Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK.
Soc Sci Med. 2021 Jun;279:113981. doi: 10.1016/j.socscimed.2021.113981. Epub 2021 May 1.
There is consistent evidence that members of the black Caribbean population in the UK are more likely to have coercive relationships with mental health services, typified by high levels of police involvement and compulsory treatment. This research has relied upon a medical epidemiological framework that has enumerated differences in service use but failed to unravel the complex interplay of individual, social, and cultural factors that inform the pathway to care. The purpose of this study was to explore the journey through mental health services from the perspective of individuals from the black Caribbean and majority white British population to help understand variation in the use of mental health services. Individual interviews were conducted with 17 black Caribbean, 15 white British, and 3 non-British white people with psychosis as part of AESOP-10, a 10 year follow up of an ethnically diverse cohort of individuals with first episode psychosis in the UK. Thematic narrative analysis identified three overarching narrative categories: 'losing self within the system' narratives gave primacy to individuals' identity as a chronic psychiatric patient with participants unable to break the cycle of service use; 'steadying self through the system' narratives combined recognition of the value of psychiatry and its limitations with the ability to access psychological therapy and protect valued social roles; 'finding strength beyond the system' narratives challenged negative dominant discourses and emphasised social, interpersonal and intrapersonal factors in recovery. We found variation in narratives across ethnic groups with 'losing self within the system' and 'finding strength beyond the system' narratives most common, though not exclusive to, black Caribbean participants. Distress appeared rooted in social structures that disadvantage black people, and psychiatry appeared to be experienced as a further form of oppression, that initially provoked resistance and fear, and over time, resignation to the identity of psychiatric patient.
有确凿的证据表明，英国的加勒比裔黑人更有可能与精神卫生服务机构建立强制性关系，其特点是警察高度介入和强制治疗。这项研究依赖于一种医学流行病学框架，该框架列举了服务利用方面的差异，但未能阐明告知护理途径的个人、社会和文化因素的复杂相互作用。本研究旨在从加勒比裔黑人和多数白种英国人的角度探讨精神卫生服务的历程，以帮助理解精神卫生服务利用的差异。作为 AESOP-10 的一部分，对 17 名加勒比裔黑人、15 名白种英国人和 3 名非英国白人精神病患者进行了个体访谈，AESOP-10 是对英国首次出现精神病发作的多种族队列进行的为期 10 年的随访。主题叙事分析确定了三个总体叙事类别：“在系统中失去自我”的叙述将个体的身份作为慢性精神科患者置于首位，参与者无法打破服务利用的循环；“通过系统稳定自我”的叙述将对精神病学的认识及其局限性与获得心理治疗和保护有价值的社会角色的能力结合起来；“在系统之外找到力量”的叙述挑战了消极的主导话语，并强调了康复中的社会、人际和内在因素。我们发现，叙事在不同种族群体之间存在差异，“在系统中失去自我”和“在系统之外找到力量”的叙事最为常见，但并非仅限于加勒比裔黑人参与者。痛苦似乎源于使黑人处于不利地位的社会结构，而精神病学似乎被视为进一步的压迫形式，最初引起了抵制和恐惧，随着时间的推移，人们对精神科患者的身份感到无奈。
