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Hassan H, Williams F, Cordwell J, Mann J. Ethnic minority fathers' experiences of the Neonatal Care Unit: barriers to accessing psychological support. J Reprod Infant Psychol 2023:1-13. [PMID: 38018095 DOI: 10.1080/02646838.2023.2287079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/19/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND The Neonatal Care Unit is a challenging environment for parents. Previous literature documents the need for increased and more specialised understanding of support for fathers. There remains a dearth of literature on the experiences of ethnic minority fathers in particular, who may be less likely to access psychological support available. METHOD This project aimed to understand the barriers ethnic minority fathers face when accessing psychology support at a Neonatal Care Unit in England. Seven fathers from ethnic minority backgrounds participated in semi-structured interviews after their babies were discharged. RESULTS Data were analysed using a Reflexive Thematic Analysis approach. Three main themes were identified: 'Psychology is a Threat', 'It's Not Really Talked About in our Culture', and 'A Space for Mum, Not Me'. These themes are discussed in reference to the extant literature, and recommendations are provided to improve access to support in this neonatal unit. CONCLUSIONS There is a need to recognise interacting influences of gender and cultural norms in supporting these fathers, including understanding the role of psychology, consideration of stigma, and knowing families in relation to their cultural context.
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Affiliation(s)
- Hibah Hassan
- The Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Oxford, UK
| | - Fin Williams
- The Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Oxford, UK
| | - Jacinta Cordwell
- Children's Psychological Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Joanna Mann
- Children's Psychological Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
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Ridge D, Pilkington K, Donovan S, Moschopoulou E, Gopal D, Bhui K, Chalder T, Khan I, Korszun A, Taylor S. A meta-ethnography investigating relational influences on mental health and cancer-related health care interventions for racially minoritised people in the UK. PLoS One 2023; 18:e0284878. [PMID: 37163472 PMCID: PMC10171693 DOI: 10.1371/journal.pone.0284878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/10/2023] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVE Despite calls to increase the 'cultural competence' of health care providers, racially minoritised people continue to experience a range of problems when it comes to health care, including discrimination. While relevant qualitative meta-syntheses have suggested better ways forward for health care for racialised minorities, many have lacked conceptual depth, and none have specifically investigated the relational dimensions involved in care. We set out to investigate the social and cultural influences on health care interventions, focusing on psychological approaches and/or cancer care to inform the trial of a new psychological therapy for those living with or beyond cancer. METHOD A meta-ethnography approach was used to examine the relevant qualitative studies, following Noblit and Hare, and guided by patient involvement throughout. Papers were analysed between September 2018 and February 2023, with some interruptions caused by the Covid pandemic. The following databases were searched: Ovid MEDLINE, EBSCO CINAHL, Ovid Embase, EBSCO PsycINFO, Proquest Sociology Collection (including Applied Social Sciences Index & Abstracts (ASSIA), Sociological Abstracts and Sociology Database), EBSCO SocINDEX, Ovid AMED, and Web of Science. The systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42018107695), and reporting follows the eMERGe Reporting Guidance for meta-ethnographies (France et al. 2019). RESULTS Twenty-nine journal papers were included in the final review. Themes (third-order constructs) developed in the paper include the centrality of the patient-practitioner relationship; how participants give meaning to their illness in connection to others; how families (rather than individuals) may make health decisions; how links with a higher power and spiritual/religious others can play a role in coping; and the ways in which a hierarchy of help-seeking develops, frequently with the first port of call being the resources of oneself. Participants in studies had a need to avoid being 'othered' in their care, valuing practitioners that connected with them, and who were able to recognise them as whole and complex (sometimes described in relational languages like 'love'). Complex family-based health decision-making and/or the importance of relations with non-human interactants (e.g. God, spiritual beings) were frequently uncovered, not to mention the profoundly emergent nature of stigma, whereby families could be relatively safe havens for containing and dealing with health challenges. A conceptual framework of 'animated via (frequently hidden) affective relationality' emerged in the final synthesis, bringing all themes together, and drawing attention to the emergent nature of the salient issues facing minoritised patients in health care interactions. CONCLUSION Our analysis is important because it sheds light on the hitherto buried relational forces animating and producing the specific issues facing racially minoritised patients, which study participants thought were largely overlooked, but to which professionals can readily relate (given the universal nature of human relations). Thus, training around the affective relationality of consultations could be a fruitful avenue to explore to improve care of diverse patients.
