SOCIAL NETWORKS AND ENGAGEMENT WITH MENTAL HEALTH SERVICES AMONG BLACK AFRICAN AND CARIBBEAN PEOPLE DIAGNOSED WITH NON-AFFECTIVE PSYCHOSIS

Abstract

Black African and Caribbean people in the UK have the highest incidence rates of non-affective psychosis and the poorest access to, and experiences and outcomes of mental health services of all ethnic groups. Research and policies, including those written by the Department of Health and the National Institute for Health and Care Excellence, have repeatedly highlighted the need to reduce ethnic inequalities and improve engagement with mental health services among Black people with psychosis. Despite this, there is a current lack of evidence examining social and psychological factors that may facilitate better service engagement in this underserved group. Theories suggest engagement with services in minority ethnic groups may be influenced by social networks, illness beliefs, mental health stigma and perceived ethnic or racial discrimination in services. The main aims of this thesis were to examine the social network characteristics in Black African and Caribbean people with non-affective psychosis and to develop psychological theories to explain engagement with mental health services in the UK. This thesis includes three separate papers. The first paper is a systematic literature review and meta-analysis examining the nature and strength of the relationships between social network size and symptomatic and functional outcomes in non-affective psychosis. The two succeeding papers report on a sample of Black African and Caribbean service users diagnosed with non-affective psychosis in the UK and include: i) a comprehensive descriptive account of social network characteristics in this sample, drawing comparisons with previous literature in predominately White samples; and ii) a cross-sectional study examining relationships between social networks, illness perceptions, stigma, racial or ethnic discrimination in mental health services and current engagement with mental health services. Meta-analytic findings in the first paper showed that a larger social network size was related to improved negative and overall psychiatric symptoms. The second paper showed that social network characteristics of Black service users with non-affective psychosis were small, densely interconnected and comprised a disproportionate number of family members. Service users’ social networks also comprised close to zero wider social contacts, mostly connected social ties (few social isolates) and were ethnically homogenous (individuals formed social ties with people of the same ethnic group to their own). Cross-sectional findings in the third paper suggested that a more ethnically homogenous social network was the strongest predictor of engagement with mental health services from both staff and service user perspectives. Specific illness perceptions (greater treatment control, greater identification with symptoms, and higher perceived concern and emotional distress related to problems) were related to better self-reported engagement with services. Higher perceived personal control and racial or ethnic discrimination in services were related to staff-reported engagement and service user reported engagement, respectively. Internalised stigma was not related to engagement. Findings suggest that social networks are important for outcomes and engagement with mental health services in non-affective psychosis. Psychosocial interventions that aim to build and maintain supportive social networks, enhance personal control over problems and beliefs about the benefits of treatment, and tackle perceived racial or ethnic discrimination in services, may facilitate better engagement, reduce inequalities and improve outcomes for Black African and Caribbean people with non-affective psychosis. Future longitudinal research is required to examine potential causal mechanisms by which social networks, illness perceptions and perceived racial or ethnic discrimination in services relate to engagement with services in this population.

Date of Award	1 Aug 2018
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Nick Crossley (Supervisor), Katherine Berry (Supervisor), Kathryn Abel (Supervisor) & Dawn Edge (Supervisor)