Clinical ethnography in severe mental illness: a clinical method to tackle social determinants and structural racism in personalised care

Ethnic inequalities in the experiences and outcomes of severe mental illness are well established. These include a higher incidence of severe mental illnesses (psychoses), adverse pathways into and through care, including crisis care, police and criminal justice systems involvement, and care under the powers of the Mental Health Act. The situation persists despite awareness and is driven by a mixture of the social determinants of poor health, societal disadvantage and structural racism, as well as conflictual interactions with care systems, which themselves are configured in ways that sustain or deepen these inequalities. Although training and education are often proposed, this is not shown to have sustained effects. Clinical processes (interviewing/assessment/formulation/intervention) need to address systemic influences and improve the cultural precision with which care is delivered, organised and commissioned. We discuss clinical ethnography and present evidence of its value in addressing systemic as well as individual care needs for diverse communities.

Automated summary

Ethnic inequalities in the experiences and outcomes of severe mental illness are driven by a mix of social determinants of poor health, societal disadvantage, structural racism, and conflicting interactions with care systems. Traditional training and education have limited impact on addressing these issues, therefore clinical processes should focus on systemic influences to improve the cultural precision of care delivery. Clinical ethnography has been shown to be valuable in addressing both systemic and individual care needs for diverse communities.