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INJUSTICE - red is the blood that was shed

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INJUSTICE - red is the blood that was shed

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(LE) No justice = Mistrust in authority, Fear of authority. When in need of help the default is to turn to local support systems instead of authority figures or professionals

(LE) This mistrust/injustice form the negative social narrative engrained in the black communities stemming from multiple generations of oppression and slavery

(LE) The blood that was shed from white people taking balck people in slavery and colonisation runs deep in the ancestral community

(LE) This leads to inter-personal trauma

(LE+PFS) Professionals need to understand the factors correlated with a higher prevalence of mental illness in BAC men, e.g., the impact of poverty, substance and alcohol misuse, crime, trauma, abuse and discrimination etc.

(LE+PFS) BAC men may have issues in trying to rediscover their voice after life experiences have made them believe silence was safer.

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(LE) Change from the black men project to knowing and understanding the Black man as an individual

(LE+PFS)The many multi-dimensions of the individual Black man e.g. religion, class, diability, gender, sexuality, culture etc..

(LE) Need to be heard

(LE) Need to be understood

(LE+PFS) Need for person centred care not just racial or gendered care

(LE+PFS) Weight of racism that informs your identity (dripping tap of systemic micro and macro generational oppression) The true weight of trauma as a black man that shapes/forms/changes your identity

(LE+PFS) When men feel listened to, heard and understood by a professional who is more representative of who they are, that can go a long way in building therapeutic connections and aiding recovery

(LE+PFS) Black are often treated monolithically by police and mental health services, with little consideration for the cultural and traditional differences within the Black community.

(LE) Being treated like human is an essential ‘health equality’ – access to good mental health support shouldn’t be linked to wealth, status or background;

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What is racism? (e.g. Daily. Constant. Fear of. Living in trauma)

(LE) Effects include tired, angry, stressed, fear, constant anticipation and expecting racism

(PFS) Healthcare professionals do not feel comfortable using language around 'race'. (e.g. is it ok to describe someone by their skin colour?) This (CL edit 'might') block communication and (might) stop (it's more subtle than this - CL) from building a rapport with people.

(LE) Need to consider conscious and unconscious bias in professionals, to challenge racism in practice. For practice to be truly progressive and based on human rights, it need to include reporting and logging incidents of racism (CL) agree - this should be an action for improvement.

(LE) Racism is making us sick

This all links with INJUSTICE - Possible sub-theme under RACISM. or Racism possible sub-theme under INJUSTICE . Two are very intrinsically interlinked

(LE) Experiences of racism/anti-Blackness (CL - Whiteness) being pathologized and part of ones mental health diagnosis.

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(LE) some types family, religious community, ancestors

(LE) Look to them for wisdom, loyalty,

(LE) What support you look for: stand with and hold up

(LE) Stand With - in times of need and injustice

(LE) Hold Up - speaks of the tiredness when you can no longer stand alone. No-one should stand alone

(LE) Accepting of vulnerability, unafraid of vulnerability

(PFS) Many families go out their way to 'hide' their men who are struggling with mental health due to the stigma, distrust and negative social narrative around mental health services. This is seen as an example of support

(PFS) Need to involve/explain the Mental Health Act to family/friends

(PFS)Need to be included in loved ones care

(PFS) Poor awareness of good services in the community

(LE+PFS) Role of family – key in both challenging the service (where poor practice) and supporting their loved ones in their recovery.

(LE) "As men we must..." Support created inwardly, community focused as opposed to individualistic framing of mental health support. "We" instead of "I"

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(LE+PFS) Should be needs led and trauma informed. Start with the people; listen to who they are, what they need, to develop a care plan for them, do not try to fit them in already existing care packages;

(LE+PFS) post-discharge meetings should explain and support healing around the detention experience and any trauma experienced on the ward

(LE+PFS) joint decision making

(LE+PFS) give back some power - rebalance the power by giving people choice in the care planning

(LE+PFS) Whiteness in the mental health system

(LE+PFS) Care path should begin in the community then pre-detention all the way through to post-discharge

(LE+PFS) "Aftercare needs to be more intense...just thinking what's going to benefit the person. Do they need to stay on home treatment for longer? Do they need a Black worker? Do they need someone who understands their ethnic background and cultural differences to support them?"

(LE) Need for family access, inclusion and involvement

(LE+PFS) Needs to be a change in societal narratives. Black men not encouraged to seek help

(LE+PFS) The nature of medical assessments does not necessarily draw on transcultural psychiatry.

