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Purpose: The National Health Service (NHS) in England plans to increase accessibility to evidence-based, trauma-informed psychological care for women in the perinatal period. Therefore, this systematic review aimed to 1) synthesise current guidance from clinical guidelines, policy documents, and care standards on trauma-informed approaches to care in maternal mental health settings within the context of pregnancy-related trauma and 2) to offer recommendations informing the implementation and evaluation of this type of care., Methods: Nine electronic databases were searched and screened. Data were extracted and analysed using narrative synthesis. Included records were quality-assessed., Results: After screening 1095 identified records, 11 records were included. The findings were synthesised into eight recommendations: 1) screening for trauma, 2) access to care, 3) clear and sensitive communication, 4) consistency and continuity of care, 5) offering individualised care whilst recognising diversity, 6) collaboration between women, families, and services, 7) care provider training to enhance skills and knowledge, and 8) supervision and peer support for care providers., Conclusions: The findings of this review are highly relevant given the current development, delivery, and evaluation of specific maternal mental health services, particularly in the United Kingdom, but also with the increase in perinatal mental health provision more globally., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Objective: Central and Eastern European (CEE) migrants are a large minority group in the UK who are vulnerable to experiencing mental health problems. However, due to their shared 'whiteness' with the majority population, health service disparities may be overlooked. This is the first study exploring CEE-born people's experiences of mental health services post-Brexit., Method: Thirteen CEE migrants who had received mental health services in the UK were interviewed and data was thematically analysed., Results: Barriers and facilitators to engagement reflected: 1) attitudes towards help-seeking; 2) cultural in/visibility; and 3) professional-service user communication. Some barriers were unique to the CEE community and not shared by other minority groups, such as the 'invisibility' of ethnic identity and this framed the way participants navigated interactions with services., Conclusions: Cultural differences and mental health stigma were reported to influence understanding of mental health, attitudes to help-seeking, and experiences of services. Flexible ethnic identity and majority group "passing" could conceal inequalities in healthcare., Practice Implications: The need for culturally informed approaches, professional upskilling, strengthened inter-agency working, and collaboration with CEE communities. The need to build on pre-existing strengths, for self-directed and self-care activities, for appropriate pacing and confidentiality discussions, and the use of web-based resources., Competing Interests: Declaration of Competing Interests The authors report no competing interests. All authors have contributed significantly, and all authors agree with the content of the manuscript., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Migrants living in Europe constitute over half of the world's international migrants and are at higher risk of poor mental health than non-migrants, yet also face more barriers in accessing and engaging with services. Furthermore, the quality of care received is shaped by the experiences and attitudes of health professionals. The aim of this review was to identify professionals' attitudes towards migrants receiving mental healthcare and their perceptions of barriers and facilitators to service provision. Four electronic databases were searched, and 23 studies met the inclusion criteria. Using thematic synthesis, we identified three themes: 1) the management of multifaceted and complex challenges associated with the migrant status; 2) professionals' emotional responses to working with migrants; and 3) delivering care in the context of cultural difference. Professionals employed multiple strategies to overcome challenges in providing care yet attitudes towards this patient group were polarized. Professionals described mental health issues as being inseparable from material and social disadvantage, highlighting a need for effective collaboration between health services and voluntary organizations, and partnerships with migrant communities. Specialist supervision, reflective practice, increased training for professionals, and the adoption of a person-centered approach are also needed to overcome the current challenges in meeting migrants' needs. The challenges experienced by health professionals in attempting to meet migrant needs reflect frustrations in being part of a system with insufficient resources and without universal access to care that effectively stigmatizes the migrant status.

Objectives: In the UK, people of African-Caribbean background have the highest rates of psychosis and greatest inequity in mental health services of all ethnicities. National policies have highlighted the lack of evidence-based psychological interventions for this group. The aim of this study was to examine the acceptability of a novel Culturally adapted Family Intervention (CaFI) for African-Caribbean individuals diagnosed with non-affective psychosis and their relatives., Design: A qualitative design., Methods: Semi-structured interviews conducted with 22 service users and 12 family members following participation in CaFI. The interview topic guide included perceptions of the needs and benefits of CaFI; usefulness, cultural specificity and accessibility of CaFI therapy and supporting materials; content and delivering of CaFI sessions; views and experiences of working with CaFI therapists; and perceived barriers and facilitators to implementation., Results: Deductive framework analysis identified three main themes for service users: perceived benefits, barriers and limitations, and delivery of the therapy. Four themes were identified for family members: perceived benefits, perceptions of therapists, delivery of therapy, and accessibility of therapy content, supporting materials, and cultural appropriateness., Conclusions: CaFI was found to be an acceptable intervention for African-Caribbean service users with psychosis and their relatives. Family interventions considering the needs of ethnic and cultural groups have the potential to improve the mental health care and experiences of service users and their families., Practitioner Points: The Culturally adapted Family Intervention (CaFI) was viewed as acceptable to African-Caribbean service users with psychosis and their families. Through adapting interventions to be more culturally sensitive, it is possible to enhance the care of those who typically have poor engagement with mental health services. In-keeping with their ethos of individualized care delivery, mental health services should place more emphasis on being able to offer appropriate, culturally adapted interventions to their service users., (© 2021 The Authors. British Journal of Clinical Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

In the United Kingdom, one-in-four individuals with mental health problems access mental healthcare with police involvement. However, little is known about police officers' perceptions of their role in pathways to services. The aim of this study was to examine UK police officers' views and experiences of their involvement in mental healthcare, focusing on decision-making in emergency situations. Using volunteer sampling, we recruited 15 police officers from a large metropolitan conurbation in the North West of England. Semi-structured interviews, including a vignette depicting a mental health emergency, were used to elicit data. Interviews were transcribed verbatim and analysed at the manifest level using thematic analysis, yielding three main themes: 'Doing What's Right', 'Challenges of Working Together' and 'Training versus Experience'. Our findings indicate that, while police officers believe they have a duty of care to protect people in mental health emergencies, they sometimes lack relevant knowledge, skills and confidence in decision-making. Challenges associated with multi-agency working were also perceived as impeding officers' ability to effectively manage these emergencies. Our findings suggest that strengthening multi-agency working and improving training might positively influence police officers' views of their role and maximise their contribution to improving emergency mental healthcare., (© 2020 John Wiley & Sons Ltd.)

