Social Psychiatry and Psychiatric Epidemiology

PurposeThe COVID-19 pandemic has many potential impacts on people with mental health conditions and on mental health care, including direct consequences of infection, effects of infection control measures and subsequent societal changes. We aimed to map early impacts of the pandemic on people with pre-existing mental health conditions and services they use, and to identify individual and service-level strategies adopted to manage these. MethodsWe searched for relevant material in the public domain published before 30 April 2020, including papers in scientific and professional journals, published first person accounts, media articles, and publications by governments, charities and professional associations. Search languages were English, French, German, Italian, Spanish, and Mandarin Chinese. Relevant content was retrieved and summarised via a rapid qualitative framework synthesis approach. ResultsWe found 872 eligible sources from 29 countries. Most documented observations and experiences rather than reporting research data. We found many reports of deteriorations in symptoms, and of impacts of loneliness and social isolation and of lack of access to services and resources, but sometimes also of resilience, effective self-management and peer support. Immediate service challenges related to controlling infection, especially in inpatient and residential settings, and establishing remote working, especially in the community. We summarise reports of swiftly implemented adaptations and innovations, but also of pressing ethical challenges and concerns for the future. ConclusionOur analysis captures the range of stakeholder perspectives and experiences publicly reported in the early stages of the COVID-19 pandemic in several countries. We identify potential foci for service planning and research.

BackgroundSmoking rates are significantly higher in people with mental health problems, compared to those without. Negative attitudes towards smoking cessation are widespread in inpatient settings towards patients with severe and enduring mental illness. It is not clear if the same attitudes operate in psychological services towards people with common mental illness. We aimed to understand the concerns and views that patients, therapists, and smoking cessation practitioners may have about integrating smoking cessation treatment into psychological treatment for common mental illness and how these concerns may be overcome. MethodsThematic analysis of 23 in-depth interviews. Interviews took place in Improving Access to Psychological Therapies (IAPT) and smoking cessation services in England. Participants were 11 psychological wellbeing practitioners (PWPs), six IAPT patients with common mental illness, and six smoking cessation advisors. OutcomesNone. FindingsIAPT patients reported psychological benefits from smoking, but also described smoking as a form of therapeutic self-harm. PWPs seem positive towards smoking cessation treatment for people with common mental illness. IAPT PWPs and patients accept evidence that smoking tobacco may harm mental health, and quitting might benefit mental health. PWPs report expertise in helping people with common mental illness to make behavioural changes in the face of mood disturbances and poor motivation. IAPT appears to be a natural environment for smoking cessation intervention. PWPs felt confident to offer smoking cessation treatments to IAPT patients, but thought that a reduction in caseload was required to deliver smoking cessation support in an already pressed service.

Romantic/intimate relationships are an important part of most peoples lives, including people with mental health problems. However, people with mental health problems continue to have little access to support around romantic/intimate relationships. This study aimed to investigate social care staff perspectives on supporting people with romantic/intimate relationships. We conducted 15 qualitative interviews with mental health social care staff to explore their views on supporting people using services with desired romantic/intimate relationships, facilitators and barriers to these conversations, and strategies to offer support in this area. We purposively recruited staff working in a range of social care roles and with varied demographic characteristics. Interviews were analysed using reflexive thematic analysis. We identified three primary themes. These related to (i) whether romantic/intimate relationship support should be offered; (ii) how romantic/intimate relationship support should be offered; and (iii) whether social care staff are the right people to offer this support. Overall, participants felt that romantic/intimate relationship support is important for the quality of life of people accessing services. However, they noted a lack of resources and training relating to romantic/intimate relationship support, and discussed some safeguarding concerns. Findings highlight the need for clear organisational policy and training to address staff concerns, and research to understand the perspectives of people using services on romantic/intimate relationship support. Teaser TextMost people value romantic/intimate relationships in their lives, including people who use mental health services. While people with mental health issues often report that they want support with relationships, they often do not have access to it. This study sought to understand why, by interviewing 15 mental health social care staff about their views on providing support around romantic/intimate relationships to people who use social care services. Staff generally agreed that relationship support is important for helping those who use mental health services to feel empowered and improve their quality of life. However, they expressed concerns about a lack of resources and training available to help them offer romantic/intimate relationship support. They also discussed ethical worries, including wanting to protect vulnerable people and what to do when working with people who have an offending history. Accordingly, organisations should develop clear policies and practical training to help staff gain skills and confidence in providing this support. There is also a need for future research to find out more about what service users themselves want and need in this area.

