Experiences of acute mental health care in an ethnically diverse inner city: qualitative interview study

Weich, Scott; Griffith, Laura; Commander, Martin; Bradby, Hannah; Sashidharan, S. P.; Pemberton, Sarah; Jasani, Rubina; Bhui, Kamaldeep

doi:10.1007/s00127-010-0314-z

Cited by 27 publications

(53 citation statements)

References 26 publications

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“…11 16 Although Weich et al showed no evidence of service users' perceived ethnicity as a major influence on their experience of acute care, our and other studies have shown that service users can be acutely aware of the 'whiteness' of institutions and perceive mental health services to reinforce a White Euro-centric model of healthcare with little consideration or understanding of ethnicity. 24 The prominent role of social networks identified in our study was consistent with previous research, 23 24 in particular the preference of family and friends as a source of help for common mental health problems, rather than healthcare professionals. Participants recognised social networks as a source of support, enabling discussion of problems and access to services.…”

Section: Discussionsupporting

confidence: 90%

Perceived barriers to accessing mental health services among black and minority ethnic (BME) communities: a qualitative study in Southeast England

et al. 2016

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ObjectiveIn most developed countries, substantial disparities exist in access to mental health services for black and minority ethnic (BME) populations. We sought to determine perceived barriers to accessing mental health services among people from these backgrounds to inform the development of effective and culturally acceptable services to improve equity in healthcare.Design and settingQualitative study in Southeast England.Participants26 adults from BME backgrounds (13 men, 13 women; aged >18 years) were recruited to 2 focus groups. Participants were identified through the registers of the Black and Minority Ethnic Community Partnership centre and by visits to local community gatherings and were invited to take part by community development workers. Thematic analysis was conducted to identify key themes about perceived barriers to accessing mental health services.ResultsParticipants identified 2 broad themes that influenced access to mental health services. First, personal and environmental factors included inability to recognise and accept mental health problems, positive impact of social networks, reluctance to discuss psychological distress and seek help among men, cultural identity, negative perception of and social stigma against mental health and financial factors. Second, factors affecting the relationship between service user and healthcare provider included the impact of long waiting times for initial assessment, language barriers, poor communication between service users and providers, inadequate recognition or response to mental health needs, imbalance of power and authority between service users and providers, cultural naivety, insensitivity and discrimination towards the needs of BME service users and lack of awareness of different services among service users and providers.ConclusionsPeople from BME backgrounds require considerable mental health literacy and practical support to raise awareness of mental health conditions and combat stigma. There is a need for improving information about services and access pathways. Healthcare providers need relevant training and support in developing effective communication strategies to deliver individually tailored and culturally sensitive care. Improved engagement with people from BME backgrounds in the development and delivery of culturally appropriate mental health services could facilitate better understanding of mental health conditions and improve access.

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Section: Discussionsupporting

confidence: 90%

Perceived barriers to accessing mental health services among black and minority ethnic (BME) communities: a qualitative study in Southeast England

et al. 2016

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“…Most notably, many service users are dissatisfied, describing wards as non-therapeutic and frightening [3], [4], [5]. Poor relationships between staff and service users are frequently reported [6], [7], [8]. Inpatient ward staff identify several barriers to developing therapeutic relationships including: low staffing levels; an associated lack of staff continuity; bureaucratic demands; and uncertainty about the adoption and implementation of therapeutic models [9].…”

Section: Introductionmentioning

confidence: 99%

The Relationship between Therapeutic Alliance and Service User Satisfaction in Mental Health Inpatient Wards and Crisis House Alternatives: A Cross-Sectional Study

