The Patient and Carer Race Equality Framework: a model to reduce mental health inequity in England and Wales

Smith, Shubulade Mary; Kheri, Amna; Ariyo, Kevin; Gilbert, Steve; Salla, Anthony; Lingiah, Tony; Taylor, Clare; Edge, Dawn

doi:10.3389/fpsyt.2023.1053502

Cited by 5 publications

(3 citation statements)

References 59 publications

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“…Clinicians in the current study explicitly highlighted a bias towards detaining Black men. This has been widely reported in other studies which have reported clinician biases and racial profiling being among the proposed explanations for the over-representation of Black men in detentions [10], and there are recent efforts to improve clinical practice and introduce unconscious bias training in mental health care [26]. Furthermore, this links with England and Wales government White Paper - Reforming the Mental Health Act [27].…”

Section: Discussionmentioning

confidence: 58%

Exploring Pathways to Compulsory Detention and Ways to Prevent Repeat Compulsory Detentions; Clinician Perspectives

Kular,

Birken,

Wood

et al. 2024

Preprint

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BackgroundRates of compulsory detention in psychiatric hospitals have risen over several decades in England and some other higher income countries. This study explores clinicians’ perspectives on how service users come to be compulsorily detained in psychiatric hospitals and their suggestions for reducing these detentions in the future.MethodsSemi-structured qualitative interviews were conducted with 23 clinicians working with individuals who have been compulsorily detained under the Mental Health Act in England. Interviews were carried out by telephone or videoconference. Data were analysed using template analysis.ResultsThree major themes were identified, with multiple sub-themes (a) service user factors that increase risk of compulsory detention, including high levels of risk, previous/underlying trauma, medication non-adherence, service user perceptions of their mental health state, disadvantage and discrimination, and lack of stability and involvement from family and social networks; (b) service-level reasons for being detained, including lack of communication and continuity of care, historical inability to obtain trust and confidence from parts of population, clinician biases and assumptions, lack of resources, lack of treatment and care variety, and systemic/institutional barriers to engagement; and (c) ways to improve services to reduce compulsory detainment, including increasing quality of care and patient/family level interventions, investing in services, offer choice regarding medication, offer alternatives to compulsory detention, and improve discharge planning.ConclusionsFindings suggested clinicians see that at least some compulsory hospital admissions as avoidable, particularly through better resourced and more accessible services and changes in staff attitudes to address unconscious biases and promote collaborative care. Our findings provide a range of potential means to reduce detentions, which warrant development and testing in research and practice.

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Section: Discussionmentioning

confidence: 58%

Exploring Pathways to Compulsory Detention and Ways to Prevent Repeat Compulsory Detentions; Clinician Perspectives

Kular,

Birken,

Wood

et al. 2024

Preprint

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“…Addressing any inequalities of access to services and reducing racial discrimination and disparities appears to be a key issue to address across several mental health systems (21, 22, 74, 75). Service users from minoritised ethnic groups reported experiences of racism and unfair treatment, thus efforts to promote equality, diversity and inclusion and anti-racist practice are needed, a recent example of which is the Patient and Carer Race Equality Framework in England and Wales (76).…”

Section: Discussionmentioning

confidence: 99%

A qualitative meta-synthesis of service users’ and carers’ experiences of assessment and involuntary hospital admissions under mental health legislations: a five-year update

Bartl,

Stuart,

Ahmed

et al. 2024

Preprint

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Background Compulsory admissions occur in psychiatric hospitals around the world. They result in coercive and sometimes traumatic experiences for service users and carers. Legal and service reforms in various countries are intended to reduce rates of detention and improve service user experience. We aimed to inform policy and service delivery by providing an up-to-date synthesis of qualitative evidence on service usersʼ and carersʼ experiences of assessment and detention under mental health legislation, updating previous reviews in which we searched for literature published up to 2018. Methods We searched five bibliographic databases for studies published between January 2018 and March 2023. We identified 24 additional studies reporting qualitative investigations of service usersʼ or carersʼ experiences of assessment or detention under mental health legislation. A team including researchers with relevant personal experience analysed and synthesised data using a thematic synthesis approach. Results Findings suggest that views on compulsory admissions and assessment varied: many reports highlighted its often negative, traumatic impacts on emotional well-being and self-worth, with fewer accounts of it as an opportunity to access help and support, accompanied by feelings of relief. Experiences of racial discrimination, inequality of access, and dissatisfaction with support before and after hospital stay were more prominent than in our previous reviews. Conclusions Increasing service user and carer involvement in treatment decisions, provision of timely information at key stages of the admission process, training of key personnel, addressing the issue of discrimination, and investing in community alternatives of inpatient care may contribute to and lead to better overall treatment experiences.

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“…At a service system level, provision of community alternatives when in crisis [35] and focusing resources on long term, high quality and individualised community care in which service users are supported to participate in decisions and provided a broad range of help with supported self-management, medication management and social difficulties was supported by our findings as a potential means of reducing compulsory admission. A single participant referred to discrimination, but many participants felt disempowered and lacking a voice in the care, an experience to which racial inequalities may also have been relevant [36].…”

Section: Discussionmentioning

confidence: 99%

Exploring pathways to compulsory detention in psychiatric hospital and ways to prevent repeat detentions; Service user perspectives

Birken,

Kular,

Nyikavaranda

et al. 2024

Preprint

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PurposeThis study, co-produced by a team of academics, lived experience researchers and clinicians, explores the views and experiences of people who have been compulsorily detained in hospital under the Mental Health Act (1983) (MHA) in England, to understand how and why, from their perspective, compulsory detentions occur, and what might help prevent them.MethodsSemi-structured qualitative interviews were conducted with 20 people (55% male, 40% Black/Black British, 30% White British) who had been compulsory detained in hospital within the past 5 years. Lived experience researchers with relevant personal experience carried out interviews via telephone or videoconference and participated in analysis of data via a template approach.ResultsWe derived three over-arching themes from interviews. The first theme “Individual factors increasing or reducing likelihood of being detained” encompassed factors related to people’s own lives and attitudes, including life stressors, not taking medication, the risk individuals may pose to themselves or others, and their attitude to and management of their mental health. The second theme “Family and Support Network” reflects how attitudes and support from family, friends and support network may contribute to compulsory detentions or support people to stay well. The third theme “Need for improvement in Service Responses” identified limitations of services that contribute to detention, including lack of collaborative care and choice, poor quality of professional support, and discriminatory attitudes from staff. Each theme also included potential approaches to addressing these limitations and reducing compulsory detentions.ConclusionFindings suggest multiple interacting factors may lead to people being detained in hospital under the MHA, and that improvements to services, such as increasing collaborative care and service user-led family involvement, could prevent further detentions.

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The Patient and Carer Race Equality Framework: a model to reduce mental health inequity in England and Wales

Cited by 5 publications

References 59 publications

Exploring Pathways to Compulsory Detention and Ways to Prevent Repeat Compulsory Detentions; Clinician Perspectives

Exploring Pathways to Compulsory Detention and Ways to Prevent Repeat Compulsory Detentions; Clinician Perspectives

A qualitative meta-synthesis of service users’ and carers’ experiences of assessment and involuntary hospital admissions under mental health legislations: a five-year update

Exploring pathways to compulsory detention in psychiatric hospital and ways to prevent repeat detentions; Service user perspectives

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