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Affiliation(s)
- Damien Ridge
- School of Social Sciences, University of Westminster, London, United Kingdom
| | - Karen Pilkington
- School of Health and Care Professions, University of Portsmouth, Portsmouth, United Kingdom
| | - Sheila Donovan
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Elisavet Moschopoulou
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Dipesh Gopal
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Kamaldeep Bhui
- Department of Psychiatry, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- Wadham College, University of Oxford, Oxford, United Kingdom
- World Psychiatric Association Collaborating Centre, Oxford, United Kingdom
| | - Trudie Chalder
- Department of Psychological Medicine, Kings College London, London, United Kingdom
| | - Imran Khan
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Ania Korszun
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Stephanie Taylor
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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Bansal N, Karlsen S, Sashidharan SP, Cohen R, Chew-Graham CA, Malpass A. Understanding ethnic inequalities in mental healthcare in the UK: A meta-ethnography. PLoS Med 2022; 19:e1004139. [PMID: 36512523 PMCID: PMC9746991 DOI: 10.1371/journal.pmed.1004139] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/11/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Evidence regarding the presence and persistence of ethnic inequalities in mental healthcare is well established. The reasons for these inequalities and lack of progress in diminishing them are less understood. This meta-ethnography aims to provide a new conceptual understanding of how ethnic inequalities are created and sustained; this is essential to develop effective interventions. Specifically, we sought to understand why people from ethnic minority groups are underrepresented in primary care mental health service provision and overrepresented in crisis pathways and detention. METHODS AND FINDINGS Following eMERGe guidelines for meta-ethnographies, we searched OpenGrey, Kings Fund, CINAHL, Medline, PsycINFO, and Social Care Online databases for qualitative articles published from database inception until October 2, 2022, using broad categories of search terms relating to "ethnicity AND (mental illness/mental health/emotional distress) AND (help-seeking/service utilisation/experience/perception/view)." We included all conceptually rich articles that used qualitative methods of data collection and analysis and excluded non-UK studies and those that focused solely on causation of mental illness. Our patient, public, and practitioner lived experience advisory group provided feedback and input on key stages of the project including search terms, research questions, data analysis, and dissemination. A total of 14,142 articles were identified; 66 met the inclusion criteria. We used reciprocal, refutational, and line of argument analytical approaches to identify convergence and divergence between studies. The synthesis showed that current models of statutory mental healthcare are experienced as a major barrier to the delivery of person-centred care to those in ethnic minority groups due to the perceived dominance of monocultural and reductionist frameworks of assessment and treatment (described as "medical" and "Eurocentric") and direct experiences of racist practice. The lack of socially oriented and holistic frameworks of knowledge and understanding in medical training and services is experienced as epistemic injustice, particularly among those who attribute their mental illness to experiences of migration, systemic racism, and complex trauma. Fear of harm, concerns about treatment suitability, and negative experiences with health providers such as racist care and medical neglect/injury contribute to avoidance of, and disengagement from, mainstream healthcare. The lack of progress in tackling ethnic inequalities is attributed to failures in coproduction and insufficient adoption of existing recommendations within services. Study limitations include insufficient recording of participant characteristics relating to generational status and social class in primary studies, which prevented exploration of these intersections. CONCLUSIONS In this study, we found that the delivery of safe and equitable person-centred care requires a model of mental health that is responsive to the lived experiences of people in ethnic minority groups. For the people considered in this review, this requires better alignment of mental health services with social and anti-racist models of care. Our findings suggest that intersections related to experiences of racism, migration, religion, and complex trauma might be more relevant than crude ethnic group classifications. Strategies to tackle ethnic inequalities in mental healthcare require an evaluation of individual, systemic, and structural obstacles to authentic and meaningful coproduction and implementation of existing community recommendations in services.
