Research Snapshot: Black men with schizophrenia describe their experiences receiving mental health services

What you need to know

Researchers conducted semi-structured interviews with seven Black men with schizophrenia, who were described by their treatment teams as disengaged from services. They found that these men felt controlled and sometimes coerced by their treatment teams. The clients disliked receiving treatment centered on medication and felt angry about their lack of control, despite recognizing some benefits of mental health services. The participants also identified how the stigma of receiving mental health services negatively affected their identity and social relationships. Service providers could benefit from this research by addressing the issues presented here in their practice in order to increase engagement.

 

This Research Snapshot was based on the article, “Experiences of mental health services for ‘black’ men with schizophrenia and a history of disengagement: A qualitative study” published in International Journal of Mental Health Nursing in 2018.

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What is this research about?

Many coping with mental health issues also struggle to stay engaged with treatment. This is especially true of people with psychotic disorders like schizophrenia. Engagement refers to things like maintaining connection, personal investment and emotional vulnerability with service providers. Disengaging from treatment means the clients’ needs aren’t met, they will be likely have more social problems, and their wellbeing will often suffer. Considering these outcomes, it’s important to understand more about why people disengage. In particular, what are the experiences of Black men with schizophrenia who aren’t engaged with mental health services?

What did the researchers do?

Working out of England, the researchers spoke to participants who were described as disengaged from services to hear more about their experiences. All seven participants had a diagnosis of schizophrenia, self-identified as Black, and were receiving care from Assertive Outreach Teams.

Through two rounds of semi-structured interviews, one to collect general information and another to ask clarification questions, the participants were given the space to talk about their experiences with mental health services and describe their relationship with their treatment team. The researchers then reviewed and coded the interview transcripts to find themes related to disengagement. Through a formal process of interpretation, they found some commonalities in what the participants had described.

What did the researchers find?

The researchers found four themes that may help explain why the participating men with schizophrenia felt disconnected from their treatment teams:

  • Feeling “hounded” by service providers: It was common for the participants to report feeling bothered and controlled by their service providers. Some believed that it would be better if they were left alone to sort out their mental health issues themselves. The older participants were more able to recognize some of the benefits of engaging with their treatment team.
  • Disliking their prescribed medication: Another common complaint was that mental health services center around medication and that there are elements of coercion at play. Many participants felt angry about their perceived lack of control. They disliked injectable, slow-release forms of medication in particular, and disliked how their medication made them feel.
  • Preferring the ability to make their own choices: Most participants didn’t actually say they felt disengaged. They appreciated having options and identified some aspects of their treatment that they did need, like having someone to talk to. However, they did not always feel their treatment team listened to them.
  • Wanting to avoid mental health stigma: Finally, participants felt that because of mental health stigma, their attachment to their treatment team negatively affected both their identity and their social relationships. They expressed feelings of isolation and exclusion from society.

Limitations of the research

This study gave a voice to a small number of participants to develop some insights into the problem of disengagement. However, such a sample size prevents generalization. It’s also worth considering whether the participants were able to be fully honest discussing their experiences with researchers who didn’t share their ethnic identity.

Acknowledgements

This knowledge exchange activity is supported by Evidence Exchange Network (EENet), which is part of the Provincial System Support Program at the Centre for Addiction and Mental Health - “CAMH”). EENet has been made possible through a financial contribution from the Ministry of Health (“MOH”). The views expressed herein do not necessarily represent the views of either MOH or of CAMH.

About the researchers

Christopher Wagstaff,1 Hermine Graham,2 Derek Farrell,3 Michael Larkin,2 Mary Nettle4

  1. Department of Nursing, University of Birmingham, Birmingham
  2. Department of Psychology, University of Birmingham, Birmingham
  3. Institute of Health & Society, University of Worcester
  4. Mental Health User Consultant, University of Worcester

This Research Snapshot was based on the article, “Experiences of mental health services for ‘black’ men with schizophrenia and a history of disengagement: A qualitative study” published in International Journal of Mental Health Nursing in 2018. https://doi.org/10.1111/inm.12305