BackgroundMost people seek to establish romantic or intimate relationships in life, including people with mental health problems. However, this has been a neglected topic in mental health practice and research. This study aimed to investigate views of mental health and social care staff about the appropriateness of helping service users with romantic relationships, barriers to doing this, and suggestions for useful ways to support this. MethodsAn online survey comprising both closed, multiple response and free-text questions was circulated to mental health organisations across the U.K. via social media, professional networks and use of snowballing sampling. A total of 63 responses were received. Quantitative data were analysed using descriptive statistics, and are reported as frequencies and percentages. Qualitative data were interpreted using thematic analysis, using an inductive approach. ResultsAlthough most participants reported that finding a relationship conversations were appropriate in their job role, many barriers to supporting service users were identified, including: a lack of training; concerns about professional boundaries; concerns about service user capacity and vulnerability; and concerns about being intrusive. Participant suggestions for future support included educating service users on safe dating behaviours, and practical interventions such as assisting service users to use dating sites and engage with social activities to develop social skills and meet others. ConclusionsStaff were willing to help service users seek an intimate relationship but may need specific training or guidance to facilitate this confidently and safely. This study elucidates the need for further research in this area, particularly in understanding service user perspectives, and in developing resources to support staff in this work.

BackgroundDespite improving legal protections in recent decades for sexual minorities in the UK, sexual minorities continue to experience significant mental health disparities relative to heterosexuals, and report negative experiences within mental health services that is related to their sexual identity. However, little attention has been paid to the impact of these negative experiences on outcomes within services, or to the experiences of sexual minority staff. To overcome these gaps, the aim of this review is to explore the experiences of sexual minority staff and service users in statutory mental health services in the UK, including a focus on outcomes for service users. MethodsFor the systematic search, we searched: Applied Social Sciences Index & Abstracts, EMBASE, MEDLINE(R), PsycINFO, CINAHL Plus, and Web of Science for relevant articles, and for the suppementaty search, we searched the websites of relevant organisations, in addition to searching Google, Google Scholar, and DuckDuckGo. We included all study designs, published from 2010 onwards, that included first-hand accounts of sexual minority staff or service users in statutory mental health services in the UK. We used a narrative synthesis to synthesise the findings. ResultsOf 7427 articles identified, 84 were assessed at full text screening, with 11 being included in the review. 9 of the included studies were with adults, with the majority being conducted in the context of Talking Therapies and primary care counselling services (n = 7). Across studies, sexual minorities reported anticipatory anxiety about experiencing prejudice and discrimination in services, microaggressions (e.g., heteronormative assumptions) and the pathologization of their sexual minority identities. There are mixed findings about whether certain sexual minority groups have worse outcomes in Talking Therapies services. We found no studies that explored the experiences of sexual minority staff. ConclusionsSexual minority service users are reporting negative experiences in some statutory mental health services in the UK that are related to their sexual identity. In line with service user recommendations, services should consider introducing sexual minority training for staff to improve the experiences of service users. An absence of research on sexual minority staff, and little research on the experiences of young people from sexual minorities, highlight the need for research in this area

