Black and Minority Ethnic Groups’ Perception and Experience of Early Intervention in Psychosis Services in the United Kingdom

Abstract

In the United Kingdom, Black and minority ethnic (BME) service users experience adverse pathways into mental health care. Ethnic differences are evident even at first-episode psychosis; therefore, contributory factors must operate prior to first presentation to psychiatric services. This study examines the cultural appropriateness, accessibility, and acceptability of the Early Intervention (EI) for Psychosis Services in Birmingham (the United Kingdom) in improving the experience of care and outcomes for BME patients. Thirteen focus groups were conducted with EI service users (n = 22), carers (n = 11), community and voluntary sector organizations (n = 6), service commissioners (n = 10), EI professionals (n = 9), and spiritual care representatives (n = 8). Data were analyzed using a thematic approach and framework analysis. Findings suggest that service users and carers have multiple, competing, and contrasting explanatory models of illness. For many BME service users, help-seeking involves support from faith/spiritual healers, before seeking medical intervention. EI clinicians perceive that help-seeking from faith institutions in Asian service users might lead to treatment delays. The value of proactively including service user's religious and spiritual perspectives and experiences in the initial assessment and therapy is recognized. However, clinicians acknowledge that they have limited spiritual/religious or cultural awareness training. There is little collaborative working between mental health services and voluntary and community organizations to meet cultural, spiritual, and individual needs. Mental health services need to develop innovative collaborative models to deliver holistic and person-centered care.

Conceptualizations of subjective recovery from recent onset psychosis and its associated factors: A systematic review

“…Given that the development status of a country has been identified as a potential contributing factor to recovery outcomes, cultural diversity within countries should also be considered and this may be an important gap in our current understanding of subjective recovery. A study in the United Kingdom, though not specifically about subjective recovery, found that people from minority ethnic groups link or relate mental illness to something supernatural, and therefore prefer to deal with it in their own traditional way (Islam, Rabiee, & Singh, ) which affects their recovery. Less representation of minority ethnic groups in different recovery studies (Law et al, ; Law, Neil, Dunn, & Morrison, ) limits the global view of the issue.…”

Modifying illness beliefs in recent onset psychosis carers: Evaluating the impact of a cognitively focused brief group intervention in a routine service

“…A third limitation relates to the illness beliefs under measure and the overall bio‐psycho‐social conceptualization of psychosis suggested. The model, whilst representing best knowledge and practice, remains embedded with western psychiatry and not necessarily at one with other illness perspectives that may also be considered to play an important role in some BAME groups and cultures (Banerjee & Roy, ; Islam et al, ; Suhail & Cochrane, ). Furthermore, exploring the contribution of ethnic membership on specific carer outcomes would be an important area to explore.…”

“…Furthermore, the meanings assigned to illness symptoms and labels can differ between and within carer and patient groups, depending on ethnic membership (Patel, Chawla, Krynicki, Rankin, & Upthegrove, 2014;Upthegrove, Atulomah, Brunet, & Chawla, 2013;Zafar, Syed, & Tehseen, 2008). Qualitative investigations of BAME service users and carers accessing early intervention in psychosis services suggest an increased need for better information about illness course and recovery outcomes (Islam, Rabiee, & Singh, 2015).…”

“…The group format may have driven the positive changes observed. Furthermore, whilst no substantial differences were observed between carers who provided complete pre and post data and those who did not, it is possible that the former may have had a more positive stance towards the group and its aims and greater readiness to modify their beliefs in the con- embedded with western psychiatry and not necessarily at one with other illness perspectives that may also be considered to play an important role in some BAME groups and cultures (Banerjee & Roy, 1998;Islam et al, 2015;Suhail & Cochrane, 2002). Furthermore, exploring the contribution of ethnic membership on specific carer outcomes would be an important area to explore.…”

The supportive care needs of individuals recovering from first episode psychosis: A scoping review

“…[17][18][19] Data relating to the needs of individuals recovering from FEP were present in all other articles; however, needs were not the primary phenomenon being investigated. 6,8,[20][21][22][23][24][25][26][27][28] For each of the domains of the SCNF, both broad categories of need and specific needs were identified. The majority of these needs are present in Fitch's outline of the SCNF.…”