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This paper reports on primary research that focused on men from specific black and minority ethnic (BME) groups. The project aimed to provide a better agreement of the men'southward beliefs about mental health and their experiences of mental health services. The paper presents key findings and issues in interpreting the experiences of BME groups. It considers the complexities of men'south gendered identities and the interplay of these with 'race', ethnicity and cultural influences. Twelve focus groups, each consisting of men from specific BME groups, were convened in various locations in London and the West Midlands. The ethnic groups were equally follows: two African-Caribbean groups, 2 African groups, two Indian groups, two Pakistani groups, two Bangladeshi groups and two Chinese groups. The findings include BME men's narratives of well-beingness, which highlight the importance of relational and normative aspects and the influences of gender and ethnicity on aspirations, identity and values. Factors contributing to mental illness relate to gendered and racialised social expectations, economic factors, generational and gender issues, and experiences of services. The newspaper concludes that a circuitous mix ofgendered and racialised experiences, including social stigma, the coercive ability of institutions, and men's ain perceptions of services, and vice versa, can contribute to cycles of disengagement and isolation for marginalised BMEmen with mental health problems. Specific recommendations are made for breaking out of the wheel. For research, it is suggested, the priority should now turn to identifying and assessing initiatives that address the issues, and in particular,identifying models of support towards recovery.

What is known on this subject

• A asymmetric number of BME men, compared with white men, come into contact with mental health services via adversarial or crisis-related routes.

• Mutual concerns include the loftier rates of schizophrenia and psychotic disorders, and depression levels of confiding/emotional support for BME men with mental health bug.

• The reluctance ofBME men to engagewith services at an early stage has been viewed in terms of mistrust of services, reinforced by racialised experiences of services that lack cultural competence, as well equally gender attitudes to health, and stigmatisation of mental ill health in society.

What this paper adds

• It explores the social underpinnings of the views of BME men virtually their well-existence. This highlights the influence of gender and culture on social, relational and normative aspects.

• It examines BME men's experiences of poor mental health, identifying how the influence of social expectations most gender, combined with racialisation and other social factors, could contribute to a negative cycle of disempowerment and stalled recovery.

• It makes evidence-based recommendations for creating environments of trust and breaking the cycle, with regard to services engaging with the formative influences of masculinities and ethnicities, and with men's understandings of and wishes for well-being, and with a focus on men'due south cocky-defined expectations and lifestyle preferences.

Central words

gender, ethnicity, mental illness, recovery, stigma, well-beingness

Introduction

This paper reports findings from a contempo research project which aimed to provide a better agreement of black and minority ethnic (BME) Men'due south beliefs and experiences with regard to mental wellness, and their experiences of mental wellness services. The 'Improving the Mental Wellness of BME Men' projection was commissioned past the Men'south Health Forum and funded by the Section of Wellness (the primary funder), the National Institute for Mental Wellness in England (NIMHE) and the Football Foundation. The project aimed to piece of work with BME and mental health organisations to inform healthcare professionals about ways of engaging effectively withBME men, and to consider the time to come development of resource for this group. The project also aimed to increment awareness of mental health bug and services amongst BME men.

For the purposes of this newspaper, BME is an umbrella term that refers to men who describe themselves as belonging to a minority group in the Uk, with a shared ethnicity and language and/or civilisation. This included African Caribbean area, African, Indian, Bangladeshi, Pakistani and Chinese men, simply could also include diverse white European groups, Irish, Travellers, mixed heritage men, and various groups of asylum seekers and refugees. The paper highlights BME men's views of their well-being and their narratives concerning histories of emotional distress and mental illness, and attributions of causality. In detail, the paper explores the place of gender within BME men'due south behavior and experiences, and examines the implications of BME men's experiences of socially mediated disempowerment for potential approaches to supporting them to recovery.

