How do parents within the Orthodox Jewish community experience accessing a community Child and Adolescent mental health service? Gemma Rowland A thesis submitted in partial fulfilment of the requirements of the University of East London for the Doctoral Degree in Clinical Psychology May 2016 Final word count: 31000 i Abstract Previous research suggests that children of minority groups may be underserved by mainstream services (Elster, Jarosik, VanGeest & Fleming, 2003). There has been an identified need for research that focuses on barriers to accessing services faced by minority groups, such as the Orthodox Jewish community (Dogra, Singh, Svirdzenka & Vostansis, 2012). Given that parents are often the gate-keepers to care (Stiffman, Pescosolido & Cabassa, 2004), understanding their help-seeking behaviour is crucial to ensure that Orthodox children and families are given the same opportunities to access services as their majority group peers. To date there is extremely limited research on the help-seeking behaviours of Orthodox Jewish parents. The current study sought to consider the experiences of Orthodox Jewish parents who have accessed Child and Adolescent Mental Health Services (CAMHS) in order to seek help for their families. Semi-structured interviews were completed with nine Orthodox Jewish parents with regards to their experiences of accessing tier 2 CAMHS for their child. A thematic analysis was conducted. Four themes were found: ‘The Orthodox community as unique’, ‘Pathways to help’, ‘Attitudes towards mental health’ and ‘The parental journey’. Participants described a number of significant cultural barriers to seeking help. Stigma was identified as occurring in relation to mental health and also in relation to the process of help-seeking, as suggested by previous research within adult Orthodox populations (Feinberg & Feinberg, 1985). These stigmas relate to concerns regarding labelling and future matchmaking for the child and their siblings. Parents experience emotional and practical strains in parenting a child with mental health difficulties and in accessing psychological support for their children. The implications for service level change and clinical practice are considered. ii Acknowledgments I would firstly like to thank the parents who took the time to participate in this research and to share their experiences. Thank you to Dr Beth Hill for your boundless enthusiasm and support throughout the research process, and to Dr Jo Temple and First Steps clinicians for helping with recruitment. Thank you to Dr Paula Magee for your supervision in completing this research. I would like to thank my family and my friends for accepting my training-related absences and for offering support over the last three years. And of course, extensive thanks to Paul, for your endless patience and encouragement and for making me laugh every single day. I would like to dedicate this thesis to my parents, who have believed in me when I could not believe in myself and who helped me to find help when I needed it. iii Contents Abstract .................................................................................................................................... ii Acknowledgments ................................................................................................................... iii Chapter 1: INTRODUCTION ...................................................................................... 1 1.1 Background and context .................................................................................................... 1 1.1.1 The Orthodox Jewish community .................................................................................... 2 1.1.2 The Orthodox community and acculturation ................................................................... 2 1.1.3 Key groups within the Orthodox community ................................................................... 4 1.1.4 The role of community leaders ........................................................................................ 6 1.1.5 The Orthodox community in Hackney ............................................................................. 6 1.2 Children and young people; help-seeking for mental health difficulties ............................. 8 1.2.1 Parents as gatekeepers to care ...................................................................................... 9 1.2.2 Parents experiences of accessing CAMHS .................................................................... 9 1.2.3 Factors affecting help-seeking ...................................................................................... 10 1.3 Literature review .............................................................................................................. 15 1.4 Mental health and the Orthodox community .................................................................... 18 1.4.1 Stigma and cultural barriers to psychological help in the Orthodox community ........... 19 1.4.2 Mental health, and Orthodox children and young people. ............................................ 20 1.4.3 Culturally sensitive practice .......................................................................................... 21 1.5 Equal access to services ................................................................................................. 23 1.6 Research rationale ........................................................................................................... 24 1.7 Research aims ................................................................................................................. 25 CHAPTER 2: METHODOLOGY ............................................................................... 26 2.1 Ethical and epistemological positions .............................................................................. 26 2.1.2 Epistemological positions .............................................................................................. 27 2.2 The recruitment site and service context ......................................................................... 27 2.3 Research design and rationale ........................................................................................ 28 2.3.1 Rationale for methodology ............................................................................................ 28 2.3.2 Approach to TA ............................................................................................................. 30 2.4 Procedure ........................................................................................................................ 30 2.4.1 Ethical considerations ................................................................................................... 30 2.4.2 Confidentiality and anonymity ....................................................................................... 31 2.4.3 Ethical approval ............................................................................................................ 32 2.4.4 Protection from harm .................................................................................................... 32 2.4.5 Informed consent .......................................................................................................... 32 2.4.6 Supervision ................................................................................................................... 33 iv 2.4.7 Recruitment of participants ........................................................................................... 33 2.4.8 Inclusion and exclusion criteria ..................................................................................... 33 2.4.9 Participants ................................................................................................................... 34 2.5 Data collection ................................................................................................................. 35 2.5.1 Resources ..................................................................................................................... 35 2.5.2 Interview process .......................................................................................................... 35 2.5.3 Interview schedules & design ....................................................................................... 35 2.5.3 Transcription ................................................................................................................. 36 2.6 Data analysis ................................................................................................................... 37 2.7 Reflexivity ......................................................................................................................... 38 2.7.1 The researchers’ position .............................................................................................. 38 2.7.2 Relationship to Judaism ................................................................................................ 38 Chapter 3: ANALYSIS .............................................................................................. 40 3.1 Summary of key themes. ................................................................................................. 40 3.1.1 Development of themes ................................................................................................ 41 3.2 The Orthodox Jewish Community as unique ................................................................... 42 3.2.1 An insular, traditional community