9. developing culturally appropriate treatments

What is race?

• has a disputed biological bias

• based on visible traits to group people either externally or seld-identified

• misused to justify hierarchies

What is ethnicity?

Social group defined by shared characteristics such as faith, language, traditions, and distinctive cultures - over overlaps with nationality

How does culture and context shape and ind’s lived experience + MH

• ‘Symptoms’, Presentation, Attribution, and Meaning • Coping styles • Family / community influences • Help-seeking behaviours • Stigma • Insider/outsider perspectives • Marginalisation • Racism & discrimination • Trust

What does the ‘Cultural Formulation’ in mental health highlight?

The effect of culture on:;

• Symptom expression

• Definition of illness: factors related to psychosocial envrio

• Treatment: acceptability + impact of cultural identity on clinician patient relos

Why is it important to develop culturally adapted family intervention for people with Sub-Saharan African and Caribbean descent?

Due to negative care pathways

• 40% more likely access care via CJS

• 37% Black vs 9% White British prisoners schizophrenia/delusional disorder

• 4x more MHA detentions

\What are key ethnic mental health disparities in psychosis care?

• Ethnic minorities face more coercive care e.g. higher use of injectable antipsychotics

• Worse outcome

• Lack of culturally-informed care w culturally naïve staff

• limited psychological therapies

• labelled ‘hard-to-reach’.

What are the NICE guidelines for psychosis?

Individualised treatment plans of either:

• 16 CBTp

• Early intervention in psychosis

• 10 FI

AND antipsychotic medications

How does the evidence support FI in schizo + psychosis care?

• Clinically + economical

• Reduces family tension

• Facilities engagement and improved clinical care

• Reduces relapse/readmission rates

• Decreases length of hospital stays

What are the weaknesses of FI?

• Low uptake in minoritised groups esp Afro Caribbean

• Limited effectiveness, acceptability, accessibility w minoritised

  • SO urgent need to develop culturally informed care

What was the design of the CaFI Feasibility Study?

A feasibility cohort design with qualitative components, divided into three phases:

1. Co-production of CaFI via qualitative work and a consensus conference,

2. Development and delivery of culturally informed therapist training,

3. Feasibility trial (n=31) assessing fidelity to the therapy manual and acceptability.

What were the aims of the feasiblity study?

• Evaluate the feasibility of implementing it, esp with Caribbean service users diagnosed w shizo + related psychoses, and other key stakeholders

• Establish the feasibility and acceptability of delivering FI w proxy families (family support) where biological unavailable.

What is coproducing research?

Patients, researchers, practicioners + public collaborate to share power + responsibility from the start to end by generating + sharing knowledge.

How was co-production with stakeholders carried out in developing CaFI?

• Literature review to generate typical components of CA psycho interventions to serve as initial framework that incorporates other important concepts

• Focus groups with service users, carers + professionals to develop structure and core concepts whilst addressing sterotypes of Caribbeans

• Consensus conference to refine to content, outcome and delivery

What does CaFI therapy entail?

• 10 × 1 hr sessions - hybrid model

• Delivered by Lead + Co-therapist dyad with bespoke therapy manuals

• Family support as therapy partners

What does the bespoke training programme for therapists say about cultural competency in family work?

1. Core competence to work with service users experiencing psychosis and families

2. Impact of culture on family work

3. Relationship between racism, discrimination, adversity, and psychological distress

4. Power and prejudice in building trusting therapeutic relationships

What does the bespoke training programme for therapists say about the CaFI manual?

1. Context of CaFI: Historical and sociocultural context of African-Caribbean mental health in the UK

2. Development of CaFI

3. CaFI’s “Ethos of Delivery” = Shared learning’ & ‘Cultural humility’

4. Components and bespoke resources

5. Delivering therapy in research

What were the strength of the feasibility study?

• 30 service users randomised; SU + Family/FSM = family unit

• 24/26 FU completed all sessions; half were FSMs too

  • Acceptable + Recommended

What were the negatives of the feasibility study?

• Lack of control group

• Insufficient power to assess effectiveness

• Caribbean origin only

What were the CaFI reported benefits?

• SU: ↑ understanding, function + communication

• FM: ↑ understanding + engagement

• Healthcare professionals: ↑ cultural awareness + understanding needs of C ppl, used CaFI in everyday practice

What are the key features of the CaFI Randomised Controlled Trial (RCT)?

• A national RCT with 300 service users and therapy partners from Caribbean and Sub-Saharan African backgrounds across the North West, Midlands, London, and South.

• Evaluates cost and clinical effectiveness vs. usual care, with an embedded process evaluation focusing on:

  • implementation barriers/facilitators

  • accessibility

  • fidelity

  • acceptability.

What are key considerations when researching with under-represented groups?

• Involve under-rep people throughout the research

• address real-world vs research settings

• consider funding and hidden costs (e.g., assertive engagement)

• redefine success based on what matters to the community.

What are key implications for practice?

should be individualised, holistic, and needs-led. It involves shared learning, strong communication, culturally informed training, and therapy partners like Family Support Members. It also requires NHS workforce planning, and values cultural humility and peer support