Abstract
BackgroundBlack and Minority Ethnic (BME) groups in receipt of specialist mental health care have reported higher rates of detention under the mental health act, less use of psychological therapies, and more dissatisfaction. Although many explanations have been put forward to explain this, a failure of therapeutic communications may explain poorer satisfaction, disengagement from services and ethnic variations in access to less coercive care. Interventions that improve therapeutic communications may offer new approaches to tackle ethnic inequalities in experiences and outcomes.MethodsThe THERACOM project is an HTA-funded evidence synthesis review of interventions to improve therapeutic communications between black and minority ethnic patients in contact with specialist mental health services and staff providing those services. This article sets out the protocol methods for a necessarily broad review topic, including appropriate search strategies, dilemmas for classifying different types of therapeutic communications and expectations of the types of interventions to improve them. The review methods will accommodate unexpected types of study and interventions. The findings will be reported in 2013, including a synthesis of the quantitative and grey literature.DiscussionA particular methodological challenge is to identify and rate the quality of many different study types, for example, randomised controlled trials, observational quantitative studies, qualitative studies and case studies, which comprise the full range of hierarchies of evidence. We discuss the preliminary methodological challenges and some solutions. (PROSPERO registration number: CRD42011001661).
Highlights
Black and Minority Ethnic (BME) groups in receipt of specialist mental health care have reported higher rates of detention under the mental health act, less use of psychological therapies, and more dissatisfaction
Background policy and research The challenges faced by people from a black or minority ethnic group when they come into contact with psychiatric services are well documented in previous research reviews and in evidence-based policies [1,2]
Our initial analysis has identified that interventions of interest can broadly be defined as those that: (a) aim to improve outcomes from existing care through mediation, better understanding and take up; (b)seek to manage divergent views, conflict and differing explanatory models and illness perceptions through negotiation and mediation; (c) employ cultural consultation models and other narrative based or ethnographic methodologies; (d)involve methods proposed within the social sciences or communications studies, for example, linguistics, but applied to health and social care; (e) apply cultural competence interventions that aim to improve communication; (f ) improve two-way communication as a therapeutic tool through technology (e.g. NHS direct, telemedicine, email)
Summary
Black and Minority Ethnic (BME) groups in receipt of specialist mental health care have reported higher rates of detention under the mental health act, less use of psychological therapies, and more dissatisfaction. Background policy and research The challenges faced by people from a black or minority ethnic group when they come into contact with psychiatric services are well documented in previous research reviews and in evidence-based policies [1,2]. These highlight ethnic inequalities of experiences and outcomes, including concerns about patient safety, disproportionate number of admissions and detentions in psychiatric hospitals, conflict with carers and staff, fear of services, lack of engagement or poor access to effective services, anxieties about contact with the criminal justice system and police, a lack of available psychological therapies and inequalities in pharmacotherapy. Dissatisfaction and inequalities are prominent among Anglophone migrants and other people from BME groups who speak English [4,5]
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