British Asian families and the use of child and adolescent mental health services: a qualitative study of a hard to reach group.

We explored attitudes to and experiences of Child and Adolescent Mental Health Services (CAMHS) among families of South Asian origin who are underrepresented as service-users in an area of a Scottish city with a high concentration of people of South Asian origin. Six community focus groups were conducted, followed by semi-structured interviews with families who had used CAMHS and with CAMHS professionals involved in those families' cases. Lastly, parents of children who had problems usually referred to CAMHS but who had not used the service were interviewed. Qualitative analysis of transcripts and notes was undertaken using thematic and logical methods. Participants consisted of 35 adults who identified themselves as Asian and had children; 7 parents and/or the young service users him-herself; 7 health care professionals involved in the young person's care plus 5 carers of 6 young people who had not been referred to CAMHS, despite having suitable problems. Focus groups identified the stigma of mental illness and the fear of gossip as strong disincentives to use CAMHS. Families who had been in contact with CAMHS sought to minimise the stigma they suffered by emphasising that mental illness was not madness and could be cured. Families whose children had complex emotional and behavioural problems said that discrimination by health, education and social care professionals exacerbated their child's difficulties. Families of children with severe and enduring mental illness described tolerating culturally inappropriate services. Fear of gossip about children's 'madness' constituted a major barrier to service use for Asian families in this city. Given the widespread nature of the concern over the stigma of children's mental illness, it should be considered in designing culturally competent services for children's mental health.