Flipping between cultural worlds: a qualitative exploration of stigma experiences of British Asian people using an Early Intervention in Psychosis Service.

Background Addressing stigma is a government priority in the United Kingdom (U.K.). It is recognised that people with a psychosis diagnosis experience higher levels of stigma compared to any other mental health diagnosis. Therefore their experiences of stigma are more likely to have detrimental personal consequences. Mental health stigma is also a pervasive issue within South Asian communities. It was recently found that second-generation minority groups are at increased risk of developing psychosis. Moreover, there is currently an under-representation of South-Asian people using mental health services in the UK. However, to date there are no qualitative studies specifically examining the experiences of stigma from the perspective of second-generation British-Asian people (those born in the U.K. rather than migrants to the U.K.) experiencing psychosis. Aim The current study aimed to explore the stigma experiences of second-generation British-Asian people using Early Intervention in Psychosis (EIP) services. Method The present study took a critical realist ontological position and a contextualist epistemological position. A qualitative research methodology was employed and semi-structured interviews were conducted with a total of 10 participants. Thematic Analysis was used to interpret findings. Recruitment took place in EIP services in an urban and diverse area using purposive sampling. Findings Four themes and twelve sub-themes were constructed. The main themes included ‘the burden of silencing’, ‘the un-noticed aspects’, ‘experience as the other’ and ‘finding ways to cope and thrive’. Themes incorporated forms of internalised and public stigma. They describe how participants felt distressed and silenced by stigma. Themes also explored dual identities and how participants’ straddled eastern and western frameworks of understanding. Additionally participants outlined ways in which EIP services had not noticed these aspects of them. Themes also captured ‘othering’ experiences faced by participants like discrimination and islamophobia which led to isolation and exclusion. The importance of supportive relationships and social inclusion was also described within the findings. Discussion This study was able to explore second-generation British-Asian peoples’ experience of stigma. Findings were discussed and linked to theory and previous research. Multiple intersecting stigmas were overarching across the findings. The current study adds novel insights about an under-researched population who have experienced historic and present-day stigmatisation and marginalisation in society. Strengths and limitations, dissemination and the researchers’ reflections are presented. Implications for clinical practice and future research are discussed based on specific study findings.