Growing up in a Caribbean family that had experienced various traumas and challenges, I had some awareness of how mental illness impacted myself and my relatives. However, it wasn’t until I attended a masterclass last year on Black mental health hosted by BAME in Psychiatry & Psychology and the Centre of Pan African Thought that I realised the nuanced challenges faced by members of the Black community.
Inequalities in mental health care
In the United Kingdom, Black British/African/Caribbean people are four times more likely than White British people to be sectioned under the Mental Health Act, with people of Black Caribbean ethnicity having the highest rate of detention in psychiatric wards. Unfortunately, there is also evidence to suggest that the Black community are less likely to access mental health support from GPs during the first signs of trouble. For many Black people who live with a mental health condition, such as bipolar disorder or schizophrenia, their first contact with mental health services is often through law enforcement and restraint (i.e. being sectioned).
For over 30 years, the poor experiences of Black people who have accessed mental health services have been well documented. Examples of negative experiences include excessive use of medication, fear of stigma, reports of discrimination, disproportional experience of forceful treatment and a lack of cultural awareness among staff.
This in turn accounts for the lack of engagement among the Black community with preventative and early interventions offered by the NHS services.
Based on what we know so far, there are three key features of a mental health service that the community needs:
- A service which acknowledges and speaks to the diverse cultural backgrounds within the Black community. One where staff members and clients recognise the stigma and discrimination ethnic minorities in the UK face and how that impacts mental health.
- A service which empowers its clients and enables them to have ownership over their mental health care.
- A service that is not only designed to meet the needs of the Black community but is designed by members of the community – “for us, by us”.
Designing mental health care owned by the Black community
The aim of my dissertation project is to co-design a mental health intervention that encourages and supports self-management amongst Black people who live with a mental health condition. This intervention will be developed using a design framework based on the theory of psychological ownership.
Consider the difference between these alternative statements that a colleague might say to you:
“This is the hot desk I share with co-workers” vs “This is MY desk”
“Here is where I am renting” vs “Here is MY flat”
“That is the office I work in” vs “That is MY office”.
Think about how and why your colleague’s feelings would align more with the statements on the right as opposed to the left. In practical terms, what would it take to shift someone’s perspectives from the statements on the left to the ones on the right? This is along the lines of what we are thinking about when we look at the theory of psychological ownership.
Psychological ownership theory has been used to explain how and why people feel like they own physical objects, services or even more abstract things like an idea or a place. As a design framework, it has been applied to create experiences and interactions which foster a sense of ownership and attachment to objects and services among consumers. These attachments impact consumer behaviours, such as increasing engagement and investment. But how do you design features of an intervention which make people feel a sense of ownership over their mental health care? Essentially, how do we go from:
“My community mental health team is responsible for managing my mental health care” to “Managing my mental health care is MY responsibility”.
The Oremi Centre is a mental health day service based in the Royal Borough of Kensington and Chelsea which works exclusively with African and Caribbean clients. As part of the project, I have interviewed clients and staff to understand the ways in which members of the community have ownership over their mental healthcare.
Improving the patient experience through collaboration
The next step in the collaboration is to use the key themes from the interviews to co-design a mental health self-management solution which gives a sense of ownership to Black people who live with a mental health condition. By working with other people from our community who have lived experience of mental health conditions, I hope we can identify and implement solutions which can support and uplift people who find managing their mental health more challenging.
As a Black researcher at Imperial with lived experience of mental ill-health, I think there is real value in using our research skills to not only address healthcare challenges, but also bring the voices and needs of underserved members in our society to the forefront of discussion. Only in this way can we ensure the provision of high-quality care for everyone that is safe, effective and focussed on the patient experience.
Clarissa Gardner is a research assistant in digital health at Imperial’s Institute of Global Health Innovation and student on the MSc Healthcare and Design course.