A substantial body of research indicates that, for people from Black and Asian ethnic minorities, access to, use of and treatments prescribed by mental health services differ from those for White people (Lloyd & Moodley, 1992; for a review see Bhui, 1997). Pathways to mental healthcare are important, and the widely varying pathways taken in various societies may reflect many factors: the attractiveness and cultural appropriateness of services; attitudes towards services; previous experiences; and culturally defined lay referral systems (Goldberg, 1999). Contact with mental health services may be imposed on the individual, but people who choose to engage with services usually do so only if they think that their changed state of functioning is health-related and potentially remediable through them. In such cases, they will contact whoever they perceive to be the most appropriate carer, and these individuals are often not part of a national healthcare network.

The care pathway approach focuses on the point of access to care and the integration of care by culturally diverse carers. For example, if for African– Caribbean men in crisis the most common point of access to mental health services is through the police and the criminal justice system rather than through their general practitioner (GP), then the challenge is to explore the reasons for this at the interface of these agencies. Carers include the popular and folk sectors of healthcare provision as well as standard primary and secondary care services and the voluntary sector.