Sweeney¹,

Fahmy²,

Nolan

et al. 2014

PLoS ONE

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BackgroundPoor service user experiences are often reported on mental health inpatient wards. Crisis houses are an alternative, but evidence is limited. This paper investigates therapeutic alliances in acute wards and crisis houses, exploring how far stronger therapeutic alliance may underlie greater client satisfaction in crisis houses.Methods and FindingsMixed methods were used. In the quantitative component, 108 crisis house and 247 acute ward service users responded to measures of satisfaction, therapeutic relationships, informal peer support, recovery and negative events experienced during the admission. Linear regressions were conducted to estimate the association between service setting and measures, and to model the factors associated with satisfaction. Qualitative interviews exploring therapeutic alliances were conducted with service users and staff in each setting and analysed thematically.ResultsWe found that therapeutic alliances, service user satisfaction and informal peer support were greater in crisis houses than on acute wards, whilst self-rated recovery and numbers of negative events were lower. Adjusted multivariable analyses suggest that therapeutic relationships, informal peer support and negative experiences related to staff may be important factors in accounting for greater satisfaction in crisis houses. Qualitative results suggest factors that influence therapeutic alliances include service user perceptions of basic human qualities such as kindness and empathy in staff and, at service level, the extent of loss of liberty and autonomy.Conclusions and ImplicationsWe found that service users experience better therapeutic relationships and higher satisfaction in crisis houses compared to acute wards, although we cannot exclude the possibility that differences in service user characteristics contribute to this. This finding provides some support for the expansion of crisis house provision. Further research is needed to investigate why acute ward service users experience a lack of compassion and humanity from ward staff and how this could be changed.

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“…They also are in keeping with findings of significant variations between places, 9 20 with the largest increase in the South East of England. Despite the great success and popularity of home treatment for acute mental health crises, 10 it is clear that these services are hard to provide in places with high levels of socioeconomic deprivation and where family and other sources of community support are difficult to secure and sustain. These are also the areas with the largest ethnic minority populations and where services are most likely to be perceived as coercive and unsatisfactory.…”

Section: Limitations Of the Studymentioning

confidence: 99%

“…[4][5][6][7] This increase in the use of compulsory detention sits uneasily with patients and professionals equally. [8][9][10][11][12] It is also a source of concern to service commissioners and service providers, given the high costs of inpatient care. The increasing rate of involuntary treatment represents a major financial obstacle to further investment in community services, particularly at times of austerity.…”

Section: Introductionmentioning

confidence: 99%

Association between provision of mental illness beds and rate of involuntary admissions in the NHS in England 1988-2008: ecological study

Keown

Weich

Bhui

et al. 2011

BMJ

101

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Objective To examine the rise in the rate of involuntary admissions for mental illness in England that has occurred as community alternatives to hospital admission have been introduced. Design Ecological analysis.Setting England, 1988England, -2008 Data source Publicly available data on provision of beds for people with mental illness in the National Health Service from Hospital Activity Statistics and involuntary admission rates from the NHS Information Centre. Main outcome measuresAssociation between annual changes in provision of mental illness beds in the NHS and involuntary admission rates, using cross correlation. Partial correlation coefficients were calculated and regression analysis carried out for the time lag (interval) over which the largest association between these variables was identified. ResultsThe rate of involuntary admissions per annum in the NHS increased by more than 60%, whereas the provision of mental illness beds decreased by more than 60% over the same period; these changes seemed to be synchronous. The strongest association between these variables was observed when a time lag of one year was introduced, with bed reductions preceding increases in involuntary admissions (cross correlation −0.60, 95% confidence interval −1.06 to −0.15). This association increased in magnitude when analyses were restricted to civil (non-forensic) involuntary admissions and non-secure mental illness beds. ConclusionThe annual reduction in provision of mental illness beds was associated with the rate of involuntary admissions over the short to medium term, with the closure of two mental illness beds leading to one additional involuntary admission in the subsequent year. This study provides a method for predicting rates of involuntary admissions and what may happen in the future if bed closures continue.

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Experiences of acute mental health care in an ethnically diverse inner city: qualitative interview study

Abstract: Home treatment was popular but hard to deliver in deprived surroundings and placed a strain on carers. Interventions to enhance community treatments in deprived areas are needed, along with remedial interventions to improve therapeutic relationships in hospital settings.

Cited by 27 publications

References 26 publications

Perceived barriers to accessing mental health services among black and minority ethnic (BME) communities: a qualitative study in Southeast England

Perceived barriers to accessing mental health services among black and minority ethnic (BME) communities: a qualitative study in Southeast England

The Relationship between Therapeutic Alliance and Service User Satisfaction in Mental Health Inpatient Wards and Crisis House Alternatives: A Cross-Sectional Study

Association between provision of mental illness beds and rate of involuntary admissions in the NHS in England 1988-2008: ecological study

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