Current testify

People from BME communities are more likely to experience inequality and social exclusion, including racial discrimination, poor socio-economic status and unemployment, all of which are risk factors for poor mental health (Office of the Deputy Prime Government minister, 2004; Joseph Rowntree Foundation, 2007; Gervais, 2008). The literature identifies issues specific to detail groups as well equally shared concerns that affect all BME groups, such as high rates of schizophrenia and psychotic disorders (King et al, 1994; Bhugra et al, 1997; Lloyd et al, 2005; Kirkbride and Jones, 2008), and depression levels of confiding/emotional support for BME men with mental wellness problems (Sproston and Nazroo, 2002). This article highlights these shared concerns and and then explores their gendered dimensions.

The social construction of mental illness is a recurring theme in accounts of diverse understandings of mental illness among specific BME groups (Kleinman et al, 2006). In particular, a human relationship has been identified between perceived racism and mental ill health (Karlsen et al, 2005), which is exacerbated past the social disadvantages experienced by BME men (Nazroo, 1997; Erens et al, 2001). The over-representation of BME men in prisons is as well correlated with social exclusion (Nazroo, 1997), and raised levels of mental health problems within prison populations are a major business organization (Fazel et al, 2005).

Compared with white men, BME men unduly come into contact with mental health services via adversarial or crunch-related routes (Sainsbury Centre for Mental Health, 2006). For example, rates of hospitalisation with mental health problems are higher among BME men in general, and admissions and lengths of stay are specially high among blackness groups (Healthcare Commission, 2008). These findings accept been interpreted as evidence of persistent institutional racism (McKenzie and Bhui, 2007). A reluctance of BME men to appoint at an early stage with services (National Institute for Mental Health in England, 2004; Galloway and Gillam, 2006) has been viewed in terms of mistrust of services, reinforced by racialised experiences of services defective in cultural competence, gender attitudes to wellness, and stigmatisation of mental ill wellness in gild (Johnson and Verma, 1998, Bhui et al, 2001,Tidyman, 2004; Foolchand, 2006; Keating, 2007). This delay in assist seeking contributes to low referral rates from GPs for farther treatment (Begum, 2006).

Recommendations from enquiry for improving service delivery and enhancing engagement include the development of culturally competent mainstream services and advancement services, sounder financing of support services for recovery, training of staff, improved partnerships, and development of non-statutory provision (Seebohm et al, 2005).

Although policy recognition of the complex interplay between gender and ethnicity and its importance for mental health promotion has been forthcoming (National Plant for Mental Health in England, 2007), this interplay remains under-researched. However, changing gender roles and expectations are likewise of import influences on BME men's mental health, affecting the gendered aspect of major risk factors associated with elevated levels of stress (Bakery, 2000; Sproston and Nazroo, 2002). Every bit the following section makes clear, understanding the intersecting forces relating to gender, ethnicity and mental health that contribute to BME men's well-being poses specific challenges.

Theoretical bug

Challenges arise when concepts such as gender, ethnicity, 'race' and racism, and mental illness are linked in order to analyse and understand men'due south experiences. Concerns virtually identity were crucial to the men'due south accounts. Gender theory conceptualises masculine identity in terms of social practice in everyday life, whereby identities are socially constructed through (inter)action (Connell, 1995), in the contexts of other overlapping layers of identity structure, such as form, and obviously 'race' (Frosh et al, 2002).

Two recent theories about gender highlight this complexity. The first is that of gender as operation. Since the 1970s, ethnomethodologists have explored how gender is achieved through action and interaction (Brickell, 2005). The concept of gender as repetitive acts that establish an apparently coherent and stable cadre gender identity was developed by Butler (1990). Co-ordinate to this view, gender is constituted through the reproduction of social scripts, and no stable gender identity exists prior to that.

