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Ethnicity, detention and early intervention : reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study
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Singh, Swaran P., Islam, Zoebia, Brown, L. A. (Lorraine A.), Gajwani, Ruchika, Jasani, Rubina, Rabiee, F. and Parsons, Helen (2013) Ethnicity, detention and early intervention : reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study. Programme Grants for Applied Research, 1 (3). doi:10.3310/pgfar01030
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Official URL: http://dx.doi.org/10.3310/pgfar01030
Abstract
Background
Black and minority ethnic (BME) service users experience adverse pathways into care. Ethnic differences are evident even at first-episode psychosis (FEP); therefore, contributory factors must operate before first presentation to psychiatric services. The ENRICH programme comprised three interlinked studies that aimed to understand ethnic and cultural determinants of help-seeking and pathways to care.
Aims and objectives
Study 1: to understand ethnic differences in pathways to care in FEP by exploring cultural determinants of illness recognition, attribution and help-seeking among different ethnic groups. Study 2: to evaluate the process of detention under the Mental Health Act (MHA) and determine predictors of detention. Study 3: to determine the appropriateness, accessibility and acceptability of generic early intervention services for different ethnic groups.
Methods
Study 1: We recruited a prospective cohort of FEP patients and their carers over a 2-year period and assessed the chronology of symptom emergence, attribution and help-seeking using semistructured tools: the Nottingham Onset Schedule (NOS), the Emerging Psychosis Attribution Schedule and the ENRICH Amended Encounter Form. A stratified subsample of user–carer NOS interviews was subjected to qualitative analyses. Study 2: Clinical and sociodemographic data including reasons for detention were collected for all MHA assessments conducted over 1 year (April 2009–March 2010). Five cases from each major ethnic group were randomly selected for a qualitative exploration of carer perceptions of the MHA assessment process, its outcomes and alternatives to detention. Study 3: Focus groups were conducted with service users, carers, health professionals, key stakeholders from voluntary sector and community groups, commissioners and representatives of spiritual care with regard to the question: ‘How appropriate and accessible are generic early intervention services for the specific ethnic and cultural needs of BME communities in Birmingham?’
Results
There were no ethnic differences in duration of untreated psychosis (DUP) and duration of untreated illness in FEP. DUP was not related to illness attribution; long DUP was associated with patients being young (< 18 years) and living alone. Black patients had a greater risk of MHA detention, more criminal justice involvement and more crisis presentations than white and Asian groups. Asian carers and users were most likely to attribute symptoms to faith-based or supernatural explanations and to seek help from faith organisations. Faith-based help-seeking, although offering comfort and meaning, also risked delaying access to medical care and in some cases also resulted in financial exploitation of this vulnerable group. The BME excess in MHA detentions was not because of ethnicity per se; the main predictors of detention were a diagnosis of mental illness, presence of risk and low level of social support. Early intervention services were perceived to be accessible, supportive, acceptable and culturally appropriate. There was no demand or perceived need for separate services for BME groups or for ethnic matching between users and clinicians.
Conclusions
Statutory health-care organisations need to work closely with community groups to improve pathways to care for BME service users. Rather than universal public education campaigns, researchers need to develop and evaluate public awareness programmes that are specifically focused on BME groups.
| Item Type: | Journal Article | ||||||
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| Subjects: | D History General and Old World > DA Great Britain H Social Sciences > HT Communities. Classes. Races J Political Science > JC Political theory R Medicine > RA Public aspects of medicine |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > ( - July 2016) Medical Education Hub Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Mental Health and Wellbeing Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Discrimination in medical care, Discrimination in medical care -- Great Britain, Health services accessibility, Health services accessibility -- Great Britain, Equality -- Health aspects, Equality -- Health aspects -- Great Britain, Minorities -- Medical care, Minorities -- Medical care -- Great Britain, Ethnic groups -- Medical care , Ethnic groups -- Medical care -- Great Britain, National health services -- Great Britain, Blacks -- Medical care , Blacks -- Medical care -- Great Britain, Great Britain -- Social conditions | ||||||
| Journal or Publication Title: | Programme Grants for Applied Research | ||||||
| Publisher: | National Institute for Health Research | ||||||
| ISSN: | 2050-4322 | ||||||
| Official Date: | December 2013 | ||||||
| Dates: |
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| Volume: | 1 | ||||||
| Number: | 3 | ||||||
| DOI: | 10.3310/pgfar01030 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Restricted or Subscription Access | ||||||
| RIOXX Funder/Project Grant: |
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