An exploration of factors contributing to ethnic disparities in compulsory detention with a focus on Black women's experiences

In the UK, there are ethnic disparities in the rate of compulsory detention, with Black people being more likely than White British people to be detained against their will. Part I of this thesis explores the reasons underlying the disparities and proposes a new model to explain the underlying causes. The new model considers the contexts in which the Black person being assessed under the mental health act and the healthcare professionals conducting the assessment are situated. It also outlines mechanisms and inter- and intra-personal processes that interact to influence how both parties behave and make decisions during the sectioning process. Part II of the thesis is comprised of an empirical paper exploring four Black women’s experiences of the decision being made for them to be compulsorily detained and the factors that they believe influenced that decision. Interpretative phenomenological analysis (IPA) was used to explore how the women made sense of their experiences. Results demonstrated that the women found the experience of being detained to be distressing and that meaningful relationships helped them to manage. Where care provision did not feel sufficient, they acknowledged the under-resourced nature of the healthcare system. The women believed that their behaviour and mental health needs were primary reasons for the decision being made to compulsorily detain them. Part III of the thesis provides a critical appraisal of the research process, with a particular focus on how the researcher’s identity influenced and interacted with the research topic

Clinical outcomes and neural correlates of 20 sessions of repetitive transcranial magnetic stimulation in severe and enduring anorexia nervosa (the TIARA study): study protocol for a randomised controlled feasibility trial

BACKGROUND: Anorexia nervosa (AN) is a serious mental disorder with multiple comorbidities and complications. In those with a severe and enduring form of the illness (SEED-AN), treatment responsivity is poor and the evidence base limited. Thus, there is a need for novel treatment strategies. This paper describes the theoretical background and protocol of a feasibility randomised controlled trial (RCT) of real versus sham (placebo) therapeutic repetitive transcranial magnetic stimulation (rTMS) in SEED-AN. The aim of this trial is to obtain information that will guide decision making and protocol development in relation to a future large-scale RCT of rTMS in this group of patients, and also to assess the preliminary efficacy and neural correlates of rTMS treatment. DESIGN: Forty-four adults from the community with a DSM-5 diagnosis of AN, an illness duration >3 years and a previous course of unsuccessful treatment will be randomly allocated to receive 20 sessions of either real or sham rTMS, in a parallel group design. As this is a feasibility study, no primary outcome has been defined and a broad range of outcome variables will be examined. These include weight/body mass index (BMI), eating disorder psychopathology, other psychopathology (for example, depression, anxiety), quality of life, neuropsychological processes (such as self-regulation, attentional bias and food choice behaviour), neuroimaging measures (that is, changes in brain structure or function), tolerability and acceptability of rTMS, and additional service utilisation. The feasibility of conducting a large-scale RCT of rTMS and the appropriateness of rTMS as a treatment for SEED-AN will be evaluated through: assessment of recruitment and retention rates, acceptability of random allocation, blinding success (allocation concealment), completion of treatment sessions and research assessments (baseline, post-treatment and follow-up assessments). The acceptability and tolerability of the treatment will be assessed via semi-structured interviews. DISCUSSION: The effect sizes generated and other findings from this trial will inform a future large-scale RCT with respect to decisions on primary outcome measures and other aspects of protocol development. Additionally, results from this study will provide a preliminary indication of the efficacy of rTMS treatment for AN, the neural correlates of the illness, and potential biomarkers of clinical response. TRIAL REGISTRATION: ISRCTN14329415. Date of registration: 23 July 2015. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13063-015-1069-3) contains supplementary material, which is available to authorized users

Additional file 1: of Clinical outcomes and neural correlates of 20 sessions of repetitive transcranial magnetic stimulation in severe and enduring anorexia nervosa (the TIARA study): study protocol for a randomised controlled feasibility trial

TIARA study schedule of enrolment, interventions and assessments. This table presents the time schedule of enrolment, interventions and assessments, consistent with the figure provided in the SPIRIT Statement (2013) recommendations for reporting protocols. (DOCX 20 kb