Secondly, the structure of multiple masculinities (Ridge et al, 2011) refers to plural and hierarchically arranged masculinities (Connell, 1995). It has been suggested that the social construction of masculinities in the 'current Western gender club' consists of a hierarchical gild equanimous of hegemonic (in other words, dominant), subordinated, marginalised and complicit masculinities (Connell, 1995, p. 77; Robertson, 2007; run into Box 1). In this project, findings concerning BME men's struggles to sustain a healthy masculine identity position were interpreted within a view of masculinities equally multiple and variegated, synthetic afresh in practice by each person in relation to positions made available inside wider cultures, involving tensions and the 'pain of belonging or non belonging' (Frosh et al, 2002, p. 174).

Post-obit Keating (2007) and Cooper et al (2005), nosotros besides viewed race and ethnicity equally social constructions, with unlike individual and social meanings according to the context in which they are practical. Racialisation, namely the procedure of producing racial meanings, is one facet of the men's identities, and overlaps with other social divisions, such as age and gender (Keating, 2007). A further issue was the stigma surrounding mental affliction (Goffman, 1963) and that arising from other factors such as institutional racism. When a person is labelled as having a mental illness, they take on an identity that is stigmatised (Fernando, 2006). Information technology has to be noted that stigma theory bases universal claims on testify and theory collected cross-culturally, rendering problematic any ethnicspecific assay of stigma which operates inside a concealed norm of white ethnicity (Falk, 2001).

Methodology

The project aimed to provide a meliorate understanding of BME men'south behavior and experiences with regard to mental wellness, and their experiences of mental health services. The design consisted of a literature review of current prove on mental health and services for BME men, and primary enquiry involving focus groups consisting of men from specific BME groups.

Ethical blessing for the research was granted by the Research Ethics Committee of Leeds Metropolitan University Kinesthesia of Health.

Data collection and analysis

At that place were 12 focus groups, each consisting of men from specific BME groups. They were selected as a purposive sample through contacts known to the enquiry team and the informational group, and convened in various customs locations in London and the Westward Midlands. The groups were stratified past historic period, with six groups consisting of men aged 18–25 years and half dozen groups consisting of men aged 26–55 years (see Tabular array 1). The sampling, interview topic schedule and questioning were informed by theoretical insights into the social construction of mental illness (Kleinman et al, 2006; see Box 2). The partition by age and ethnicity took account of theoretical insights into gender and ethnicity, and of changing experiences of masculinity, the particular challenges facing younger men (due east.g. regarding substance misuse and mental health), racialisation and the stigma surrounding mental health across the life-course.

Table 1: Stratification of groups past age

The focus groups were recorded and transcribed verbatim. Transcribed data from the 12 focus groups withBMEmen were entered into NVivo software, and thematic analysis was performed to address the main research aims, highlighting the main areas from the interview topic schedule. The analysis used a 'abiding comparative method' (Glaser and Strauss, 1967), which was further informed past:

1 an initial assay framework developed from previous evidence review and theory (run across Box iii)

ii identifying new themes from discussion groups

iii synthesis of both of the above.

Ideals

Information sheets (translated where advisable) were provided to all participants as part of the recruitment process. All of the participants who expressed involvement were invited to participate. Written informed consent was obtained from all participants.

Findings

This department presents findings related to the following cardinal themes: views of mental well-being, causal explanations of ill health, finding help, and practical resources for modify.

Views of mental well-being

BME men's complex views of mental well-being reflected both individual differences and collaborative thinking, where men engage together in a meaningmaking process. Three models that underpinned BME men'due south understanding of mental well-being emerged from the information. Their views often involved more than 1 of the post-obit underlying models, which appeared to allow the men to prefer unlike, socially mediated positions from time to time during discussion. The power to articulate different positions can involve different levels of reflexive awareness concerning identity, simply if recognised inside recovery practice in mental health information technology may exist a cardinal aspect of supporting men to discover narratives of hope.