(LE+PFS) MH should be embedded in the community - Community based support is key – best space to open up, un-silence silences, re-build trust in oneself, the community and support services;

(LE+PFS) People experience trauma because of the detention experience - creates a vicious cycle of ill mental health

(LE+PFS) Politics of outdated MHAct and detention process - links to power theme

(LE+PFS) Assessment and Interventions are not always culturally adapted for the needs of Black men - diagnosis - needs to be informed by transcultural psychiatry

(LE+PFS) Many of the therapeutic interventions are idiographic (e.g. cognitive behavioural therapy) need for radical change to adapt interventions to include social factors cause ill mental health (e.g. racism, injustice, poverty, substance use etc)

(LE+PFS) Need to diversify the health care workforce

(LE+PFS) Radical change is needed to fix a broken system

From Support Theme below:

(PFS) Need to involve/explain the Mental Health Act to family/friends

(PFS)Need to be included in loved ones care

(PFS) Poor awareness of good services in the community

(LE+PFS) Role of family – key in both challenging the service (where poor practice) and supporting their loved ones in their recovery.

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MISCONCEPTION -  (includes risk or danger)

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MISCONCEPTION -  (includes risk or danger)

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(LE+PFS) Aggression/danger/risk needs to be understood from both perspectives (the professionals and the men with lived experience)

(LE+PFS) Black men have a stigma of being aggressive - need to understand the root cause of their aggression ie. the protection of self due to generational racism, injustice and the societal narrative of people being tazered and restrained leading to death historically

(LE+PFS) The act of being detained involves the black men being the victim of violence/aggression. If they then are being detained again aggression may be an innate reaction to protect themself from the original violence/aggression they experienced in the 1st instance

(LE) need to explore the different perspectives of 'risk'. Who is protecting who from what risk during detention?

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(LE+PFS) Detention is enforced on someone

(LE+PFS) The language and communication during and after detention is jargonistic. People have no idea what's happening to them or why

(LE) Need to humanise the detention process and humanise communication

(LE+PFS) Pathways to care are hidden

(LE) Want to be free from control

(LE) Power is stripped from the individual being detained.

(LE+PFS) Detention process is dominated by Mental Health Act. The process is very arbitrary it doesn't take the 'person' into account. This demonstrates the black men have a power disadvantage over healthcare professionals but also healthcare professionals have a power disadvantage over the outdated policies/acts/assessments dictating how they do their job

(LE) Family/loved ones/carers worried that voicing their complaints will affect the care of the person in services

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(LE) Current biomedical model biased towards Christian beliefs

(LE) Religion is where some black people/communities turn to for support

(LE) Communities may be shy in coming forth with their religious beliefs as they are contrary to the Western mental health model (e.g. hearing voices, praying to higher powers, receiving wisdom from higher powers etc)

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(LE+PFS) Medication is tested on White populations leading to mistrust of mediation and its efficacy on the Black community.

(LE+PFS) Medication refusal seen as aggression but in reality the medication side effects are so unpleasant they can't be lived with.

(LE) People who don't want to take medication not believed, their own belief and understand not being taken seriously or prioritised.

(LE) Medication = big issue! The need for right (anti-psychotic) medication, right person, right need, right time

(LE) Medication as a form of control

(LE) The actual effects of being medicated (over medicated specifically), being a shell of oneself, looking/feeling like a zombie, carers watching their loved ones in services change

(CL) Professionals lack full understanding of spirituality/cultural beliefs when assessing for psychosis and schizophrenia. This can lead to racist practices from professionals around diagnosis and medication management e.g., diagnosis is applied via a Eurocentric diagnostic manual (ICD-10) and antipsychotic medication is predominately 'tested' on the White male population. Black men are mistrustful of anti- psychotic's efficacy (note Rastafarians beliefs around medication contaminating the body, therefore alternative treatment approaches are sought e.g. acupuncture, homeopathy)

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(LE) What is viewed as stigma of black men (mental health, big black men, aggression) is really a trauma response created by years of racism, and injustice

(CL) Stigma (Goffman)and Self Stigma. Stigma power (Pinker) is the commonest form of violence used with a democratic society, and is a form of power and inequality (Tyler). We should consider - How is Whiteness experienced? How is Whiteness embedded in Mental Health Services and its commissioning (this is a form of stigma power). I think commissioners have a key role in providing services that are person led and informed by cultural needs.

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The LE, PFS and LE+PFS is about where that bullet point came from.  ‘LE’ is the voice of Lived experience and ‘PFS’ is Professionals.  LE+PFS means it came out in both stakeholders findings. 

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The LE, PFS and LE+PFS is about where that bullet point came from.  ‘LE’ is the voice of Lived experience and ‘PFS’ is Professionals.  LE+PFS means it came out in both stakeholders findings. 

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Isaiah + Kenny - THEME ONE including: Identity, Stigma, Spirituality, Racism 

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Isaiah + Kenny - THEME ONE including: Identity, Stigma, Spirituality, Racism 

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Jeremy + Kim - THEME TWO including: Power, Misconception, Injustice  

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Jeremy + Kim - THEME TWO including: Power, Misconception, Injustice  

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Caroline + Debbie - THEME THREE Mental Health Care and Treatment including: Mental Health, Medication 

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Caroline + Debbie - THEME THREE Mental Health Care and Treatment including: Mental Health, Medication 