Staff perceptions of patient inequalities in a UK secure mental healthcare setting

• Date: 24 April 2023
• Pages: 1051-1068
• DOI: https://doi.org/10.1108/EDI-04-2022-0095
• Published date: 24 April 2023
• Author: Elizabeth Bayo-Idowu,Sarrah Fatima,Kristina Brenisin,Aile Trumm,Paul Wallang,Kieran Breen

Staff perceptions of patient

inequalities in a UK secure mental

healthcare setting

Elizabeth Bayo-Idowu, Sarrah Fatima, Kristina Brenisin and

Aile Trumm

St Andrew’s Healthcare Northampton, Northampton, UK

Paul Wallang

Department of Languages and Psychology, University College London,

London, UK and

Faculty of Arts, Science and Technology, University of Northampton,

Northampton, UK, and

Kieran Breen

St Andrew’s Healthcare Northampton, Northampton, UK

Abstract

Purpose –Inequalities can have a cumulative effect that leads to the presentation and subsequent progression

of mental health difficulties. The detrimental effects can be compounded in the healthcare environment if staff

lack an awareness of patients’’ inequalities, and therefore, educating staff is of particular importance.

The development of awareness training requires a deep understanding of staff perceptions of patient

inequalities in a secure mental health care setting and the impact that this can have on mental illness.

Design/methodology/approach –The study was carried out using a qualitative design, where staff were

asked to complete a 22-question survey from which the output is analysed using thematic analysis. In total,

100 patient-facing staff members working in a secure mental health facility completed the survey.

Findings –The results highlight that staff employed in a secure mental health care setting have an

understanding of patient inequalities and how these can impact on patients in both the short and longer terms.

The results highlighted the importance of awareness by staff and how an increase can have a significant

benefit on the quality of the care provided within secure mental health facilities.

Originality/value –There is an increasing awareness of the impact of inequalities on mental health and how

this can influence a patient’s journey. This study involving staff employed in a secure care mental health

facility highlights the role of staff awareness of inequalities and also underlines the importance of

understanding the key role of staff awareness in mental ill health.

Keywords Inequality, Forensic, Medium secure, Mental health

Paper type Research paper

Introduction

Mental health difficulties can arise from various factors. Whilst some conditions have a genetic-

associated component which predispose people to such challenges, socioeconomic factors or

inequalities can also influence their development (Macintyre et al.,2018). The word “inequality”

is generally associated with social and economic problems and suggests a departure from some

idea of fairness pertaining to status, rights and opportunities (Afonso et al.,2015). Despite a

strong political link, there is also a connection between inequality, health and ultimately

healthcare provision (Siegrist and Marmot, 2004). Such inequalities in health can arise due to the

circumstances in which people live and work in addition to the services available locally to

Staff

perceptions of

patient

inequalities

1051

The authors are very grateful to NHS England for funding this important evaluation as part of the

national Women’s Secure Blended Service pilot programme.

The current issue and full text archive of this journal is available on Emerald Insight at:

https://www.emerald.com/insight/2040-7149.htm

Received 25 April 2022

Revised 30 September 2022

16 January 2023

21 March 2023

Accepted 23 March 2023

Equality, Diversity and Inclusion:

An International Journal

Vol. 42 No. 8, 2023

pp. 1051-1068

© Emerald Publishing Limited

2040-7149

DOI 10.1108/EDI-04-2022-0095

manage illness (Mackenbach, 2012). Examples of inequalities include inherent characteristics

such as gender, race, sexual orientation, disability, age and religion as well as environmental

factors such as unemployment, poverty, level of education, support and social class as well as

experience of abuse (Richter and Dragano, 2018). The presence of such inequalities can also act

as a foundation from which future inequality may occur from The repercussions from such

inequalities have implications for the health of the population and may contribute to the rise in

both physical ill health and mental health difficulties. Furthermore, the presence of inequality

can have unequal impact upon different groups that can largely worsen the disadvantages of

those already less advantaged. This can result in the development of a marginalised status

which can impede subsequent support access (Bobo et al., 2021).

Inherent characteristics such as age, gender and/or ethnicity etc. may not guarantee the

presence of inequalities, but may facilitate its presence. Further, the presence of a

disadvantage such as low socioeconomic status can give rise to further inequality through the

presence of job insecurity, poor consequent living environment and thus a reduced quality of

daily life. This low socioeconomic status can arise from social stratification which sees those

already marginalised at an even more disadvantaged position due to a lack of opportunity

and resource (McLeod, 2015). Moreover, characteristics such as race, age and/or gender can

further limit opportunity and present as a basis for discrimination, from which inequality can

arise. The role of an individuals’social environment facilitating inequality highlights the

importance of overall awareness of what inequalities are and how they may be compounded

upon. Further, the role of racial disadvantage has a substantial foundation from which

further inequalities can occur. Anglin et al. (2021) identified racial inequality as a key societal

structure from which further discrimination and inequality may occur and can be present

within education systems, workplaces andmostrelevantlyinthecurrentstudy,

the healthcare sector (Dar et al., 2021;Ozturk and Berber, 2022;Thornicroft et al., 2022).

In the UK, like other countries, there is an expected overall yearly improvement in the health

of the population (Stephenson et al.,2019)as health is considered as an indicative measure of the

country’s overall social and economic progress (Meurs et al., 2019).Itissuggestedthatwhena

society is flourishing, the health of the population tend s to improve in parallel. However, when

society is met with significant socioeconomic inequalities, this effect is mirrored in the level and

quality of healthcare provision (Catalano et al., 2011;Bloom et al., 2018). The Marmot report

suggests that the cost of treating illness and disease arising from health inequalities in England

has been estimated at £5.5bn (Marmot, 2020). In 2010, the Government was concerned that the

health inequalities in England were too wide and action was required (Marmot, 2020). This

highlights the importance of educating healthcare staff, improving service access and thus

reducing thenegative impact of patient inequalities following admission into in-patient care.

When such inequalities occur, there can be far-reaching domino-like effects, especially on

an individual’s mental health. Financial strains and economic disadvantages have been cited

as key inequalities contributing to poor mental health (Dijkstra-Kersten et al., 2015;Silva et al.,

2016). These can trigger the onset of disorders including anxiety and depression as well as

more severe psychiatric conditions such as schizophrenia (Burns et al., 2014). A loss of income

can reduce standard of living and associated quality of life which in turn will impact on their

mental health status (Hisw



als et al., 2017). The loss of employment can influence social

identities, reduce social network and purpose, whilst raising stress and income insecurity

(van Eersel et al., 2019). This highlights the intersectional nature of inequalities (Men

endez-

Espina et al., 2020;Maxwell et al., 2019).

Racial discrimination is another key inequality that can exist throughout an individual’s life.

Individuals may become vulnerable to factors associated with racial inequalities such as

bullying (Roberts et al.,2020;Peguero, 2012) Whilst this has been traditionally been associated

with childhood, it is now commonplace within the workplace where it has the potential to trigger

the onset ofmental health difficulties (Brenisin et al.,2021). Relevantly, studies have suggested

EDI

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