Models that highlight social underpinnings of mental well-existence

Social relational and normative aspects were considered extremely important. Social norms, although presenting problems of unattainability for some men (e.g. because they cannot live upwards to ideals), have a major impact on well-being, in that men want to experience that they fit in. Hither the intersection of gender and cultural norms is credible:

'In our culture we are the men. We are providers. And in that location is a lot of force per unit area to provide for our families and weddings and deaths.' (Pakistani human, 26–55 years age group)

Mental health was too perceived as involving the ability to perform daily societal routines and activities. Watson (2000, p. 118) described this as the functional utilise of a 'normal everyday body' in guild to fulfil specific (gendered) roles required in the social world. This has been seen equally constituting men'south most mutual mode of experiencing and 'caring' about their own bodies (Robertson, 2007, p. 68). All the same, the problem for men with mental health concerns is that this puts them in a land of dependence with external social structures and pressures which tin can prevent them from working in a rewarding way in the social world.

'What is normal though?' (Indian man, 26–55 years age group)

'Being able to work is normal.' (Bangladeshi man, 18–25 years age group)

'To live normal – nosotros don't apply the give-and-take normal whatsoever more than, normal is a word that nosotros don't really understand.' (Indian man, 26–55 years historic period group)

'Beingness normal, being able to do a normal chore, having a family.' (Indian human, 26–55 years age group)

'They are fantasies aren't they? Because you tin can't become a job.' (Indian man, 26–55 years age grouping)

Being unable to fulfil normative social routines was likewise a threat to men's sense of existence in control. There is an apparent gendered dimension to viewing mental well-being in terms of control of thought and action, since to be in control is an important attribute of hegemonic masculinity (Robertson, 2007).

Integration with their concrete and social environment was as well fundamental to well-existence for the BME men. The importance of friendship and family unit relationships was highlighted, while being accepted and embraced by pregnant others and beingness enabled to give affection were important to the well-being of those with a history of mental ill health. This social–relational emphasis indicates that, for marginalised older BME men in particular, well-beingness is non always associated with self-sufficiency (a hegemonic trait sometimes associated with white men), but rather with interdependence:

'Making friends, talking to people. Yeah, it's very important every bit a person when your people honey yous and you tin also requite dorsum their love. And that's well-being.' (African human, 26–55 years age group)

'When I amhealthy, my brother and sister, they say come to u.s.a., come to united states.' (Bangladeshi man, 26–55 years age group)

Models that highlight holistic aspects of mental well-being

Many BME men too highlighted the fact that holistic aspects are central to well-beingness. With regard to holistic emotional/expressive aspects, the emotional dimension was strongly related to cocky-esteem or cocky-acceptance, which had powerful emotional furnishings related to men's identity. For example, emotional resilience was important to well-being, and involved maintaining a personal balance. The importance of cocky-efficacy (that is, being in command of one's thoughts, decisions and deportment), independence, awareness, goal orientation andmotivation was highlighted. Self-efficacy, associated with the importance of identity to well-being, is also uniform with interdependence:

'It's being comfy within yourself, and that is what health is to me.' (African Caribbean human being, 26–55 years age group)

'For me, mental well-being is similar you begin with yourself first; have yourself.' (African man, 26–55 years age group)

'Happy or non is non a problem, the most of import is whether yous can accept yourself.' (Chinese man, 26–55 years age group)

The emphasis on cognitive and emotional balance and harmony with the social and physical surround perhaps resonates with a non-Western holistic view of homo life as an indivisible whole in which heed, body, spirituality and other dimensions are ultimately interconnected, and a balance is sought between the elements (Fernando, 2009). In this sense, men's emotional state was viewed as beingness embodied in 'thinking, moving, feeling complexes which radiate through the body' (Boden and Williams, 2002, p. 497) and which connect with wider environments. This can be viewed as reflecting a historically and/or culturally embedded viewpoint that is compatible with a potentially cocky-directed and emergent lifestyle narrative of choice, rather than with hegemonic masculinities.

