Social capital, participation and the perpetuation of health inequalities: obstacles to African-Caribbean participation in 'partnerships' to improve mental health

Abstract

Objectives: There has recently been much emphasis on the role of 'partnerships' between local community 'stakeholders' in strategies to redress health inequalities. This paper examines obstacles to participation in such partnerships by African-Caribbean lay people in local initiatives to improve mental health in a town in southern England. We present a 'social psychology of participation' which we use to interpret our data. Our work seeks to illustrate some of the micro-social mechanisms through which social inequalities are perpetuated, using Bourdieu's conceptualisation of the role played by various forms of capital (economic, social, cultural and symbolic) in perpetuating social inequalities. Design: Our empirical research consists of a qualitative case study of attitudes to participation in mental health-related partnerships in a deprived community. In-depth interviews and focus groups were conducted with 30 local community 'stakeholders', drawn from the statutory, voluntary, user and lay sectors. Results: While interviewees expressed enthusiasm about the principles of participation, severe obstacles to its effective implementation were evident. These included severe distrust between statutory and community sectors, and reported disillusionment and disempowerment within the African-Caribbean community, as well as low levels of community capacity. Moreover, divergent understandings of the meaning of 'partnership' suggested that it would be difficult to satisfy both community and statutory sectors at once. Conclusions: We suggest that disadvantaged and socially excluded communities are often deprived of the social resources which would provide a solid basis for their participation in partnerships with state health services. In the absence of efforts to remove such obstacles, and to generate the necessary resources for participation, partnerships may be 'set up to fail', leaving social inequalities to prevail