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Developing a Culturally Sensitive Mental Healthcare Model for Communities in the UK Affected by Youth Violence

Reducing the barriers preventing Black and Brown people in the UK from accessing mental health services by engaging the community and drawing on the experiences and views of young people, their families and the health professionals who work alongside them.
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With violence affecting young people on the rise in the UK, Power the Fight, a London-based organization, is bringing together communities and policymakers to co-design long-term solutions for sustainable change. Working collaboratively with the NHS and the Mayor of London’s Violence Reduction Unit, its Therapeutic Intervention for Peace (TIP) model seeks to respond to the challenges faced by young people and communities through culturally sensitive mental health support for those who need it most.

Mental ill health is the single largest cause of disability in the UK, and one that also disproportionately affects Black and Brown communities. Johnson & Johnson UK is joining forces with Power the Fight to help reduce the barriers preventing Black and Brown people in the UK from accessing mental health services, including distrust resulting from structural racism. Jointly supported by Johnson & Johnson Foundation and Johnson & Johnson UK, this three-year project seeks to expand the TIP program in education and healthcare settings, and at a strategic local government level.

While Power the Fight does not subscribe to the perception that knife/gang crime across the UK is predominantly a Black issue, it acknowledges—especially in a London context—that it disproportionately impacts Black and Brown people. 23% of all sharp instrument homicide victims in England and Wales in 2019 were Black, despite Black people comprising only 3.4% of the population.

“When you think about gaps in community health, our Black and Brown communities have not had access to the tools and resources they need to thrive,” says Rhoda Steel, Global Community Impact Leader at Johnson & Johnson UK. “These social determinants affect everything—from children falling behind in school to people not getting access to the GP. It’s all interconnected. Our young people and their families who are victims of violence are also victims of some of the systemic issues in our community that have not supported them to thrive.”

“Nothing about us without us.”

The partnership with Power the Fight embodies the three areas—mental health, racial health and social health—identified by the Johnson & Johnson Local Community Impact team as key to its mission to reduce health inequities and disparities. It also aligns with Johnson & Johnson’s Our Race to Health Equity initiative, an enterprise-wide initiative that aspires to help eradicate racial and social injustice as a public health threat by eliminating health inequities for people of color.

“In the context of the UK, we recognized that the solutions to address the deep health disparities in racial health and mental health might not necessarily surface through traditional routes,” adds Steel. “We solicited feedback from our employees, our partner network and the community to come up with stronger and better models to deliver community healthcare that removes the barriers for young people to achieve their full potential.”

The team was drawn to Power the Fight’s focus on cultural sensitivity for all stakeholders involved in the system. “When we talk about putting in place tools and strategy to support them, there needs to be a real understanding of culture,” says Steel. “This intervention model reflects the sentiment voiced by one of our team members—nothing about us without us.”

The TIP program engages the community, drawing on the experiences and the views of the young people, their families and the health professionals who work alongside them. The school-based project will include therapeutic sessions and workshop programs, and anti-racism work to improve mental health for all three groups, reduce risk factors and incidents of youth violence, and ultimately enable communities to recover and flourish.

Driving systemic change across education and healthcare settings

“The COVID-19 pandemic exacerbated issues around race, mental health and physical health,” says Dr. Winnie Chege, Clinical Lead at Power the Fight. “We saw gang violence and knife crime rise consistently. With poor mental health and trauma identified as key risk factors for interpersonal youth violence, sadly we have seen the number of young people struggling with their mental health skyrocket. Mental health services are inundated with high waitlists and provisions are often uneven, particularly for children’s mental health, resulting in poor reach for those that need it. Our focus should be on preventative, holistic and whole systems change, not disease-based models.”

TIP tackles the access problem by looking at youth violence through a public health lens and applying a holistic, multi-faceted approach to identify and tackle its root causes. The program includes training and policy development at strategic levels across education and health services and commissioning bodies, alongside development and delivery of culturally competent therapy to improve the well-being and resilience of young people, families and frontline staff impacted by youth violence.

“We educate people around what holistic support for young people looks like and how trauma reverberates throughout a community,” says Chege. “Are young people avoiding particular shops or bus stops because they are concerned about violence? How does this impact their emotional well-being and behavior? How does inequality and poverty feed into the communities we’re serving? If we don’t have buy-in from multiple levels within the community, our approach doesn’t work.”

This holistic approach also extends to working with schools to ensure that the young people have solid support systems in place even after Power the Fight’s workshops have finished, offering staff reflective practices to improve their own well-being, and providing a platform for policy change by connecting local communities with the UK Government.

The current project with Johnson & Johnson UK is being developed as a replicable model of culturally sensitive training and therapeutic services across a minimum of three schools in the London boroughs, and several local safety and policing authorities and services.

Moving forward, Power the Fight hopes to support communities across the UK to use the TIP approach to take charge of their own health. “We don’t want to expand into other areas and pretend we know what they need,” explains Chege. “Instead, we want to serve this community the best way we possibly can, develop the model and then train other people to use the model in their own local contexts.”

September 2022