Models that highlight a spiritual dimension to well-being

Faith in more than than mundane social norms was also important for some to provide space for reflection, and self-integration or coherence. There was also a proposition that male person role models who had struggled and thrived from like ethnic backgrounds would have a significant role in assisting men towards wellbeing, equally through their stories these men could become trusted holistically with a spiritual as well as physical connectedness.

This section shows that a number of different socially mediated positions were taken past BME men with regard towell-being. Some of these positions (due east.g. about actual activity and command) appear to exist representative of a western, gendered social discourse irrespective of ethnicity, whereas others (e.grand. holistic integration) appear to be representative of a more cross-cultural social soapbox of non-western provenance. Positions about social norms and expectations for men as providers appeared to indicate a specific intersection of gendered and cultural influences.

Causal explanations of ill health

BME men'due south accounts of run a risk factors for mental illness included major social determinants such as social expectations, racialisation and socio-economic exclusion. Personal determinants such as biological inheritance and cerebral factors relating to self-efficacy were accounted important. In improver, highly significant mediating service factors with regard to treatment, care and recovery emerged. This department focuses on social expectations, highlighting gender-based issues, while also drawing attention to the intersection of multiple social influences relating to BME men's expectations of services, treatment and recovery. The literature on racialisation and the social stigma surrounding mental health is extensive. Even so, less has been written about the further impact of masculinity and expectations almost male person roles. The affect of these factors varies according to age, within cantankerous-cutting social processes that were highlighted as contributing to a disempowering spiral for BME men with feel of mental illness.

A mutual thread uniting BME men'due south wide-ranging accounts of causes of mental ill health relates the stressful impact of unreasonable and/or unrealistic social expectations on individuals' identity and mental health. Hegemonic masculinity exerts immense pressures on men to reach ideals, racialisation creates undermining negative and positive stereotypes, and acculturation in communities may too challenge males with contradictory and sometimes unattainable customary and economic expectations. Contradictions in expectations were evident amid men from various indigenous communities, across different historic period groups, thus overriding generational differences. These expectations are influenced by forces that include the post-obit:

• how BME people are treated in club

• how people with mental health issues are treated

• the power of institutions to control and coerce people with mental health bug

• perceptions of BME people of mental wellness services, and vice versa (Keating, 2007).

To these must exist added a 5th influence, namely how men are viewed and view themselves within social club.

Young men

Immature men who were well aligned themselves more than closely with hegemonic norms, and were therefore less willing to admit weakness, than older men, many of whom had a history of mental illness. In some younger male person peer groups, hegemonic masculine identities were sustained in the context of young men's perceptions of limited economical opportunity and racism. At that place seemed to be little room for articulating dissimilar positions, negotiating emotional vulnerability or coping with transitions. In the accounts of some men, with the apparent absence of alternative male role models, such as older mentors, trivial space remained for displays of male–male intimacy, or for disclosure of weakness. Hegemonic masculine identities were sustained by the peer culture in what seemed, to some extent, to be a defensive cultural motility in the context of perceptions of lack of economic opportunity and systemic racism, just which offered little support for negotiating vulnerability or coping with transitions (e.grand. from adolescence to adulthood, employment, family stress or bereavement):

'It's a survival of the fittest thing because the surround has certain standards and certain means of living up to that. Anybody wants to get to a certain place.' (African Caribbean human, 18–25 years age grouping)

There was a perception that, in this context, a beau seeking help for a mental health trouble would be rejected as non masculine plenty, at risk of stigmatisation by his peer group, his family, his wider community and a racialised society. Aslope gendered peer proscription on displays of vulnerability, there might likewise be gendered inhibitions within the family about showing emotions. The effect at worst was to generate lack of trust, together with denial and repression.