The COVID-19 pandemic caused major disruptions to everyday life for children and young people. The aim of this study was to examine professionals views on the mental health problems and vulnerabilities of children and young people during the early phase of the COVID-19 pandemic. We conducted a secondary analysis of an online survey completed by mental health professionals in the UK between 22 April 2020 and 12 May 2020. The final sample was N = 601 professionals who at least partly worked with children and young people. Quantitative and qualitative survey data showed that professionals were concerned about young people experiencing economic disadvantage and young people from minority ethnic groups, as pre-existing social inequalities resulted in increased risk of infection and reduced access to physical and mental health care. Professionals were concerned about young people with little family support and young people at risk of relapse or deterioration in mental health, reporting the exacerbation of pre-existing mental health difficulties and challenging behaviours. Further research, involving young people as researchers, is needed to explore the continued impact for children and young people, and their families, including in comparison to their experiences before the pandemic.

Healthcare workers across the world have risen to the demands of treating COVID-19 patients, potentially at significant cost to their own health and wellbeing. There has been increasing recognition of the potential mental health impact of COVID-19 on frontline healthcare workers and growing calls to provide psychosocial support for them. However, little attention has so far been paid to understanding the impact of working on a pandemic from healthcare workers own perspectives or what their views are about support. This rapid review identified 40 qualitative studies which have explored healthcare workers experiences and views from previous pandemics, including and comparable to COVID-19. Meta-synthesis of this qualitative data using thematic analysis derived eight key themes which transcended pandemics, time, and geographical boundaries. This pandemic is not unprecedented; the themes that arose from previous pandemics were remarkably resonant with what we are hearing about the impact of COVID-19 globally today. We have an opportunity to learn from the lessons of these previous pandemics, mitigate the negative mental health impact of COVID-19 and support the longer-term wellbeing of the healthcare workforce worldwide.

IntroductionBoys and young men face an elevated risk of mental health problems and suicidality, yet they remain less likely than their female peers to seek professional help. Online counselling services such as krisenchat offer low-threshold support and may help reduce gender-specific barriers, but little is known about how young men use these services. ObjectiveThis study investigates male krisenchat users in comparison to other users, focusing on demographics, utilization patterns, satisfaction, chat topics, and barriers to help-seeking behavior, in order to generate insights for improving mental health support for young men. MethodsAnonymized data were obtained from n = 29,387 krisenchat users between January and December 2023. After data cleaning, the final sample comprised of N = 9,584 participants. Demographic information, utilization behavior, suicidality, and use of professional help services were documented by counsellors, while user satisfaction, recommendation rates, and emotional distress were assessed through voluntary surveys following consultation. ResultsYoung males accounted for 19.9% of krisenchat users, were on average older than female users and were less likely to have been in prior treatment. Male users sent fewer messages, accessed the service during late-night hours more often than females, and tended to find the service via search engines rather than institutional or social media channels. Compared to female users, they were less likely to disclose self-harm, family problems, or sexual violence, but more likely to bring up sexuality and LGBTQIA+ topics. Importantly, no gender difference was found for suicidality. Despite differences in some utilization patterns, acceptability outcomes -- including reductions in distress, satisfaction, and likelihood of recommending the service -- were comparable across genders, suggesting equivalent counselling benefits once engaged. ConclusionsDigital crisis services like krisenchat hold potential for reducing gender disparities in mental health support. However, targeted strategies to improve visibility, adapt communication styles, and strengthen follow-up pathways are essential to increase engagement and sustained help-seeking among young men. Study RegistrationDRKS00026671

