Bhui Kamaldeep, Mooney Roisin, Joseph Doreen, McCabe Rose, Newbigging Karen, McCrone Paul, Raghavan Raghu, Keating Frank, Husain Nusrat
Department of Psychiatry, University of Oxford, Oxford, UK
Department of Psychiatry, University of Oxford, Oxford, UK.
BMJ Ment Health. 2025 Aug 5;28(1):e301655. doi: 10.1136/bmjment-2025-301655.
The rates of compulsory admission and treatment (CAT) are rising in mental health systems in the UK. Persistent disparities have been reported among migrants, and black and ethnic minorities in Europe and North America for decades. Lived experience data can provide novel insights to reduce coercive care.
We purposively sampled people within 2 years of receiving CAT, to maximise diversity by age, sex, ethnicity and different 'sections' of the Mental Health Act (England and Wales) from eight health systems in England. Using participatory photovoice workshops, we assembled images, captions and reflective narratives, which were transcribed and subjected to thematic and intersectional analyses. The interpretation privileged lived experiences of participants and peer researchers alongside the research team. Preventive insights informed a logic model to reduce CAT.
Forty-eight ethnically diverse people contributed over 500 images and 30 hours of recorded narratives. A significant proportion of participants reported multimorbidity, adverse childhood experiences and carer roles. Their experiences indicated insufficient co-ordination to prevent CAT despite early help seeking; they were not taken seriously or believed when seeking help. Dismissive responses and even hostility from professionals and unnecessary police involvement were distressing, stigmatising and risked criminalisation. Participants wanted more (a) advocacy given in crisis, (b) trauma-informed therapeutic and creative support from inpatient into community settings, (c) family and carer involvement and (d) more information about how to negotiate care options, appeals, restriction and seclusion. Practitioners were felt to lack the essential skills to care for racialised and traumatised people subjected to CAT.
We propose a lived experience logic model for the practice, policy and legislative solutions to reduce epistemic injustice, CAT and criminalising care.
在英国的心理健康系统中，强制收治率正在上升。几十年来，在欧洲和北美的移民以及黑人和少数族裔中，一直存在着持续的差异。生活经历数据可以为减少强制性治疗提供新的见解。
我们有目的地对接受强制收治后两年内的人群进行抽样，以通过年龄、性别、种族以及英格兰八个卫生系统中《精神健康法》（英格兰和威尔士）的不同“条款”来实现最大程度的多样性。通过参与式摄影声音工作坊，我们收集了图像、文字说明和反思性叙述，对其进行转录并进行主题分析和交叉分析。在研究团队之外，解释过程优先考虑参与者和同行研究人员的生活经历。预防性见解为减少强制收治的逻辑模型提供了依据。
48名不同种族的人提供了500多张图像和30小时的录音叙述。很大一部分参与者报告存在多种疾病、童年不良经历以及照顾者角色。他们的经历表明，尽管早期寻求了帮助，但在预防强制收治方面协调不足；他们寻求帮助时未被认真对待或不被信任。专业人员的不屑回应甚至敌意以及警方的不必要介入令人痛苦、带来污名化，并有被定罪的风险。参与者希望在危机中能得到更多（a）宣传倡导，（b）从住院治疗到社区环境的创伤知情治疗和创造性支持，（c）家庭和照顾者的参与，以及（d）更多关于如何协商护理选项、上诉、限制和隔离的信息。人们认为从业者缺乏照顾接受强制收治的种族化和受创伤人群的基本技能。
我们提出了一个基于生活经历的逻辑模型，用于实践、政策和立法解决方案，以减少认知不公正、强制收治和将护理定罪的情况。
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