scheppers, E., van Dongen, E., Dekker, J., Geertzen, J. and Dekker, J. (2006). Potential barriers to the use of health services among ethnic minorities: a review. Family Practice, 23, 325348. doi:10.1093/fampra/cmi113.
Seabrooke, V. and Milne, A. (2009). Early intervention in dementia care in an Asian community. Lessons from a dementia collaborative project. Quality in Ageing, 10, 2936.
Shah, A. (2007). Demographic changes among ethnic minority elders in England and Wales: implications for development and delivery of old age psychiatry services. International Journal of Migration, Health and Social Care, 3, 2232.
Shah, A. (2008). Estimating the absolute number of cases of dementia and depression in the black and minority ethnic elderly population in the United Kingdom. International Journal of Migration, Health and Social Care, 4, 415.
Shah, A. and Elanchenny, N. (2002). Dementia services for ethnic minority elders with dementia. In Benson, S. (ed.), Dementia Topics for the Millennium and Beyond (pp. 2735). London: Hawker Publications.
Shah, A. and MacKenzie, S. (2006). Disorders of ageing cross cultures. In Bhugra, D. (ed.), Textbook of Cultural Psychiatry. Cambridge: Cambridge University Press.
Shah, A. K. and Oommen, G. (2006). Designing and delivering culturally appropriate mental health services for older people. In Moodley, P. and Williams, R. (eds.), A Manual to Support Training in Cultural Capability. London: Gaskell.
Shah, A., Lindesay, J. and Jagger, C. (1998). Is the diagnosis of dementia stable over time among elderly immigrant Gujaratis in the United Kingdom (Leicester)? International Journal of Geriatric Psychiatry, 13, 440444.
Silveira, E. and Ebrahim, S. (1995). Mental health and health status of elderly Bengalis and Somalis in London. Age and Ageing, 24, 474480. doi:10.1093/ageing/24.6.474.
Silveira, E. R. T. and Ebrahim, S. (1998). A comparison of mental health among minority ethnic elders and whites in East and North London. Age and Ageing, 27, 375383. doi:10.1093/ageing/27.3.375.
SubCo Trust Ltd. (2007). Reach Out to Elders Report. Research Project Focussing on Asian Elders Views of Services in Newham. Available at: trust reach out to elders.pdf; last accessed 5 October 2012.
Suchman, E. A. (1965). Social patterns of illness and medical care. Journal of Health Human Behaviour, 6, 216.
Tribe, R. (2009). Working with interpreters in mental health. International Journal of Culture and Mental Health, 2, 92101. doi: 10.1080/17542860903115976.
Tribe, R., Lane, P. and Heasum, S. (2009). Working towards promoting positive mental health and well-being for older people from BME communities. Working with Older People, 13, 3540.
Vulpiani, P., Comelles, J. M. and van Dongen, E.(eds.), (2000). Health for All, All in Health. European Experiences on Health Care for Migrants. Perugia: Cidis/Alisei.
Westminster Advocacy Service for Senior Residents/Dementia Advocacy Network (2009). Bringing Dementia Out of the Shadows for BME Elders. A Report on the Work of the Ethnic Minorities Dementia Advocacy Project (EMDAP). Available at:; last accessed 3 August 2012.
Yu, W. K. (2000). Chinese Older People. A Need for Social Inclusion in Two Communities. Bristol: Policy Press.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed