We found 26 papers or reports, describing 22 diverse qualitative studies, meeting our inclusion criteria. Most of the studies were well conducted and clearly described.
There were studies of refugees/asylum seekers (n = 5 studies), university students (n = 4) and studies among young people experiencing particular mental health problems: schizophrenia or psychosis (n = 3, including one of university students), eating disorders (n = 3, one of university students), PTSD (n = 3, all of asylum seekers), substance misuse (n = 3), self-harm (n = 2) and OCD (n = 1). There were also three studies in ethnic minority young people who were receiving particular mental health treatments: families engaging with multisystemic therapy, young people receiving CBT, and African Caribbean young people taking part in family-based talking therapy.
Most studies had been conducted with young people or their parents from a range of different ethnic backgrounds. However, nine studies were about young people from particular ethnic groups: asylum seekers from Afghanistan (n = 2), and black and South Asian (n = 2), black African and black Caribbean (n = 2), South Asian (n = 1), Pakistani or Bangladeshi (n = 1) and Orthodox Jewish (n = 1) people.
We searched for but did not identify any qualitative studies conducted in Arab, Chinese or South-East Asian people (unless in small numbers within refugee/asylum-seeking populations), or in Gypsy or Irish Traveller people. We also found no studies that were specifically aimed at understanding care-seeking, access to care or service engagement by those from ethnic minorities with the following mental health conditions or difficulties: personality disorders, conduct disorders, disorders of sleep, somatoform disorders, ADHD, gender dysphoria, general stress, or those with autism/social communication disorders and/or learning disabilities (where the primary focus was on mental health).
Implications for future research
The quality and usefulness of future qualitative research and other studies in this area could be improved by the following:
Purposively sampling young people and/or their parents from particular ethnic minority groups to be able to identify recurring experiences, issues or factors that explain poor access to care, poor engagement with services, or poor cultural adaptation or racist practices within services that might be distinctive to particular ethnic minority groups, or experienced in a different way by them. Purposively sampling in qualitative studies to also gain a diversity of experiences from enough boys/men and girls/women to understand gender differences in how they experience mental health problems and services.
Conducting larger, qualitative studies with purposive sampling that enable separate and comparative analysis of the experiences of those in different minority ethnic groups would also be useful to identify factors that are specific to particular groups. Larger samples might also allow more valid and trustworthy insights about how ethnic identity and cultural beliefs affect boys/young men, or girls/young women differently (or those with other gender identities), for example in relation to acknowledging, talking about and seeking care for mental health problems, or understanding practitioner and service accessibility.
Including data from multiple stakeholders’ perspectives – importantly, from young people and their parents/carers, but also from community members and service providers, service commissioners and other professionals. In addition, studies would ideally cover multiple regions, including rural areas, with related variations in local population need, service configurations and accessibility.
Focusing on the different routes to mental health care/support followed by those from ethnic minority groups – not exclusively on the experiences of those who manage to access specific services. There was a particular lack of qualitative evidence from those professionals, whether in the NHS or in schools, who might identify and refer children and young people experiencing mental health difficulties to other services.
Focusing on how children and young people from ethnic minority backgrounds experience being supported by multiple teams or services, for example when there are complex needs and factors involved (mental health and physical health services, mental health and social care).
Focusing on how the (lack of) ethnic diversity in the mental health workforce shapes the experiences of children and young people seeking support for their mental health, and their willingness to engage with and trust those providing such support.
Better reporting, especially in terms of describing the methods of data collection adequately. For example, future studies need to make explicit the theoretical or ideological/cultural (including ethnic) perspective of the authors, showing greater consideration to any limitations of the methods or data that may have affected the results, and more carefully basing any claims to generalisability on the strength and plausibility of the data, and the integrity of any themes and theoretical insights produced. Also, the demographic (including ethnic identity) characteristics of the originator of all quotations could be more consistently reported in qualitative studies.
More nuanced and context-sensitive insights may also be yielded by conducting a more formal evidence synthesis of selected groups of qualitative studies summarised in this scoping review. For example, synthesising qualitative evidence from the four studies about university students, or the five studies about refugees/asylum seekers might yield more detailed and context-sensitive insights for improving access to mental health support and services for young people in those situations and settings. Such formal evidence synthesis should consider using an explicit theory or logic model for understanding access to health-care services.
These are just preliminary suggestions, based on the apparent evidence gaps and shortcomings in study quality that we have identified. Stronger recommendations for commissioners of research would require a more collaborative, comprehensive and inclusive engagement process with a wider range of stakeholders than was possible within our short project. Such a research priority-setting exercise could compare the ‘gaps’ in evidence about ethnic groups, mental health needs or services for which there is no or little evidence (as identified by our review) with those mental health needs, contemporary service developments or policy changes that are of particular importance to ethnic minority children, young people, their parents/carers and other stakeholders.
A recent research priority-setting exercise by the McPin Foundation (with guidance from the James Lind Alliance) was conducted in 2017 about interventions and services for children and young people’s mental health,64 and it echoes some of the findings from our review. The McPin Foundation’s consultation with young people produced a wide range of mental health research priorities, including priority 11 – ‘How can the number of effective culturally appropriate approaches available in children and young people’s mental health services be increased, particularly for ethnic minority groups?’.64 As well as being an important stand-alone question, the young people consulted wanted this question to be a consideration within every one of the top 10 priorities identified.
