The lived experiences of Black and Minority Ethnic patients within a high security hospital

Black and minority ethnic (BME) communities are disproportionately overrepresented in mental health and legal systems within the UK. People from BME communities are detained more frequently, receive poorer mental health care, and are restrained and secluded more often than individuals from non-BME backgrounds. High security hospitals represent the physical spaces in which mental health and legal disciplines merge, thereby offering unique contexts for study.Ten narrative interviews were conducted with individuals who identified themselves as being of BME backgrounds within a high security hospital. These aimed to i) explore the experiences of BME individuals accommodated within a high security hospital; ii) investigate BME individuals’ experiences of coercion and restrictive practices, including security, restraint, seclusion and segregation; and iii) identify themes that promote health outcomes for BME individuals in this context. Data was analysed using an iterative-inductive approach, allowing for the emergence of themes from the data, and for links to be made between findings, theories, policies and practice.Three themes emerged from the findings: i) turbulent journeys; ii) discovering stability; and iii) freedom, hope and aspirations. Turbulent journeys related to the challenges of seeking help and support, and of experiencing oppression, hopelessness, fear and mistrust. Discovery of stability had subthemes rooted in breaking the vicious cycles of detention and discharge, of working with rather than against the system, and of developing individual roles, identities and forms of self-expression. Freedom, hope and aspirations captured the importance of relationships, occupation, health and wellbeing.Based on these findings, this report recommends that: i) BME individuals must have equal access to mental health care, and fair treatment within mental health and legal services, to improve their experiences of health, care and wellbeing; ii) guidance mist be revised, developed and implemented to ensure that restrictions within secure hospitals do not impinge upon individuals’ expressions of self, identity and culture; and iii) it is imperative that restrictive practices, for example, restraint, seclusion and segregation, do not inadvertently become forms of structural violence by perpetuating the fear and violence they set out to contain. These are each paramount to improve the health and wellbeing of BME individuals