'You lot just hold it in until the point you tin't take it no more, all right, then someone will trigger y'all off and that'due south it.' (African Caribbean man, xviii–25 years age group)

'Go on it locked upwards – if you tell one guy and you recollect you can trust him, he'll probably get and tell another mate and he'll tell everyone.' (Pakistani man, xviii–25 years age group)

Older men

Older men experienced gendered pressures of expectation from their social environment to be providers, and managed experiences of racism and isolation. For at least some of these BME men, male social identities were marginalised by the stigma surrounding mental illness, race, and not sustaining hegemonic masculinity. This confirms previous enquiry indicating a gender-related stigma with regard to mental wellness interventions, which was partly related to stressful feelings of being unable to cope with aspects of daily life (Robertson, 2007).

Many older men struggled to mensurate upward to family unit expectations. For example, in families of South Asian heritage it was said that the oldest son should be strong and economically resilient to back up the extended family:

'In the Bengali community and a lot of other communities, the eldest, huge responsibility, huge pressure, and the pressure was so much with me.' (Bangladeshi human being, 26–55 years age grouping)

For these older men, rifts could arise due to failure to sustain the expected masculine family unit provider role. Some older men, having experienced mental health problems, described emotional attrition, contrasting their experiences with those of younger people. They described the erosion of identity and promise, with their hopes beingness worn down past fiscal pressures, changes in the types of work that men must practice, and family unit rifts. Older men of Southward Asian heritage had struggled to provide support to extended family members, often trans-continentally. Some men spoke from beyond broken marriages, isolated and burdened by family unit and community rejection. Their fathers' generation had possibly been ill equipped to support them through mental illness. The intergenerational family differences were isolating in that the men felt unable to confide in anyone. They lacked family or peer support, or support services:

'He was very supportive the first 12 months, only then the barriers started to build upward, arguments, and because the parents aren't of the same ideology and psychology as the children at that place are barriers, conflicts.' (Indian man, 26–55 years age group)

'For men there accept been no Asian male counsellors, no specific support scheme.' (Indian man, 26–55 years age group)

'Part of being a homo is keeping it locked in. You don't tell anybody.' (Indian human, 26–55 years historic period grouping)

Men'southward views here consistently offered confirmation of the social and cultural construction of mental illness and care (Kleinman et al, 2006). Their narratives highlighted a complex web of intersecting social influences on expectations of BME men, which confirmed previous research findings. These were every bit follows.

• The racialisation of identity formation. Racialised identity formation starts early on, and the widespread perception of racism causes stress, mistrust, diminished self-esteem and lowered likelihood of disclosure. Men's narratives of racialised identity evolution and discrimination in service and leisure encounters were often interwoven with those of community marginalisation and exclusion.

'Say you're going to a society, where there'south a whole variety of people, white, blackness, all types, and there'southward someone come up upwardly to you proverb ''You're Bengali, get out of here, don't ever come back''.' (Bangladeshi homo, 18–25 years age group)

• Experiences of the mental wellness system and services. BME men'southward mistrust of service provision for men with mental health problems was far-reaching. Perceptions of racialised services reinforcing gendered patterns and the stigma surrounding mental health oftentimes led to fright, avoidance of help seeking, and further risks of isolation for vulnerable men.

'A lot of people don't actually get assist. They either become arrested or they become sectioned. That'south obviously where the condition has escalated.' (African Caribbean man, 26–55 years age group)

• Socio-economic factors. Financial hardship is a major stressor underlying mental health problems. Older men were expected to perform traditional provider roles, and younger men faced a crisis of expectations relating to consumerism. BME men with mental wellness problems then faced further major challenges over unemployment, change in family status, and treatment costs.

'I was a businessman, in this company I lost when at that place was a recession. I lost my home, also my business organization.' (Bangladeshi man, 26–55 years historic period grouping)

• Acculturation. BME men described gendered and racialised challenges involving family migration and cultural transition. Tensions that were experienced in terms of relationships, acculturation and social course mobility created stresses throughout the life form of British-built-in BME men.

