Researchers at King’s College London have explored how individuals from black Caribbean and white British populations navigate UK mental health services in order to help reduce healthcare disparities.

A new study, published in Social Science & Medicine, explores how individuals from black Caribbean populations experiencing psychoses navigate UK mental health services. It was conducted as part of AESOP-10 – a 10-year follow up of 532 ethnically diverse individuals with first episode psychosis.

Researchers from the Department of Health Service and Population Research at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) explore the perspective of individuals across ethnicities experiencing severe forms of mental distress to better understand the social and cultural factors which influence how people experience UK mental health services.

The study presents findings from a series of interviews with individuals across ethnic groups who had interacted with mental health services. The narratives of many individuals from black Caribbean populations suggested that many felt unable to break the cycle of service use. Self-reported distress was often attributed to social and environmental experiences, such as socioeconomic status, which have been shown to disproportionately affect minoritised ethnic groups. Vitally, participants lacked hope that their circumstances or their illness would improve.

The authors propose that structural inequalities that disproportionately impact people from ethnic minorities , e.g., discrimination, increased rates of unemployment, and lower socioeconomic position, are a major cause of mental health disparities and may explain differences in how individuals experience mental health services within the UK.

The authors analysed several key themes which arose within the narratives of individuals across ethnicities – (1) ‘losing self within the system’, (2) ‘steadying self through the system’, (3) ‘finding strength beyond the system’.

They found that the experience of ‘losing self within the system’ was more common among individuals from black Caribbean populations. White British participants, on the other hand, were more likely to experience ‘steadying self through the system’, instead indicating that mental health services helped them manage their mental distress. They also appeared more likely to benefit from positive social circumstances that helped to maintain careers and education and provide access to psychological therapy, helping individuals to believe that they could recover.

The study enhances our understanding of persistent inequalities in healthcare access and quality among minority ethnic groups and the impact this has on navigating mental health services. The findings highlight the importance of interventions which target social disadvantage for reducing mental health disparities and improving the experiences of mental health services among black Caribbean and other populations.

Lead author, Dr Vanessa Lawrence of King’s IoPPN said “These findings underline the necessity of working with communities to develop interventions that target social disadvantage in this population, including better access to psychological therapies, and opportunities for employment and social participation. Without addressing these complex social challenges, we fear that the mental health system will continue to disadvantage non-white ethnic groups, and ultimately keep them trapped in a system that is not working for them.”

This study was funded by the UK Medical Research Council (MRC), the National Institute for Health Research Biomedical Research Centre (NIHR BRC) at South London and Maudsley NHS Foundation Trust (SLaM), and King’s College London.

Lawrence, V., McCombie, C., Nikolakopoulos, G., Morgan, C. (2021). Navigating the mental health system: Narratives of identity and recovery among people with psychosis across ethnic groups. Social Science & Medicine. DOI:10.1016/j.socscimed.2021.113981

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