Severe Mental Illness (SMI), such as schizophrenia and bipolar disorder, affects around 1% of the population but has a disproportionate impact in terms of overall disease burden. SMI also has a disproportional effect on ethnic minorities with reviews showing up to 3 times increased incidence overall. Historically SMI has been described as following a chronic deteriorating course; a view largely discounted in recent decades with studies promoting recovery as a viable outcome for many. The original proponents of a “recovery model” emphasised the importance of social factors, moving away from a prevailing biomedical model. Despite this, while there has been a wealth of research into social factors and illness onset, most of the literature is “strangely silent” about socio-structural inequalities in recovery. This shortfall is particularly noticeable in ethnicity studies with ethnic inequalities in SMI aetiology having received considerable research attention while this is rarely addressed in terms of recovery. This is particularly important given the ethnic inequalities in prevalence overall. It is likely that a number of factors are relevant to ethnic differences in recovery, such as corresponding socio economic disadvantage as well as ethnic inequalities in the use of more coercive and solely medication-based treatment, although these questions are rarely addressed.
This mixed-methods study therefore has two aims: firstly, to compare recovery rates for different ethnic minority groups and examine how these relate to different socio-economic factors and treatment modalities; secondly, to investigate in detail how ethnicity shapes the experience of recovery through a series of in-depth interviews with relevant stakeholders.
The CASE partner for this project, Rethink Mental Illness, are a large mental health charity (over 22,600 clients) with a strong commitment to tackling ethnic inequalities in severe mental illness. They currently have a particular interest in developing measures to assess recovery for their clients and plan to role these out over the next year. The project will work with Rethink in two ways: firstly, by drawing on Rethink’s client base to recruit ethnic minority service users with a severe mental illness, who score highly on these recovery measures, for a series of semi-structured interviews. Alongside this will be interviews with Rethink staff, with ethnically diverse caseloads, investigating their views on ethnicity and recovery. Rethink will also provide detailed data on clients’ recovery status using a variety of recovery related measures alongside information about their social circumstances.
To complement this quantitative analysis the study will also include an analysis of the Clinical Record Interactive Search (CRIS) case register – providing de-identified Electronic Health Records of all patients using secondary mental health services in South London. This will look at ethnic differences in who is discharged from services as well as routinely collected measures related to recovery, including relevant socio-economic indicators and comprehensive information about treatment.
Outputs from this study will provide a comprehensive picture of ethnic inequalities in SMI recovery to inform services so that they are able to provide more equitable treatment and care and therefore help tackle ethnic inequalities in disease prevalence.
Click here for more information, including how to apply: ESRC CASE Studentship. Ethnic inequalities in recovery from severe mental illness. (kcl.ac.uk)