Culturally appropriate advocacy, improving access, experience and outcomes for racialised people in mental health services.

Background The Mental Health Act (MHA) 2007 introduced independent mental health advocacy (IMHA) to protect and promote the rights of people detained under the MHA 1983.

Research has identified IMHA as a measure to improve both the quality and outcomes of care, to provide a function for qualifying patients to have their voice heard, and for their rights to be protected and promoted. While research to date is limited, it does indicate that the benefits of IMHA are not always realised by everyone.

A small number of studies raise questions about equity for racialised people.

Against a background of concerns about structural racism in mental health services, and equitable access to IMHA, the Independent Review of the MHA also confirmed shortfalls in IMHA for racialised people, leading to a call for culturally appropriate advocacy (CAA).

Aims and Objectives This study aims to build on a national scoping review, and pre-pilot concept-testing, to understand the best way to implement CAA, and whether CAA pilots provide accessible, effective and appropriate support to racialised people.

Research questions The following questions will guide the research: What factors, individual, organisational and system-wide, determine service equity of CAA? What considerations help to design an economic evaluation of CAA?

Research plan Multiple methods will be used to capture data about how CAA is provided; who uses CAA and to explore the experiences of CAA from different perspectives. The research has two stages.

Stage 1 is concerned with identifying dimensions and parameters of quality for CAA by examining research and expert evidence, to develop three preliminary models: a set of quality performance indicators, a rights framework and organisational typology.

Stage 2 will use a comparative case study design across the three pilot sites to capture both quantitative data and in-depth qualitative data. It entails applying and adapting the preliminary models developed in stage 1 to evaluate CAA pilot delivery.

Planned timeframe: Months 1-4 project preparation: establishing project Steering Committee and lived experience advisory panel; developing resources; securing ethical approval and staff recruitment.

Months 4-7 developing preliminary models: completion of an evidence synthesis, stage 1 qualitative data collection, involving 50 participants in focus groups using content analysis, followed by nominal group technique for stakeholder consensus.

Months 8-16 data collection: stage 2 qualitative interviews, 60 research participants, thematic analysis, quantitative data collection and analysis, comparative data synthesis, and applying and refining preliminary models.

Months 12-18 final analysis, report writing and dissemination: Data analysis and synthesis, estimating per participant costs of CAA models, agreeing a dissemination plan, circulating research report and co-produced workshops.

Dissemination The research will offer key information about measures to ensure equitable access to IMHA which are culturally appropriate, both relevant to service delivery and commissioning.

To optimise the benefits of the research findings, we will use our clinical and policy networks to ensure that the main findings are shared as widely as possible.

Two workshops will be delivered, one for strategic policy leads, and another co-produced with advocacy infrastructure organisations, to enhance learning from the research findings.