'My parents were foreign to this country, and had foreign means and attitudes and it fed downwardly to me. As an Englishborn person I take to go into the mainstream with foreign attitudes and education, and the stress of going into the mainstream and trying to do everything normal that my other white kindred practise, it didn't piece of work. I was getting racism, negativity, pushed to 1 side and it brought a lot of stress.' (African-Caribbean man, 26–55 years age grouping)

• Customs and family. In some environments, sick health of a family unit member puts the family'due south reputation at risk, and stigma constitutes an economic threat. While BME men tended to describe stigma and taboo as attributes of communities' specific social models, the communities themselves were seen as irresolute and internally differentiated. Social stigma was seen as universal. Social stigma surrounding mental health in families and communities could reinforce 'masculine' reluctance to seek help.

'In every society there is stigma most mental illness.' (Indian human, 26–55 years historic period group)

'Everybody judges you. You lot become dysfunctional then you lot can't operate in society like normal people would.' (Indian man, 26–55 years age group)

• Biomedical and cognitive causes. BME men described an interaction of social, biological and cognitive causal factors relating to illness. Stories of mental ill wellness running in a family unit could contribute to stigmatising every fellow member of that family. Causes of mental wellness bug were recognised every bit being psychologically circuitous and dynamic, influenced by childhood and boyhood, including (but not bars to) gendered and racial causes.

'It's a limerick of hereditary and ecology factors.' (Indian man, 26–55 years historic period grouping)

Figure 1 demonstrates how the influence of social expectations about gender could contribute to a negative cycle of stalled recovery. Younger men sought to sustain expectations around hegemonic masculinities, merely in the context of other biopsychosocial take a chance factors shown above, they had little scope for adopting alternative positions to express emotional vulnerability or cope with transitions. Older men experienced gendered pressures arising from the expectations for them to be economical providers for family unit networks. If they could not achieve this and if alternative narratives were not available and they developed mental affliction, they could exist marginalised by social stigma and by the impact of service treatment regimes. For many older men, this translated into a bicycle of stalled recovery and disempowerment (come across Figure 1).

Finding assist

The most of import gene for BME men when looking for help was trust. These men frequently lacked hopeinspiring relationships of trust to enable disclosure of vulnerability, and to assist them towards recovery. The participants considered the following homo resources factors to exist important.

• Independent male person advocates within a particular community could support men towards recovery and empowerment, provided that they received sufficient training.

• Breezy mentors or life coacheswith experience of mental illness and recovery, perhaps from specific BME communities, could have credibility with peers.

Advancement has been demonstrated to take great potential for promoting engagement and greater choice for BME men (Newbigging et al, 2007). To engender trust, not-medicalised community-based approaches to mental health promotion are recommended (Friedl, 2002; Tidyman, 2004).

The following resources too need to be developed with due consideration for specific challenges with regard to trust.

Figure 1: Cycle of disempowerment

• Peer support and friendships. Opportunities for trust building and social participation were sought past BME men with mental health problems. Participating in men'due south groups and coming together others with similar experiences was institute to be therapeutic. Self-help groups, if protective of confidentiality, might offer great potential for support and overcoming isolation. Having a trusted friend was highly valued, but younger men felt that male friends might be judgemental.

• Family. Seeking help from family unit members could be problematic due to anxieties and stigma. In general, fatherswere considered hard to arroyo, whereas mothers were felt to be more than approachable. This is an important consideration for health promotion letters.

• Services. To build trust, a drib-in-centre with staff who knew the community well was felt to be useful, and personal key workers who visited men could be valued.

Practical resources for modify

BME men deployed a wide range of strategies and resources to enhance their well-being.

Exercise was associated with masculinity in different ways. For younger men, a masculine physique was strongly associated with self-confidence, whereas older men with a history of mental illness viewed exercise as i style of recovering inside an embodied social practice that included carrying out routine activities, engaging in relationships, and taking an involvement in the environment. Some medication regimes (eastward.k. treatments for reducing psychotic symptoms) unfortunately reduce the capacity for physical activity, despite the benefits in terms of improving mood, raising selfesteem and relieving stress. Therefore it is critically important to integrate medical handling with a more holistic recovery programme.