Objective: To determine how to improve the cultural appropriateness and acceptability of an extant evidence-based model of family intervention (FI), a form of 'talking treatment,' for use with African Caribbean service users diagnosed with schizophrenia and their families., Design: Community partnered participatory research (CPPR) using four focus groups comprising 31 key stakeholders., Setting: Community locations and National Health Service (NHS) mental health care settings in northwest England, UK., Participants: African Caribbean service users (n=10), family members, caregivers and advocates (n=14) and health care professionals (n=7)., Results: According to participants, components of the extant model of FI were valid but required additional items (such as racism and discrimination and different models of mental health and illness) to improve cultural appropriateness. Additionally, emphasis was placed on developing a new ethos of delivery, which participants called 'shared learning.' This approach explicitly acknowledges that power imbalances are likely to be magnified where delivery of interventions involves White therapists and Black clients. In this context, therapists' cultural competence was regarded as fundamental for successful therapeutic engagement and outcomes., Conclusions: Despite being labelled 'hard-to-reach' by mainstream mental health services and under-represented in research, our experience suggests that, given the opportunity, members of the African Caribbean community were highly motivated to engage in all aspects of research. Participating in research related to schizophrenia, a highly stigmatized condition, suggests CPPR approaches might prove fruitful in developing interventions to address other health conditions that disproportionately affect members of this community., Competing Interests: Competing Interests: None declared.

Equitable access to primary care for people with common mental health problems in the UK remains problematic. The experiences of people from hard-to-reach groups offer important insights into barriers to accessing care. In this study, we report on secondary analysis of qualitative data generated within seven previously-reported studies. Thirty-three of ninety-two available transcripts were re-analysed using a new heuristic of access, generated to frame narrative-based comparative case analysis. The remaining transcripts were used to triangulate the findings via a process of collaborative analysis between a secondary researcher, naïve to research findings of the original studies, and primary researchers involved in data generation and analysis within the original studies. This method provided a rich body of 'fine grain' insights into the ways in which problem formulation, help-seeking, use of services and perceptions of service quality are interlinked in a recursive and socially embedded matrix of inequitable access to primary mental health care. The findings indicate both extensive commonalities between experiences of people from different 'hard-to-reach groups', and considerable diversity within each group. An idiographic generalisation and aggregation of this variety of experiences points to one main common facilitator (communicated availability of acceptable mental health services) and two main common barriers (lack of effective information and multiple forms of stigma) to equitable access to primary mental health care. We conclude that there is a need to provide local care that is pluralistic, adaptive, holistic, resonant and socially conscious in order to ensure that equitable access to mental health services can become a reality., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Objective: This study examined the extent to which stigma-related concerns about mental health care account for the underuse of mental health services among low-income immigrant and U.S.-born black and Latina women., Methods: Participants included 15,383 low-income women screened for depression in county entitlement services who were asked about barriers to care, stigma-related concerns, and whether they wanted or were getting mental health care., Results: Among those who were depressed, compared with U.S.-born white women, each of the black groups were more likely to report stigma concerns (African immigrants, odds ratio [OR]=3.28, p=.004; Caribbean immigrants, OR=6.17, p=.005; U.S.-born blacks, OR=6.17, p=.06). Compared with U.S.-born white women, immigrant African women (OR=.18, p<.001), immigrant Caribbean women (OR=.11, p=.001), U.S.-born black women (OR=.31, p<.001), and U.S.-born Latinas (OR=.32, p=.03) were less likely to want treatment. Conversely, compared with U.S.-born white women, immigrant Latinas (OR=2.17, p=.02) were more likely to want treatment. There was a significant stigma-by-immigrant interaction predicting interest in treatment (p<.001). Stigma reduced the desire for mental health treatment for immigrant women with depression (OR=.35, p<.001) to a greater extent than it did for U.S.-born white women with depression (OR=.52, p=.24)., Conclusions: Stigma-related concerns are most common among immigrant women and may partly account for underutilization of mental health care services by disadvantaged women from ethnic minority groups.

Introduction: Women's Enhanced Medium Secure Services (WEMSS) is bespoke, gender-sensitive services which opened in the UK in 2007 at three pilot sites. This study is the first of its kind to explore the experiences of WEMSS staff, directly comparing them to staff in a standard medium secure service for women. The literature to date has focused on the experiences of service users or staff views on working with women in secure care. Aim: This qualitative study, embedded in a multimethod evaluation of WEMSS, aimed to explore the views and experiences of staff in WEMSS and comparator medium secure services. Methods: Qualitative interviews took place with nine WEMSS staff and nine comparator medium secure staff. Interviews focused on factors important for recovery, barriers to facilitating recovery and operational aspects of the service. Discussion: This study provides a rare insight into the perspectives of staff working in UK women's secure services, an under-researched area in the UK and internationally. Findings suggest that the success of services, including WEMSS, is compromised by operational factors such as the use of bank staff. Implications for practice: Comprehensive training and supervision should be mandatory for all staff, so best practice is met and staff adequately supported. [ABSTRACT FROM AUTHOR]