“With Time and Space, I Can Be Me”: Black and Minority Ethnic Perspectives of the Role of Ethnicity and Social Identity in an Inpatient High Secure Setting

There is an increased number of inpatients in High Secure Forensic Hospitals from Black, Asian and Minority Ethnic (BAME) backgrounds and an under representation of research in this area. This project aimed to explore the lived experiences of these patients in a UK High Secure Hospital (HSPS) specifically in relation to their social and ethnic identity, if and how this is considered by staff in their treatment plans and understanding of perceived threat in the system. 7 semi structured interviews were conducted. A Reflexive Thematic Analysis was conducted and revealed four themes of i) intergenerational trauma ii) racial assumptions and misperceptions iii) identity as a form of sanctuary, and iii) perceived impact of ethnicity on care. Participants spoke of the negative impacts of colonisation, and historical and present racist public attitudes on their mental health. Racial assumptions and misperceptions were found to perpetuate ongoing stress and mistrust in mental health systems and staff at the HSPS which impacted on their identity and recovery. When aspects of social and ethnic identity were considered, this facilitated trust and pathed the way for recovery. Additionally, service users made calls for further representation of BAME professionals in the HSPS and a want for advocacy in early stages of admission. Findings indicate that BAME service users need enhanced support from staff through cultural competence, recognition of social and ethnic identity in assessments and treatment plans, and peer support from service users with lived experiences. Future calls for research could consider the efficacy of considering social and ethnic identities at assessment, the impact of racial trauma and the impact on treatment outcomes through Experts by Experience (EbE) advocates. Strengths and limitations are discussed.