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Publication The impact of reduced routine community mental healthcare on people from minority ethnic groups during the COVID-19 pandemic: qualitative study of stakeholder perspectives(Cambridge University Press, 2024-02-12) Winsper, Catherine; Bhattacharya, Rahul; Bhui, Kamaldeep; Currie, Graeme; Edge, Dawn; Ellard, David; Franklin, Donna; Gill, Paramjit; Gilbert, Steve; Khan, Noreen; miller, robin; Motala, Zahra; Pinfold, Vanessa; Sandhu, Harbinder; Singh, Swaran P; Weich, Scott; Giacco, Domenico; Coventry and Warwickshire Partnership NHS Trust; East London NHS Foundation Trust; University of Oxford; University of Warwick; University of Manchester; University of Nottingham; Steve Gilbert Consulting, Birmingham; University of Birmingham; McPin Foundation, London; University of Sheffield; Research and Development; Additional Professional Scientific and Technical Field; Medical and Dental; Winsper, Catherine; Singh, Swaran, P.Background: Enduring ethnic inequalities exist in mental healthcare. The COVID-19 pandemic has widened these. Aims: To explore stakeholder perspectives on how the COVID-19 pandemic has increased ethnic inequalities in mental healthcare. Method: A qualitative interview study of four areas in England with 34 patients, 15 carers and 39 mental health professionals from National Health Service (NHS) and community organisations (July 2021 to July 2022). Framework analysis was used to develop a logic model of inter-relationships between pre-pandemic barriers and COVID-19 impacts. Results: Impacts were largely similar across sites, with some small variations (e.g. positive service impacts of higher ethnic diversity in area 2). Pre-pandemic barriers at individual level included mistrust and thus avoidance of services and at a service level included the dominance of a monocultural model, leading to poor communication, disengagement and alienation. During the pandemic remote service delivery, closure of community organisations and media scapegoating exacerbated existing barriers by worsening alienation and communication barriers, fuelling prejudice and division, and increasing mistrust in services. Some minority ethnic patients reported positive developments, experiencing empowerment through self-determination and creative activities. Conclusions: During the COVID-19 pandemic some patients showed resilience and developed adaptations that could be nurtured by services. However, there has been a reduction in the availability of group-specific NHS and third-sector services in the community, exacerbating pre-existing barriers. As these developments are likely to have long-term consequences for minority ethnic groups' engagement with mental healthcare, they need to be addressed as a priority by the NHS and its partners.Publication 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(BMJ, 2023-07) Winsper, Catherine; Bhattacharya, Rahul; Bhui, Kamaldeep; Currie, Graeme; Edge, Dawn; Ellard, David R.; Franklin, Donna; Gill, Paramjit S; Gilbert, Steve; miller, robin; Motala, Zahra; Pinfold, Vanessa; Sandhu, Harbinder; Singh, Swaran P; Weich, Scott; Giacco, Domenico; Coventry and Warwickshire Partnership Trust; East London NHS Foundation Trust; University of Oxford; University of Warwick; University of Manchester; University Hospitals Coventry and Warwickshire; University of Nottingham; Steve Gilbert Consulting, Suite 2A, Blackthorn House, St Pauls Square, Birmingham, UK; University of Birmingham; McPin Foundation, 7-14 Great Dover Street, London; University of Sheffield;; Research and Innovation Department; Additional Professional Scientific and Technical Field; Winsper, CatherineBackground: 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.