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Affiliation(s)
- Narinder Bansal
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Saffron Karlsen
- Centre for the Study of Ethnicity and Citizenship, School of Sociology, Politics and International Studies, University of Bristol, Bristol, United Kingdom
| | - Sashi P. Sashidharan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Rachel Cohen
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | | | - Alice Malpass
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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A Systematic Review of Inequalities in the Mental Health Experiences of Black African, Black Caribbean and Black-mixed UK Populations: Implications for Action. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01352-0. [PMID: 35767218 DOI: 10.1007/s40615-022-01352-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/14/2022] [Accepted: 06/17/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Measurable differences in the experience and treatment of mental health conditions have been found to exist between different racial categories of community groups. The objective of this research was to review the reported mental health of Black African-Caribbean communities in the UK, determinants of mental health, and interventions to enhance their experiences of mental health services. METHOD The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement was applied. To be included, papers must be published in a peer reviewed journal; report on adult populations (over 18) from any of Black African, Black Caribbean or Black mixed people in the UK; and assess (quantitative), or discuss (qualitative) mental health experiences, determinants of mental health, or interventions intended to enhance experiences of mental health services among the target population. The aims, inclusion criteria, data extraction, and data quality evaluation were specified in advance. Searches were conducted using EBSCO (PsychInfo; MEDLINE; CINAHL Plus; psychology and behavioural sciences collection). The search strategy included search terms relating to the aim. Risk of bias was assessed using a standard tool, records were organised using Endnote, and data were extracted and synthesised using Microsoft Excel. RESULTS Thirty-six studies were included, of which 26 were quantitative and six reported exclusively on Black participants. Black populations were less likely to access mental health support via traditional pathways due to stigma and mistrust of mental health services. Black Africans especially, sought alternative help from community leaders, which increased the likelihood of accessing treatment at the point of crisis or breakdown, which in turn increased risk of being detained under the Mental Health Act and via the criminal justice system. DISCUSSION Findings suggest a cycle of poor mental health, coercive treatment, stigma, and mistrust of services as experienced by Black communities. Evidence was limited by poorly defined ethnic categories, especially where Black populations were subsumed into one category. It is recommended that mental health services work collaboratively with cultural and faith communities in supporting Black people to cope with mental illness, navigate mental health pathways, and provide culturally appropriate advice. Protocol Registration Number PROSPERO CRD42021261510.
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Shaw L, Nunns M, Briscoe S, Anderson R, Thompson Coon J. A "Rapid Best-Fit" model for framework synthesis: Using research objectives to structure analysis within a rapid review of qualitative evidence. Res Synth Methods 2020; 12:368-383. [PMID: 33006277 DOI: 10.1002/jrsm.1462] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/03/2020] [Accepted: 09/28/2020] [Indexed: 11/08/2022]
Abstract
The short time frame associated with rapid reviews can be challenging for researchers conducting qualitative evidence synthesis. In these circumstances a Best-Fit Framework Synthesis, drawing upon existing theory and/or research, may be conducted to rapidly make sense of qualitative evidence. This article discusses a "Rapid Best-Fit" approach to conducting Framework Synthesis within an 6-week rapid systematic review of qualitative evidence. In the absence of a suitable theoretical model to inform the synthesis, we drew upon our research objectives to structure a framework, and to identify the studies which contained the most relevant data. Themes from these studies were used to revise the initial framework before inductive thematic synthesis finalized theme content. This "Rapid Best-Fit" approach yielded results aligned with the needs of the commissioners of the review and is a useful addition to qualitative synthesis methods, allowing for the incorporation of diverse views and experiences into fast-paced decision making scenarios.
