Improving the Patient Experiences of African Caribbean Men Detained Under the Mental Health Act: A Co Produced Intervention Using the Silences Framework

Aim:
To inform, develop and explore the feasibility of a co-produced intervention to improve the experiences of Black African-Caribbean (BAC) men detained under the Mental Health Act (MHA)

Background:
The latest UK Government figures show that BAC people are detained significantly more than their non-Black peers under the MHA. Current evidence suggests that there is a desperate need for a wide-scale intervention to
inform best practice, focusing on co-production and user involvement with marginalised groups such as BAC men. There is also a gap in research evaluating interventions outside of London.

Objectives:
- Review the evidence regarding interventions used to address the over-representation of BAC men
detained under the MHA;
- Explore BAC men’s experiences of the ‘mental health detention’ journey;
- Explore professionals’ views to identify key areas for improvement;
- Co-produce a tailored intervention aimed at improving BAC men’s experiences of detention;
- Assess whether the intervention can be delivered to an adequate level;
- Conduct a qualitative evaluation to explore acceptability of intervention and identify any challenges;
- Consult with policy makers to inform and produce recommendations for practice improvement and change.

Methods:
This five stage mixed methods study will use The Silences Framework (TSF) and Experience Based Co-design (EBCD) to guide the research and identify the complexities around BAC men’s experiences, in their own words,
focussing on what is important to them in relation to detention.
First, a rapid evidence review with reflexive analysis will take place to culturally inform and underpin the research design to frame and understand research to date on the experiences of BAC men detained under the MHA.
Next, 15-25 EBCD narrative interviews with BAC men and members of their social networks, and 15-20 semi-structured interviews with professionals involved in the assessment or detention process (e.g. psychiatrists, GPs,
mental health nurses, AMHPs, police officers, social workers, care coordinators) will be conducted, resulting in the production of a trigger film and theory of change driven collaborative workshops to co-develop the intervention and
a logic model for testing it in practice. The feasibility of the intervention will be then tested at small scale with BAC men who have been assessed or detained under the MHA, to assess recruitment rates over a period of 9 months
and the adequacy of intervention delivery, as well as to explore any challenges and intervention acceptability. The final stage 'planning for silences' will include dissemination. A comprehensive impact strategy will be implemented
throughout all stages of the research to ensure that policy makers are equipped to act on the emerging recommendations and to enable change.

Timelines for delivery:
The research programme will take 48 months to complete (01.01.2021-31.12.2024), as outlined in the Gantt Chart.

Anticipated impact and dissemination: To maximise audience and impact, findings will be disseminated through peer reviewed publications, official
reports, practitioner magazines, conferences, parliamentary reports, media and online platforms. The study will help raise awareness of the issues that lead to over-representation of BAC men detained under the MHA and enable change through lobbying directed at policy makers.

What we know about this subject
Black African-Caribbean men are more likely to be detained under the Mental Health Act (1983) than those from
non-black communities. This means that they can be subject to discriminatory practices that are unfair and
traumatic for them and their families. This research aims to understand the experiences of these men and develop
an approach, which will reduce detention rates and improve their experiences.
What we plan to do
We will use 2 co-production methods: (1) the ‘Silences Framework’ (a dedicated way of engaging with and hearing
unheard views from people from vulnerable populations) and (2) ‘Experience-based co-design’ (a way of bringing
people together to do research that is mutually identified and agreed). Both involve creative and inclusive
approaches to gain meaningful views of people including video stories and sharing events. This will help us to
understand men’s experiences about detention, in their own words, what is important to them and their families.
The study includes 5 stages:
1. A review of the literature to identify the context in which detention under the MHA occurs for black AfricanCaribbean men;
2. ‘Reflexive’ analysis to help identify missing pieces of the puzzle, for example, exploring which questions
remain unexplored, whose voices are missing from the evidence;
3. A co developed (mutually devised and agreed) intervention based on:
a. Narrative interviews with experts by experience (Black African Caribbean men and key members
of their social networks), edited to create a powerful short film;
b. Interviews with professionals including the police, a range of mental health professionals and
social workers;
c. A number of group events bringing everyone together to identify key areas of concern and
priorities for change.
4. Feasibility: The intervention will be tested for feasibility with the police. BAC men who have been assessed
or detained under the MHA will be recruited to assess whether the intervention can be delivered as we
intend it to be. We will also assess how many participants we can recruit over a period of 9 months and
what outcomes we should be measuring.
5. Celebrations and impact: to thank participants and report on achievements, a celebratory event will be
held at the end of the study. This will help identify key actions to enable real change in practice and policy.
We will publish results in academic papers, present at conferences, use social media and work with Policy
Connect to share our work with policy makers and organisations who can support change. Importantly, we will
ensure our results reach the people for whom they are intended, working with experts by experience to target
agreed upon networks and communities to spread the findings in a way that can be understood by the public.