Purposethe aim of this study was to explore staff perceptions of the impact of the COVID-19 pandemic on mental health service delivery and outcomes for women who were pregnant or in the first year after birth ( perinatal women). Methodssecondary analysis of an online mixed-methods survey open to all mental health care staff in the UK involving 363 staff working with women in the perinatal period. Resultsstaff perceived the mental health of perinatal women to be particularly vulnerable to the impact of stressors associated with the pandemic such as social isolation (rated by 79.3% as relevant or extremely relevant; 288/363) and domestic violence and abuse (53.3%; 192/360). As a result of changes to mental health and other health and social care services, staff reported feeling less able to assess women, particularly their relationship with their baby (43.3%; 90/208), and to mobilise safeguarding procedures (29.4%; 62/211). While 42% of staff reported that some women engaged poorly with virtual appointments, they also found flexible remote consulting to be beneficial for some women and helped time management due to reductions in travel time. Conclusionsdelivery of perinatal care needs to be tailored to the needs of women; virtual appointments are perceived not to be appropriate for assessments but may be helpful for some women in subsequent interactions. Safeguarding and other risk assessment procedures must remain robust in spite of modifications made to service delivery during pandemics.

BackgroundYouth is a period of elevated risk for mental ill health, yet young people often do not receive timely support. Barriers can include high clinical thresholds for treatment and long waiting lists, as overstretched statutory services can struggle to meet high demand. The Early Support Hubs available in some parts of England are a potentially promising model to increase access to support. These are community-based services offering open-access, holistic support for 11-25-year-olds without a referral. However, there is no standardised model and considerable variation in the support offered, highlighting the need for research to explore how Early Support Hubs operate, whether they are meeting the mental health and wellbeing needs of young people, and potential areas for improvement. AimsTo explore young peoples experiences of using Early Support Hubs for mental health or wellbeing support, and their views on best practice within these services. MethodsWe conducted semi-structured interviews with 20 young people aged 16-25 years, who had used Early Support Hub services across England. Data were analysed using codebook thematic analysis. ResultsAspects of hubs that were valued by young people included: easy accessibility; holistic approaches which go beyond clinical interventions; a sense of community, friendship and consistency; and youth-led philosophies. Limitations of the hub model included them being little known in local areas, lack of capacity to address more acute and complex mental health needs, and the limited scale of the services. ConclusionEarly Support Hubs appear to be valued by young people and have potential to be an adjunct to clinical services to help increase access to mental health support for young people. Evidence on populations served, what support they receive, and outcomes following support are needed to assess whether there is a policy case for wider roll out.

BackgroundDepressive and anxiety disorders are the most common mental health conditions. In the United Kingdom (UK), NHS Talking Therapies for anxiety and depression (TTad) has provided evidence-based interventions for these conditions since 2008, although treatment outcomes are often suboptimal. Loneliness, consistently linked with poorer mental health outcomes, remains unexplored in this context. We investigated the views of NHS TTad therapists about the nature and origins of loneliness amongst their clients. MethodsWe conducted semi-structured qualitative interviews with 19 NHS TTad therapists, purposively sampled across job roles, experience levels, and service locations. Recruitment was via professional networks and online platforms. Interviews were conducted online, and data were analysed using thematic analysis with both inductive and deductive approaches. FindingsFour key themes emerged from analysis: (1) Life-transitions, (2) Mental health conditions, (3) Barriers to connection, (4) Stigma. NHS TTad therapists described loneliness experienced amongst their clients as arising from both external factors (e.g., relocation, financial difficulties) and internal psychological processes (e.g., low self-esteem, mental health conditions). Therapists believed that loneliness was experienced even when clients had social contacts, due to barriers like cultural differences and mental health symptoms. Therapists also observed some demographic variability in the experience of loneliness amongst clients (e.g., across age, gender, mental health diagnosis). Societal factors including stigma surrounding mental health and loneliness were viewed as further contributing to clients loneliness experiences and help-seeking behaviours. ConclusionsNHS TTad therapists perceived loneliness as a common experience amongst their clients, linked to life transitions, mental health symptoms, structural, cultural, and psychological barriers to connection. These findings highlighted the importance of recognising loneliness as a relevant factor in therapy and of developing strategies to identify and address it within, or outside of NHS TTad services. Future research should also examine the impact of social media, gender, and public stigma on loneliness. Addressing these factors at societal and policy levels is essential to reduce stigma and improve support for individuals experiencing loneliness.

