Mental health services for black and minority ethnic elders in the United Kingdom : a systematic review of innovative practice with service provision and policy implications

Abstract

Background: Long-standing ethnic inequalities in access and mental healthcare were worsened by the COVID-19 pandemic.

Objectives: Stakeholders coproduced local and national implementation plans to improve mental healthcare for people from minority ethnic groups.

Methods: Experience-based codesign conducted in four areas covered by National Health Service (NHS) mental health trusts: Coventry and Warwickshire, Greater Manchester, East London and Sheffield. Data were analysed using an interpretivist-constructivist approach, seeking validation from participants on their priority actions and implementation plans. Service users (n=29), carers (n=9) and health professionals (n=33) took part in interviews; focus groups (service users, n=15; carers, n=8; health professionals, n=24); and codesign workshops (service users, n=15; carers, n=5; health professionals, n=21) from July 2021 to July 2022.

Findings: Each study site identified 2-3 local priority actions. Three were consistent across areas: (1) reaching out to communities and collaborating with third sector organisations; (2) diversifying the mental healthcare offer to provide culturally appropriate therapeutic approaches and (3) enabling open discussions about ethnicity, culture and racism. National priority actions included: (1) co-ordination of a national hub to bring about system level change and (2) recognition of the centrality of service users and communities in the design and provision of services.

Conclusions: Stakeholder-led implementation plans highlight that substantial change is needed to increase equity in mental healthcare in England.

Clinical implications: Working with people with lived experience in leadership roles, and collaborations between NHS and community organisations will be essential. Future research avenues include comparison of the benefits of culturally specific versus generic therapeutic interventions.