Racialised experience of detention under the Mental Health Act: a photovoice investigation of practice, policy and legislation

Abstract

Background: The rates of compulsory admission and treatment (CAT) are rising in mental health systems in the UK. These disparities are reported among migrants and black and ethnic minorities in Europe and North America. Lived experience perspectives from marginalised and multiple disadvantaged people are neglected in research yet may offer vital and novel insights into preventive opportunities to reduce coercive care Methods: We conducted a participatory photovoice research process to assemble the life-experiences of people within two years of receiving CAT. We purposively sampled to maximise diversity by age, ethnicity, and different sections of the Mental Health Act (England & Wales, 1983, 2007) from 8 health systems in England. The images, captions, and reflective narratives were deepened over 3 workshops before thematic analysis. Outcomes: Forty-eight ethnically diverse people with lived experience of CAT contributed over 500 images and 30 hours of transcribed narratives. Participants lives showed significant complexity in terms of multimorbidity, adverse childhood experiences, and carer roles. The findings suggest insufficient co-ordination to prevent CAT despite early help-seeking, not being taken seriously when seeking help, hostility and dismissive responses from professionals; unnecessary police involvement which was distressing, stigmatising, and risked criminalisation. Participants wanted more advocacy given their vulnerability and inability to process information in crisis, as well as therapeutic and creative activities in inpatient environments. Participants recommended more family and carer involvement, and more appropriate, frequent and personalised information about care options, appeals processes, levels of restriction, and seclusion. A major concern was the lack of highly skilled staff, trauma-informed care, and therapies into the community. Interpretation: We showed epistemic injustice in care processes and recommend better standards for essential skills, prevention, trauma informed care and therapies. Criminalising and coercive responses must also be reduced.