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Talking Our Language – a case study in Mother tongue mental health training in the Pakistani and Chinese communities of Leeds in 2009

Introduction to the project

The Department of Health Pacesetters initiative to tackle health inequalities, funded Touchstone, a community development mental health project based in Leeds, to develop and pilot a mental health awareness training for community members. At the same time the Leeds Partnership NHS Foundation Trust (the Partnership) commissioned Touchstone to find ways to get black and minority ethnic community members thinking and talking about mental health.

The resulting project was based upon the principles of co-production· and focussed on people from the Pakistani and Chinese communities in Leeds. Both communities have rich cultural understandings of mental health whilst Western bio-medical understandings of mental health may be less well understood. The project planned to offer short information sessions to community activists so they could to understand the role of ordinary people in maintaining and supporting the mental health of people around them.

The aim was to take men and women through a participative series of exercises developed by Touchstone Community Development practitioners and Community Health Educators from the Partnership. The content was to be less focussed on illness, diagnosis and treatment but rather participants’ (and those around them) understandings and the practical effects of symptoms for individuals and communities.

The Touchstone Community Development practitioners recruited 1 co-facilitator from each community and provided the necessary support and development opportunities to enable them to devise and co-facilitate the planned sessions. The CD practitioners recruited participants to each of the identified target groups: Chinese women; Chinese men; Pakistani women; Pakistani men and co-delivered the programmes. The activists approached to become Co-facilitators were not experts in mental health, training or community engagement, nor community leaders, or professional advice-givers. They were ordinary people, who were extraordinarily well connected with a community that mental health services sometimes find hard to reach, and were paid for their time, input and know-how.

Training matters including facilitators notes and supporting resources were produced which draw on existing evidence of community specific concerns. A photographic social enterprise, some of whom had learning disabilities, were commissioned to produce resource cards for use on the programme. The courses had translators and all materials were produced in Chinese, Urdu and English. The programme was delivered in mother tongue, English or a combination of languages.

Impact and Outcomes

The target of a minimum of 10 participants to attend each of the programmes with at least 80% of participants completing the programme was achieved. The participants increased their the awareness and knowledge of a range of mental health difficulties, basic skills for working with people experiencing mental health difficulties, a variety of treatment options and available services and interventions (traditional, medical and complimentary) and complaints and civil rights.

The evaluation report·produced by First People Training and Consultancy) clearly demonstrated that the level of confidence within participants from both communities doubled overall from the start to the end of the programmes. They demonstrated increased confidence:

• In being able to talk about MH in general
• In their understanding of MH
• In recognising the sign and symptoms of poor mental health
• On assisting themselves and others in MH distress
• ·In knowing where to go to get help
• To talk to someone else about their MH

Participants said they were more aware of their own mental health and the day to day strategies they can use to help themselves, family and community members to deal with stress.

Local people have been empowered to help others in their community, signpost some to volunteering, activities and services that improve their well-being, raising awareness to other community members and organisations about mental health, training and support, and challenging the negativity around mental health issues in their own communities.

The Co-facilitators are confident enough to deliver the training on their own, which· means there is an opportunity to deliver the programme with Touchstone’s other Target Communities of African Caribbean, African, Indian, Kashmiri, Refugee and Asylum Seekers, Irish, Gypsy Roma and Bangladeshi.
The sessions have been delivered to 3 further groups from the Chinese and Pakistani communities. There have been requests that the training be rolled out within the Pakistani and Chinese communities to include training for religious leaders.

The resources and programme was evaluated and the training materials refined and made available to other mental health practitioners and organisations.

The process used led to much learning on all sides and ultimately the success of the project.

Reflection and learning

A community development approach involves more people on the ground, as Touchstone were able to activate their links with local communities to involve local people to devise and deliver a learning programme. The success is a direct result of co-production/community development ideas and processes been used for the benefit of local people.

The project was evaluated and monitored at several stages.

1. The co-facilitators from local communities proofing and amending the learning materials that were developed.
2. The use of a third party external agency, First People Training and Consultancy, exploring the progress of participants, lessons learned and recommendations for future roll out.
3. The report ‘Touchstone’s Journey’ highlighted useful tips and ideas for rolling out the project and gathered all the materials and how to guides into one report.
4. An after programme evaluation by participants to see how far the training had been maintained and used by the participants in local communities.

A key piece of learning from the work came from the Co-facilitators who scrutinised the learning materials and suggested how ideas could work or needed to change. In the work with the Chinese community it became apparent that service providers understandings of how the Chinese community expressed mental health issues had moved from traditional cultural understandings based on ideas like imbalances in the four humours to more Western medical approaches, and over time the Western model had superseded traditional understandings.

Spread and sustainability is one of the five foundations of the Pacesetters programme, and this project was developed from and built on existing work and services and so was inherently more stable and sustainable, and there was a commitment, from the start, that the learning from the pilot project would inform future work and services. The learning has been widely disseminated through the production of the “Touchstone’s Journey” resources pack. Touchstone staffhave promoted the model at regional Pacesetters event and workshops for Community Development Practitioners.

The role and input of community development practitioners

Touchtone works within the values of Community Development and expect all their staff to ensure the project was inclusive, challenged assumptions, encouraged learning together from experience, built confidence and know how about accessing services and provided support to people in communities.· Touchstone’s Community Development workers were able to use their existing links and connections with community groups to work with people who do not normally get involved in community activities to help develop and participate in the programme.

The experienced Community Development practitioners for each of the target communities had a lead role in developing the project.· This included drafting an outline programme and beginning to promote the project within their respective target communities.· In addition the CDWs recruited the ‘co-facilitators’ from within the Pakistani and Chinese communities, who themselves had great reach into their own communities, an innovative feature of the model and involved them in a range of tasks alongside them.

Touchstone promoted this model of working in which there is a full partnership with people in communities to develop information sessions, content and check cultural appropriateness. Using the principles of Freirean adult education to provide learning environment where people bring with them their understanding and points of view of the situations going on in local communities the sessions were able to provide opportunities for sharing views and learning from one another.