Cultural Perceptions of Psychosis and The Impact on Pathways to Care

Taylor, Charlotte (2023) Cultural Perceptions of Psychosis and The Impact on Pathways to Care. Doctoral thesis, University of East Anglia.

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Abstract

Background: Comparatively, people from Black African, Black Caribbean and other mixed Black ethnicities, and Asian ethnic backgrounds receive a diagnosis of psychosis at a much higher rate than people from White ethnic backgrounds globally. Specifically, people from Black African and Black Caribbean ethnicities with a diagnosis of psychosis are detained under the Mental Health Act, with subsequent higher contact frequency with the criminal justice system compared to people from White ethnic backgrounds. However, there is an under-representation of people from Black African and Caribbean ethnicities within community mental health services, suggesting a gap in service provision and/or engagement difficulties. Whilst research has explored the many barriers to accessing mental health services, little enquiry has been made into what continues service disengagement and psychosis treatment outcomes for people from Black African, Black Caribbean and Asian ethnic groups. Research thus far has narrowly focussed on the individual factors for [dis]engagement whilst neglecting how wider systemic, historical and cultural factors could impact pathways to care and engagement.

Aims: The current portfolio aims to explore the societal and cultural perception of psychosis from carer perspectives and how this impacts pathways to care, as well as examine the evidence base for effective therapeutic interventions for psychosis for Black African, Black Caribbean and other Black ethnic groups, and Asian ethnic groups. A further aim is to discern the mechanisms underlying disengagement from services and how the role of the family network may add to this understanding. Systemic theories are adopted to add a new conceptual framework for understanding and improving continued engagement in psychosis support services for people from Black African and Black Caribbean ethnic groups.

Methods: A systematic review examined the outcomes of psychosocial interventions for psychosis for people from Black African, Black Caribbean and other mixed Black ethnicities and Asian ethnic groups. Narrative synthesis was used to review quantitative and qualitative articles, ascertaining treatment outcomes by intervention type and ethnicity. An empirical paper explored the perceptions of psychosis and service involvement from carers from Black African and Black Caribbean backgrounds. Semi-structured interviews (n=10) were used and analysed through a thematic analysis approach.

Results: The systematic review found that CBT interventions had the high recovery outcomes compared to other psychological interventions (EIP, FI, Psychosocial). However, CBT interventions also had the highest attrition rates. Ethnic differences were found in that people from Black African and Black Caribbean ethnicities had long-term remission rates with the inclusion of a longer therapeutic alliance and integration with the community. People from Asian ethnic groups benefitted more from the inclusion of family. Low attrition rates were found in peer support and combined traditional and clinical interventions. The empirical paper added to these findings, sharing that connection and authenticity was pivotal to service support. The thematic analysis resulted in five crucial themes; (1) The impression of psychosis, (2) Barriers to Care, (3) Hidden cost of psychosis, (4) Generational cultural and societal interplay in mental health perceptions, and (5) Improving pathways to care. The EP argues for collaborative healthcare initiatives and addressing power hierarchies through equality and involvement of people from Black African and Black Caribbean ethnicities.

Conclusion: Both papers highlight the need for and benefit of developing authentic therapeutic relationships with professionals and service users. Using systemic theories to extend the current understanding of disengagement from services provides a more collaborative approach to improving engagement. Results and implications for service structure are discussed.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Chris White
Date Deposited:	10 Mar 2025 08:54
Last Modified:	10 Mar 2025 08:54
URI:	https://ueaeprints.uea.ac.uk/id/eprint/98724
DOI:

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