Black and Asian Women’s Conceptualisations of Psychosis and Compulsory Admission within an Early Intervention Service

Aims: To explore the experiences of women from Black and Asian backgrounds, detained under the Mental Health Act (1983; 2007), on their journeys to accessing care for a First Episode Psychosis diagnosis.
Background: Black and Minority Ethnic (BME) groups are sectioned under the Mental Health Act at significantly higher rates than White ethnic groups. BME groups are also more likely to be diagnosed with psychosis – a presentation primarily understood in services within the medical model of ‘mental illness’, and related to stereotypes of ‘dangerousness’. While quantitative research highlights the inequalities impacting Black men, BME women who show similar trends are often overlooked. Additionally, limited data exists about the lived experience of coercive pathways to psychosis care for these groups.
Methodology: A critical realist research framework was used to qualitatively explore experiences of psychosis and services with Black and Asian women. Eight semi-structured interviews were conducted with women accessing Early Intervention for psychosis Services (EIS) and previously sectioned.
Results: A thematic analysis identified three themes and six sub-themes: ‘Sense of Mistrust’; ‘Navigating Unsafe Systems’; and ‘Impact of Adversity’. Psychosis was characterised as feeling unable to trust others, and yourself. Initial interactions with services, particularly the police, were experienced as unfair, re-traumatising and potentially racialised. Trauma-informed and spiritual models to explain psychosis, felt neglected by services in favour of the medical model. However, social and psychological aspects of care offered by services, were described as unexpectedly helpful by the participants. Conclusion: It is proposed potentially unhelpful wider societal discourses, such as 'the Angry/Strong Black Woman', 'the Meek Asian Woman' and ‘psychosis is dangerous’ have an impact on experiences of accessing care for First Episode Psychosis. Recommendations discussed include: a systems-wide approach to tackling bias, acknowledging intersectionality, accommodating multiple beliefs in practice, and potential alternatives to detention under the Mental Health Act.