PurposePopulation surveys underrepresent people with severe mental ill health. This paper aims to explore perceived social support and loneliness and factor associations during the Covid-19 pandemic in a sample of individuals with severe mental ill health. Design/methodology/approachWe sampled an already existing cohort of people with severe mental ill health. Researchers contacted participants by phone or by post to invite them to take part in a survey about how the pandemic restrictions had impacted health, Covid-19 experiences, perceived social support, employment and loneliness. Loneliness was measured by the three item UCLA loneliness scale. FindingsIn the pandemic sub-cohort, 367 adults with a severe mental ill health diagnosis completed a remote survey. 29-34% of participants reported being lonely. Loneliness was associated with being younger in age (adjusted OR = -.98, p = .02), living alone (adjusted OR = 2.04, p = .01), high levels of social and economic deprivation (adjusted OR = 2.49, p = .04), and lower perceived social support (B = -5.86, p < .001). Living alone was associated with lower perceived social support. Being lonely was associated with a self-reported deterioration in mental health during the pandemic (adjusted OR = 3.46, 95%CI 2.03-5.91). Practical implicationsIntervention strategies to tackle loneliness in the severe mental ill health population are needed. Further research is needed to follow-up the severe mental ill health population after pandemic restrictions are lifted to understand perceived social support and loneliness trends. OriginalityLoneliness was a substantial problem for the severe mental ill health population before the Covid-19 pandemic but there is limited evidence to understand perceived social support and loneliness trends during the pandemic.

PurposeThe COVID-19 pandemic has potential to disrupt and burden the mental health care system, and to magnify inequalities experienced by mental health service users. MethodsWe investigated staff reports regarding the impact of the COVID-19 pandemic in its early weeks on mental health care and mental health service users in the UK using a mixed methods online survey. Recruitment channels included professional associations and networks, charities and social media. Quantitative findings were reported with descriptive statistics, and content analysis conducted for qualitative data. Results2,180 staff from a range of sectors, professions and specialties participated. Immediate infection control concerns were highly salient for inpatient staff, new ways of working for community staff. Multiple rapid adaptations and innovations in response to the crisis were described, especially remote working. This was cautiously welcomed but found successful in only some clinical situations. Staff had specific concerns about many groups of service users, including people whose conditions are exacerbated by pandemic anxieties and social disruptions; people experiencing loneliness, domestic abuse and family conflict; those unable to understand and follow social distancing requirements; and those who cannot engage with remote care. ConclusionThis overview of staff concerns and experiences in the early COVID-19 pandemic suggests directions for further research and service development: we suggest that how to combine infection control and a therapeutic environment in hospital, and how to achieve effective and targeted tele-health implementation in the community, should be priorities. The limitations of our convenience sample must be noted.

We conducted a systematic review and meta-aggregate synthesis to collate qualitative evidence about mental health service users views on their needs for romantic and intimate relationships and support measures. Four databases were searched in April 2024 (PROSPERO ID: CRD42024503997). Eligible studies involved (i) adult participants with any mental health condition who had received/were receiving care from mental health services; and (ii) had qualitative data specific to romantic/intimate relationship needs and support implications. Quality appraisal was conducted using the JBI Critical Appraisal Checklist for Qualitative Research. Data extraction and synthesis were conducted using meta-aggregation and the level of confidence in the synthesised findings was assessed using the GRADE-CERQual approach. We included 17 studies and extracted 100 specific findings. From these, 17 categories were created and grouped into four synthesised findings: (i) individuals with mental health conditions have a desire for romantic and intimate relationships; (ii) mental health conditions can directly hinder romantic and/or intimate relationships at the individual-level; (ii) psychosocial factors impact romantic and/or intimate relationships; and (iv) services are lacking and can act as obstacles for service users to engage in/discuss romance and/or intimacy. We found that service users had clear needs relating to romantic and intimate relationships, but experienced multiple challenges in meeting these needs. In general, mental health services tended to not provide support in this area. Implications for practice include: (i) recognising romantic and intimate relationship needs as part of routine mental health care; (ii) making sexual health and healthy relationship information available; (iii) offering spaces for group discussion and support; and (iv) facilitating social activities to meet others and build social skills and confidence.

