South Asian women, psychological distress and self-harm: lessons for primary care trusts

The present paper reports an investigation of the self-reported needs of South Asian women suffering distress and mental health problems which may lead to self-harm and suicide, and uses the data to define indicators of good practice for primary care. The design was a qualitative study using focus group discussion. Four focus groups of South Asian women (using existing women's groups in Manchester, UK) formed the setting for this study. Each focus group was facilitated by one of the authors, and the discussions occurred in Urdu, English and Punjabi. An interview guide was used, although the direction of the discussions followed the women's agenda. Notes were taken during the focus group discussions. Analysis of notes to define themes and emergence of framework was carried out. The data were analysed according to the principles of framework analysis. A range of systemic issues were described by respondents including: social, political and economic pressures; domestic violence; poverty; language problems; family and children's issues; and health. These experiences were reinforced by an extremely efficient community grapevine and were evident in described experiences such as: racism and stereotyping of Asian women; Asian communities and Islam; and the concept of izzat (honour) in Asian family life, which was seen as a major influence in the lives of Asian women. These experiences were thought to result in mental distress, which was described in a variety of ways by the women. The women saw self-harm as a usable coping strategy to deal with their distress. Perceived barriers to services were described by the women. Services tended to be accessed only at a point of desperation, rather than prior to crisis points. This indicated the need for services to be able to respond rapidly when Asian women did ask for help. Whilst the present paper describes a local study, thus limiting its generalisability, the use of such work in commissioning local health and social services is outlined. A number of indicators for good practice were drawn up in relation to addressing systemic issues in service provision using these findings. Such indicators will be of use by primary care trusts in developing, commissioning and monitoring services for this patient group.