✅ L10 - Developing culturally-appropriate psychosocial interventions Flashcards
Define race, ethnicity, and culture?
- Race:
- Biological basis (discredited evidence)
- Race science and racial hierarchies
- Externally-classified:
+ Visible, physical differences
+ Used to distinguish people
+ Shared features in ‘human race’
- May also be self-ascribed - Ethnicity
- Social characteristics of a group:
+ Religion
+ Language
+ Traditions
- Common ancestry
+ May share distinctive cultures
+ Some overlap with nationality - Culture:
- Acquired/learned
- Non-biological
- ‘Fluid’ (context-specific behaviours)
- Social aspects of human life (e.g. norms, values, beliefs, symbols)
- Multi-cultural identities in an individual (e.g. professional cultures)
Why does culture matters in mental health?
- Culture and contexts shape individuals’ mental health, such as:
- ‘symptoms,
- coping styles
- Family/community influences
- Help-seeking behaviours (trust)
- Stigma
- Insider/outsider perspectives:
+ Maginalisation
+ Racism & discrimination - ‘Cultural formulation’ highlights the effect of culture on:
- symptoms expression (mental illness model)
- definition of illness (psychosocial environment)
- treatment (types, relationship between clinician - patient)
What does mental health treatment for psychosis/schizophrenia looks like for ethnic group?
Prevalence:
- More incidence of psychosis & schizophrenia among migrant and minoritised groups.
- Especially among people of African and Caribbean origin (compared to White British)
+ Caribbeans IRR 6.7
+ Africans IRR 4.1
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Mental health treatments:
- Negative care pathways
- 40% more likely access care via CJS
- 37% Black vs 9% White British prisoners diagnosed with schizophrenia/delusional disorder
- 4x more MHA detentions - More coercive care
- Worse clinical/non-clinical outcomes
- Lack of culturally-informed care (e.g. ‘culturally naive’ staff)
- Lack of psychological therapies
- Often labelled ‘hard-to-reach’
NICE guidelines for psychosis? What is the effectiveness for FI in schizophrenia and psychosis care?
NICE guidelines:
1. Individualised treatment plan options:
- 16 planned sessions of CBT for psychosis (CBTp)
- Early Intervention in Psychosis (EIP)
- 10 sessions of Family Intervention (FI) -> offer for families who live with or in close contact with service user
2. Antipsychotic medication
Effectiveness of FI?
1. Pros:
- Clinically- & cost-effective
- Reduces family tension
- Facilitates engagement & improved clinical care
- Reduces relapse/readmission rates
- Decreases lengths of stay in hospital
2. Cons:
- Especially low uptake in African, Caribbean, and other minoritised groups
- Limited evidence for effectiveness, accessibility with minoritised groups
- ‘Urgent need’ to develop culturally informed care -> 84% of practitioners in the UK are white
How to develop culturally-adapted family intervention for psychosis?
- Co-producing research: an approach in which patients, researchers, practitioners and the public work together, sharing power and responsibility, and sharing of knowledge throughout the project
- Co-production with stakeholders:
- Literature review: build framework (by researching components of culturally adapted interventions)
- Focus groups with service users, carers, and professionals
+ structure and core components
+ address racist stereotypes & misconceptions
- Consensus conference (refine content and delivery) -> among experts - CaFI therapy:
- 10 x 1-hour sessions:
- Hybrid model: CBT-based with BFT
- Delivered by Lead & Co-therapist pair, trained in family work and cultural awareness
- Bespoke therapy manual & resources
- ‘Family Support Members’ (FSMs) as therapy partners
- Available online (CaFI:Digital)
What are the two components of Bespoke Training Programme for Therapists?
- ‘Cultural competency’ in family work
- Core competence to work with psychosis clients and families
- Impact of culture on family work
- Relationship between racism, discrimination, adversity, and psychological distress
- Power and prejudice in building trusting therapeutic relationships - CaFI Manual:
- Context of CaFI: Historical, cultural, and social context of African-Caribbean mental health (UK)
- CaFI’s “Ethos of Delivery” -> ‘Shared learning’ & ‘Cultural humility’ (psychoeducation)
- Produce bespoke resources
- Training therapists to deliver through research
Describe a feasibility study of CaFI?
- Aim:
- How effective to adapt and implement culture in FI for Caribbean-origin service users (SU) with psychosis/schizophrenia & families
- Determine if using “proxy families” (Family Support Members) for FI is acceptable when biological families are unavailable. - Methods:
- 30 SU randomised + Family unit
- 26 family units completed all therapy sessions
=> Half involved FSMs - Results: All SU, families, and therapists found CaFI acceptable and would recommend it to others
- Limitations:
- Lack of control group
- Limited sample size
- Insufficient to assess effectiveness => more culturally-informed therapy resource
What are the reported benefits of CaFI?
- Service user (SU) benefits:
- Improved understanding of illness
- Better functioning & communication - Family members benefits:
- Increased understanding of diagnosis/condition
- Better engagement and support with SU - Healthcare professional benefits:
- More cultural awareness and understand Caribbean people’s needs
- Using CaFI skills/material in everyday practice
Describe CaFI randomised controlled trial (RCT), its progress and challenges?
- What is it?
- National 54-month RCT with ‘family units’ of Caribbean & African origin SU + therapy partners across UK
- Evaluate cost & clinical effectiveness compared with “usual care”
- Evaluate process (e.g. implementation barriers, accessibility, fidelity) - Progress & challenges:
- Delayed start (24 months)
- Covid-19 pandemic impact recruitment, access barriers, and lacking workforce (NHS therapist) - Results: 145 SUs recruited, ~60% SUs need non-family therapy partner (80% London)
What are the implications for research, policy, and practice (FI psychosis) in mental health interventions for ethnic minority groups?
- Implications for Research
- Research with people currently under-represented in research and clinical practice (study design, outcome measure)
- Different approaches, same models:
+ ‘Real world’ vs research therapy
+ Funding (hidden cost, e.g. ‘assertive engagement’)
+ ‘Success criteria’ + Reporting - Implications for Policy
- Delivering Race Equality in Mental Health
- Culturally informed/appropriate care
- Patient & Carer Race Equality Framework (PCREF)
- More evidence-based interventions for cultural adaptation - Implications of Practice (FI Psychosis)
- FI with multicultural/multi-ethnic populations
- Improved personalised therapy delivery
- NHS workforce and structures
+ training workforce on cultural competence
+ more lived experience practitioners
What would be new ways of working + researching inequality?
- Assets- vs deficits-based approaches
- Genuine co-production
- Partnership (power & knowledge sharing)
- Involve SU throughout the process - Increase accessibility
- For marginalised groups (ethnic, disability)
- Require multi-level, system-wide approaches with appropriate resources (e.g. time, people, money)
