Culturally appropriate advocacy, improving access, experience and outcomes for racialised people in mental health services
Researchers from the Centre, City St Georges, University of London, University of Manchester and East London NHS, jointly with a Lived Experience Advisory Group aimed to evaluate two pilots of Culturally Appropriate Advocacy (CAA). The CAA pilots were funded by the Department of Health and Social Care as part of the review of the Mental Health Act.
Phase 1 of the evaluation involved a rapid appraisal and qualitative enquiry to CAA quality standards and a rights framework. These tools were utilised and further refined in phase 2 of the pilot which involved a comparative case study approach.
Statistical analysis of population outcomes (e.g. use of restrictive practices, length of stay), an economic health analysis, reviewing of organisation documentation and interviews with 58 participations, service users, mental health professionals and advocacy staff, informed the basis of the case study in phase 2.
Aims of phase 2 included attempts to understand the best way to implement CAA, and whether CAA provides accessible, effective and appropriate support to racialised people. Findings indicated that models more closely aligned with addressing rights under the MHA were more likely to produce positive outcomes.
The tools developed during the evaluation, CAA quality standards and a logic model, can assist with health service reform, providing advocacy organisations and commissioners with guidance on how best to configure CAA, documenting the mechanisms and outcomes. CAA quality standards provide a tool for advocacy organisations to self-evaluate their work at both individual and organisation level.
The logic model and quality standards provide a means to guide the future development of CAA provision and may be used to evaluate existing advocacy provision in the UK and elsewhere.
Aims
To understand if, and how, CAA can meet the needs of ethnic minorities. The focus will be on CAA projects that are being tested by the Department of Health and Social Care.
Design and methods
- Look carefully at research to develop quality performance indicators to help evaluate CAA and how it supports ethnic minority people.
- Look in detail at published literature to understand the rights-issues affecting ethnic minorities in mental healthcare. This will be used to develop a rights framework to categorise how advocacy organisations can protect or promote the rights of patients, and an organisational typology to better understand different models to offering CAA.
- We will bring together experts, including people with lived experience of mental health challenges and racism, to decide which quality indicators are most relevant to CAA.
- We will carry out interviews with patients who have used CAA, and mental health professionals, to understand if CAA is protecting and promoting rights of ethnic minorities.
- We will gather information about the different CAA models being tested, including number of ethnic minorities receiving support, to understand what makes a successful model.
Patient and public involvement is embedded throughout the project. Three people with lived experience will be recruited as service user researchers, and six people with lived experience will be members of the lived experience advisory panel, directly shaping each aspect of the project.