There is an urgent need for services to address the social and economic adversities which contribute to the aetiology and outcomes of mental health problems. However, the implementation of interventions to do so is inconsistent, and entrenched cycles of poor mental health and social exclusion persist. We conducted a service evaluation survey of 28 staff working across community and inpatient teams, enhanced by a series of in-depth case studies, in the largest NHS mental health trust in the UK to explore how social and economic needs are currently assessed and addressed. We found that assessment for social and economic needs varied across different domains; for example, family relationships were more consistently assessed than domains such as education and income. A range of support is available and provided by a patchwork of teams, including Community Mental Health Teams, other NHS teams, Local Authority staff, and many third sector organisations. However, what support is available is severely restricted and respondents highlighted a lack of adequate support in every domain we considered - employment, education and training, social participation and connectedness, family relationships, community support, social security, debt, income, housing, and trauma and victimisation, as well as additional domains including healthy eating, sex and relationships, and activities of daily living. Nevertheless, our case studies illustrate examples of approaches to addressing social and economic needs to improve outcomes for people with mental health problems.

BackgroundVery little is known about the impact of previous epidemics on the care of people with intellectual and developmental disabilities, particularly in terms of mental health services. The COVID-19 pandemic has the potential to exacerbate existing health inequalities as well as expose gaps in service provision for this vulnerable population group. MethodsWe investigated the responses of 648 staff working in mental healthcare with people with intellectual disabilities and/or developmental disabilities. Participants contributed to a UK-wide online survey undertaken by the National Institute for Health Research Mental Health Policy Research Unit between 22nd April and 12th May 2020. Recruitment was via professional networks, social media and third sector organisations. Quantitative data describing staff experience over three domains (challenges at work, service user and carer problems, sources of help at work) were summarised and differences between groups explored using Chi square tests. Content analysis was used to organise qualitative data focusing on service changes in response to the pandemic. ResultsThe majority of survey respondents worked in the NHS and in community mental health services. One third had managerial responsibility. Major concerns expressed by mental healthcare staff were: difficulties for service users due to lack of access to usual support networks and health and social care services during the pandemic; and difficulties maintaining adequate levels of support secondary to increased service user need. Staff reported having to quickly adopt new digital ways of working was challenging; nevertheless, free text responses identified remote working as the innovation that staff would most like to retain after the pandemic subsides. ConclusionsUnderstanding the experiences of staff working across different settings in mental healthcare for people with intellectual and developmental disabilities during the COVID-19 pandemic is essential in guiding contingency planning and fostering service developments to ensure the health of this vulnerable group is protected in any future disease outbreaks.

Mental health services in the UK are increasingly pressured with long waiting times. Meanwhile, online forums for mental health, set up by charities, NHS services, and individual volunteers, have increased in popularity. Little is known, however, about who is using them and why. This study aimed to investigate this, using multiple methods to capture different types of users. A mixed-methods approach was used, with participants recruited from seven UK-based mental health forums. 791 forum users participated in a survey which was compared to the demographics of people accessing NHS Talking Therapies. 20 forum users took part in interviews, which were thematically analysed for reasons for use. Finally, the top keywords in the forum posts (a corpus of 28 million words) were calculated using the log likelihood test of statistical significance. One keyword was identified consistently across the forums, so its collocation profile was analysed. Surveys showed the forums were predominantly used by white, female, and younger people, though there was greater ethnic diversity and a higher proportion of non-binary people compared to NHS Talking Therapies. Thematic analysis of interviews indicated that people used forums because they are easily accessible, making it possible to overcome barriers to in-person support, such as the need to speak. Participants sought emotional support, advice, and connection with others experiencing similar challenges. The linguistic analysis showed "scared" was a common keyword across the forums, with common collocations being Im scared because and scared of. Reviewing the posts showed users tended to share fears over mental health symptoms and identity. Online forums serve as important alternative and complementary sources of mental health support, particularly for people who face discrimination or logistical barriers in accessing traditional services. These forums provide accessible, anonymous spaces for peer support, helping users to share fears and connect with others in similar situations.

