title: Experiences of mental health services for 'black' men with schizophrenia and a history of disengagement: A qualitative study.
abstract: Whilst mental disorders can be disabling they are also treatable, yet engagement with services is often poor and disengagement from treatment is a major concern for mental health nurses. Participants were service users typically perceived as the most disengaged from mental health services, yet they were willing to engage in the research interviews. The seven participants were all male with a diagnosis of schizophrenia, a history of disengagement from mental health services and described their ethnicity as 'black'. Participants were under the care of Assertive Outreach Teams and were recruited after the researcher was introduced to them by clinicians who were working with them. After ethical approval, in-depth, semi-structured interviews were used to elicit the experiences of participants. Through interpretative phenomenological analysis, themes were developed. Interpretative Phenomenological analysis generated four themes: (i) "People just keep hounding me", (ii) Antipathy to Medication, (iii) Choice and the value of services, (iv) Stigmatisation and identity. By rigorously examining how service users with schizophrenia make sense of their experience of their relationship with mental health services, there is potential to give voice to the experiences of the recipients of mental health services. This study uncovered the complex nature of disengagement and in view of this there may never be a straightforward mechanism developed to engage all people with schizophrenia with mental health services. When the participants' experiences are considered in a broader social context it may be possible to reflect on how services can be adapted to facilitate better engagement.
authors.affiliation: Department of Nursing, University of Birmingham, Birmingham, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Wagstaff
authors.affiliation: Department of Psychology, University of Birmingham, Birmingham, UK.
authors.forename: Hermine
authors.initials: H
authors.lastname: Graham
authors.affiliation: Institute of Health & Society, University of Worcester, Worcester, UK.
authors.forename: Derek
authors.initials: D
authors.lastname: Farrell
authors.affiliation: Department of Psychology, University of Birmingham, Birmingham, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Larkin
authors.affiliation: Mental Health User Consultant, Worcester, UK.
authors.forename: Mary
authors.initials: M
authors.lastname: Nettle
mesh_terms: D000328:Adult; D044383:Black People / Q000523:psychology*; D003156:Community Mental Health Services; D004739:England; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology; D036301:Qualitative Research; D012559:Schizophrenia / Q000208:ethnology* / Q000628:therapy; D012649:Self Concept; D012934:Social Isolation / Q000523:psychology*; D057545:Social Stigma
keywords: disengagement; ethnicity; interpretative; mental health services; phenomenological analysis; qualitaive; schizophrenia; service user