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Affiliation(s)
- Liz Shaw
- College of Medicine and Health, University of Exeter, St Lukes Campus, University of Exeter, Devon, Exeter, EX1 2LU, UK
| | - Michael Nunns
- College of Medicine and Health, University of Exeter, St Lukes Campus, University of Exeter, Devon, Exeter, EX1 2LU, UK
| | - Simon Briscoe
- College of Medicine and Health, University of Exeter, St Lukes Campus, University of Exeter, Devon, Exeter, EX1 2LU, UK
| | - Rob Anderson
- College of Medicine and Health, University of Exeter, St Lukes Campus, University of Exeter, Devon, Exeter, EX1 2LU, UK
| | - Jo Thompson Coon
- College of Medicine and Health, University of Exeter, St Lukes Campus, University of Exeter, Devon, Exeter, EX1 2LU, UK
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Shaw L, Nunns M, Briscoe S, Anderson R, Thompson Coon J. Experiences of the ‘Nearest Relative’ provisions in the compulsory detention of people under the Mental Health Act: a rapid systematic review. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06390] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundService users detained for assessment and/or treatment under the Mental Health Act 1983 (MHA 1983) are allocated a ‘Nearest Relative’ (NR). The NR has access to confidential information about the service user and can make decisions about their care and treatment. Tensions exist regarding the identification, displacement and powers of the NR.ObjectivesTo examine the experiences of service users, carers and relevant professionals of the NR provisions of the MHA 1983, and the equivalent Named Person (NP) provisions in Scotland. Five research objectives were defined: understanding the experiences of and issues associated with (1) the identification of the NR, (2) the displacement of the NR, (3) confidentiality and information-sharing, (4) access to support from carers and (5) making decisions about treatment or care.Data sourcesSeven bibliographic databases were searched: MEDLINE (via Ovid), MEDLINE In-Process & Other Non-Indexed Citations (via Ovid), PsycINFO (via Ovid), Social Policy and Practice (via Ovid), Health Management Information Consortium (via Ovid), Cumulative Index to Nursing and Allied Health Literature (via EBSCOhost) and Applied Social Sciences Index and Abstracts (via ProQuest). Citation searching, author contact and grey literature searches were conducted.Review methodsA rapid systematic review was conducted in 6 weeks. Evidence published after 1998 from the UK pertaining to the experiences of those involved in compulsory detention under the MHA 1983 (or UK variants), including service users, carers, family members, NRs, NPs, mental health professionals, policy-makers and lawyers, was sought. Study selection, data extraction and critical appraisal were completed independently by two reviewers. We looked for data about experiences, which were obtained through qualitative means or surveys. Included studies containing several paragraphs of participant quotations and/or author interpretations were entered into a framework synthesis; the rest were summarised descriptively. The framework synthesis was based on the five research objectives and refined using the findings of key studies from England and Scotland and an inductive thematic analysis.ResultsTwenty studies were included with 12 prioritised for framework synthesis. Four themes emerged: (1) issues regarding the identification of the NR/NP, (2) confidentiality and information-sharing, (3) enabling the use of the NR/NP role and (4) the importance of maintaining relationships. The involvement of service users in choosing their representative and the role of services in supporting the NR/NP was identified as important.LimitationsThere is little recent evidence to inform this important and complex discussion. The review was rigorously conducted despite the short time scale; however, a more in-depth, iterative thematic analysis of all the included studies may have provided additional insights into the mechanisms underpinning the issues.ConclusionsThe NR provisions of the MHA 1983 are complex and of significant importance to individuals detained under the Mental Health Act and their carers. This rapid review provides specific examples of issues that individuals may experience. More research is needed to aid understanding of this complex topic.Future workPrimary research specifically focused on the perceived and actual use and impact of the NR provisions in England and Scotland.Study registrationThis study is registered as PROSPERO CRD42018088237.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Liz Shaw
- Exeter Health Services and Delivery Research Evidence Synthesis Centre, College of Medicine and Health, Exeter, UK
| | - Michael Nunns
- Exeter Health Services and Delivery Research Evidence Synthesis Centre, College of Medicine and Health, Exeter, UK
| | - Simon Briscoe
- Exeter Health Services and Delivery Research Evidence Synthesis Centre, College of Medicine and Health, Exeter, UK
| | - Rob Anderson
- Exeter Health Services and Delivery Research Evidence Synthesis Centre, College of Medicine and Health, Exeter, UK
| | - Jo Thompson Coon
- Exeter Health Services and Delivery Research Evidence Synthesis Centre, College of Medicine and Health, Exeter, UK
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Islam Z, Rabiee F, Singh SP. Black and Minority Ethnic Groups’ Perception and Experience of Early Intervention in Psychosis Services in the United Kingdom. JOURNAL OF CROSS-CULTURAL PSYCHOLOGY 2015. [DOI: 10.1177/0022022115575737] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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.
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Affiliation(s)
- Zoebia Islam
- Senior Research Fellow, Birmingham and Solihull Mental Health NHS Foundation Trust and LOROS, Hospice Care for Leicester, Leicestershire and Rutland; Honorary Lecturer and Research Fellow De Montfort University and Warwick University UK
| | - Fatemeh Rabiee
- Professor in Public Health promotion, Faculty of Health, Education and Life Sciences Birmingham City University (BCU), UK
| | - Swaran P. Singh
- Head of Division, Mental Health and Wellbeing Warwick Medical School University of Warwick CV4 7AL; Honorary Consultant Psychiatrist Birmingham and Solihull Mental Health Foundation Trust; Commissioner, Equality and Human Rights Commission
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