BackgroundA family history of mental illness, particularly parental depression, is a risk factor for mental health difficulties in young people, with this heightened risk extending into adulthood. Evidence suggests low rates of formal mental health support in children/adolescents with depressed parents, but it is unknown whether this pattern persists into adulthood and applies to informal support. AimsWe examined the prevalence of formal and informal mental health support accessed by young adults with recurrently depressed parents. We identified factors associated with access to different support, reported satisfaction with support and identified potential facilitators/barriers to access. MethodsA mixed-method study comprising 144 young adults (mean age=23 years, range=18-28 years) who completed psychiatric assessments and reported on their use of mental health support. Regression analyses explored predictors for support. A focus group examined facilitators and barriers. ResultsYoung adults accessed a range of formal (29%) and informal (56%) support. Among those with psychiatric disorder, nearly half had not accessed formal support and one-fifth had not accessed any support. Predictors of support included psychiatric disorder, severity indicators (e.g. self-harm/suicidal thoughts, impairment), and demographic factors (e.g. education, gender). Predictors varied by type of support. Most participants reported satisfaction with support. Facilitators included role models, public mental health discussions, and practitioner training. Barriers included identifying difficulties, stigma, service limitations, and family/friends experiences. ConclusionsYoung adults at high risk of mental disorders accessed various mental health support. However, many did not access/receive support when needed. Further work is required to improve access to tailored support.

Despite increasing policy focus on mental health provision for higher education students, it is unclear whether they have worse mental health outcomes than their non-student peers. In a nationally-representative UK study spanning 2010-2019 (N=11,519), 17-24 year olds who attended higher education had lower average psychological distress (GHQ score difference=-0.37, 95%CI: -0.60, -0.08) and lower odds of case-level distress than those who did not (OR=0.91, 95%CI: 0.81, 1.02). Increases in distress between 2010 and 2019 were similar in both groups. Accessible mental health support outside higher education settings is necessary to prevent further widening of socioeconomic inequalities in mental health.

The implementation of Electronic Health Records (EHRs) in mental health contexts has been slow. Reasons for this include concerns from health care professionals regarding the collection of sensitive information and the stigma associated with mental health services. Despite the low uptake of EHRs, the benefits include patients feeling empowered and in control of their own treatment. However, minority ethnic groups often access mental health services through crisis pathways and have been found to disengage with EHRs. The aim of this review was to explore minority ethnic groups perceptions of the utility of mental health EHRs and establish perceived barriers and facilitators to access. MEDLINE, CINAHL, EMBASE, Scopus, PsycINFO, PubMed and Web of Science were searched. Included papers mentioned minority ethnic groups from the 37 listed countries on the Organisation for Economic Co-operation and Development, and included service users, clients or patients accessing EHRs in mental healthcare settings. Papers were required to be published between 2009 - 2025. Eight papers met all criteria for inclusion, and three themes emerged: Limited English proficiency as a barrier, Lack of access to technology and Perceived impact of EHRs on access to care. Barriers to access EHRs with limited English proficiency, no access to technology, and stigma was a significant issue for minority ethnic groups due to concerns of who has access to the electronic health data. Benefits of accessing EHRs included easier and efficient access to records. EHRs are critical for modern health systems and further work is required to improve EHRs usage in mental health systems for minority ethnic groups.