Creative or expressive activities and meditative routines were perceived equally having the potential to at-home the mind, increase cocky-esteem, overcome stigma and construct positive ethics. These activities may also provide a sense of coherence and control over men's inner worlds.

The lack of information almost mental health for BME men and boys was highlighted. A diversity of approaches should reflect the needs and preferences of BME men across generations. It was felt that the post-obit types of information demand to be included:

• information almost recurrence prevention for young people and communities

• improved information about the causes, diagnosis, symptoms and management of mental affliction

• a directory of services and back up

• advice nearly confidentiality, procedures and pathways to care

• advice nearly recovery, finances, work, grooming and leisure.

Conclusions and recommendations

A complex mix of gendered, racialised, community and individual experiences provides the context for BME men's identities and experiences. The intersection of these factors poses a hazard for some men's emotional resilience and well-existence. The impact of social stigma surrounding mental health, the coercive ability of institutions, and men's own perceptions of services, and vice versa, increase this complexity of risk, essentially affecting the vulnerable identities of BME men with mental wellness problems. Over a prolonged flow this mix of factors can contribute to cycles of detachment from services and isolation for marginalised BME men with mental wellness problems, and to difficulties in engaging in empowering and constructive activities towards recovery. Across different generations, these complex social influences affect the expectations and identity of the BME men whose voices were heard in our study, pressurising them to conform to unrealistic or conflicting ideals in a stress-inducing way, or dampening and fifty-fifty defeating their expectations, making it increasingly hard for them to integrate multiple aspects of cocky.

To create environments of trust and suspension the cycle of blocked recovery amidst many olderBMEmen who accept experienced prolonged periods of mental ill health, two specific recommendations are made.

1 In terms of well-being, engaging with BME men'south understanding of and desire for their ain wellness and well-being tin enable practitioners to back up these men more effectively. Instead of reinforcing narratives of illness, this arroyo helps to put BME men dorsum in control.

2 In terms of pathways to recovery, practitioners are not ever enabled by their organisational contexts to play an advocacy part or towin BME men's trust. Greater use of independent advancement can helpBME men to break the wheel.

To prevent young BME men both in the current context and in future generations from repeating the same disempowering cycle, information technology is essential to develop effective partnerships with community organisations and beyond sectors, and to create safe environments where immature men can talk most their vulnerabilities. To ensure that early on interventions do not follow the grade frequently experienced past older men with long feel of mental health problems, in addition to the above recommendations, the following practice approaches are suggested.

• Male hegemony. It is vital to empathize how masculine identity affects men'south ability to talk openly almost being vulnerable and to seek ways to communicate effectively.

• Complexity of experience. When working with BME men it is important to engage with their narratives in their complexity. This means engaging with specific formative experiences as BME men.

• Expectations. Practitioners should be enlightened of the detrimental result of lowered or unrealistic expectations on BME men's well-existence, and should assist these men to explore and define their own expectations of life, and thereby support them in selfdetermination.

• Lifestyle. BMEmen's lifestyle preferences should be understood and respected, and practitioners should support these men in pursuing their chosen physical, expressive and social activities.

• Spirituality. A holistic approach is needed that includes understanding possible specific meanings of spirituality for individual BME men in relation to well-being and connection with their environs.

A priority for research should be to identify and implement models of back up towards recovery, and to enquiry their effectiveness, including a wider range of minority ethnic groups. Information technology is suggested that the underpinning footing for effective interventions is likely to derive from a more than socially oriented model consistent with the complex formative experiences of BME men that have been described in this paper, including the interface between masculinities, ethnicity and mental wellness.

Acknowledgment

The authors would like to thank the Men's Health Forum for commissioning and supporting this research. The research was funded by the UK Department of Health, the National Institute for Mental Health in England, and the Football Foundation.

CONFLICTS OF INTEREST

None.

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