Understanding ethnic inequities in mental health care: A meta-ethnography exploring perspectives and experiences of service providers and ethnic minority groups

Problem

Ethnic inequalities in mental health care have been reported over the past forty years. Studies have consistently highlighted poorer access, experience and outcomes in ethnic minority groups compared to the majority white British population. In order to develop effective interventions, we need a better understanding of how these inequities are created, sustained and reproduced. This requires work that pulls together evidence on the experiences and perceptions of a wide range of stakeholders, including ethnic minority groups and service providers, and considers how knowledge on ethnic inequities is generated in research.

Approach

A comprehensive and systematic review of existing qualitative evidence on the experiences and perspectives of all studied ethnic minority groups and service providers in relation to help-seeking, service provision, utilisation and outcomes for emotional distress/mental ill-health. Our study sought to develop a new conceptual understanding of ethnic inequities in mental health care by taking an interpretative approach to synthesis (meta-ethnography).

Our meta-ethnography was guided by this primary research question:

- Is it possible to explain, using existing qualitative research, why people from ethnic minority groups are under-represented in primary care mental health service provision and over-represented in involuntary pathways?

Our analysis focused on equity. We explored how disparate patterns of access, experience and outcomes can be best understood across ethnic groups, social-cultural and demographic intersections, and clinical settings. This included drawing out divergence and convergence between different types and sources of evidence (grey versus published). Research questions and objectives were shaped through a series of community consultation workshops with ethnic minority groups in Bristol. Final research questions and search terms were discussed and refined with our public, service user and practitioner advisory group. We carried out a comprehensive search of published and grey literature using relevant databases (PsycINFO, Medline, CINAHL, Social care online, OpenGrey, Kings Fund).

Findings

11,227 papers and reports (hereafter articles) were identified from the published and grey literature and screened by title. 566 titles were identified as relevant and screened at abstract level and 298 were excluded. The remaining 268 full-text articles were double-screened. We will present preliminary results of the separate reciprocal synthesis of the grey literature versus the published literature. We will report on emerging recommendations.

Consequences

Our study provides a new conceptual understanding of factors and processes driving ethnic inequities in mental health care. This includes consideration of convergence and divergence in experiences across ethnic groups and stakeholders and an assessment of the contextual nature of competing evidence. Our recommendations will provide guidance for service-level and community interventions.