Institutional injustice: Implications for system transformation emerging from the mental health recovery narratives of people experiencing marginalisation

Hui, Ada; Rennick-Egglestone, Stefan; Franklin, Donna; Walcott, Rianna; Llewellyn-Beardsley, Joy; Ng, Fiona; Roe, James; Yeo, Caroline; Deakin, Emilia; Brydges, Sarah; Penas Moran, Patricia; McGranahan, Rose; Pollock, Kristian; Thornicroft, Graham; Slade, Mike

Abstract

Background:
Institutional injustice refers to structures that create disparities in resources, opportunities and representation. Marginalised people experience institutional injustice, inequalities and discrimination through intersecting personal characteristics and social circumstances. This study aimed to investigate sources of institutional injustice and their effects on marginalised people with experience of mental health problems.

Methods:
Semi-structured interviews were conducted with 77 individuals from marginalised groups with experience of mental health problems, including psychosis, Black, Asian and minority ethnic (BAME) populations, complex needs and lived experience as a work requirement. These were analysed inductively enabling sensitising concepts to emerge.

Findings:
Three processes of institutional injustice were identified: not being believed because of social status and personal backgrounds; not being heard where narratives did not align with dominant discourses, and not being acknowledged where aspects of identity were disregarded. Harmful outcomes included disengagement from formal institutions through fear and mistrust, tensions and reduced affiliation with informal institutions when trying to consolidate new ways of being, and damaging impacts on mental health and wellbeing through multiple oppression.

Conclusions:
Institutional injustice perpetuates health inequalities and marginalised status. Master status, arising from dominant discourses and heuristic bias, overshadow the narratives and experiences of marginalised people. Cultural competency has the potential to improve heuristic availability through social understandings of narrative and experience, whilst coproduction and narrative development through approaches such as communities of practice might offer meaningful avenues for authentic expression.

Citation

Hui, A., Rennick-Egglestone, S., Franklin, D., Walcott, R., Llewellyn-Beardsley, J., Ng, F., Roe, J., Yeo, C., Deakin, E., Brydges, S., Penas Moran, P., McGranahan, R., Pollock, K., Thornicroft, G., & Slade, M. (2021). Institutional injustice: Implications for system transformation emerging from the mental health recovery narratives of people experiencing marginalisation. PLoS ONE, 16(4), Article e0250367. https://doi.org/10.1371/journal.pone.0250367

• Journal Article Type: Article
• Acceptance Date: Apr 6, 2021
• Online Publication Date: Apr 16, 2021
• Publication Date: Apr 16, 2021
• Deposit Date: Apr 13, 2021
• Publicly Available Date: Apr 16, 2021
• Journal: PLoS ONE
• Electronic ISSN: 1932-6203
• Publisher: Public Library of Science
• Peer Reviewed: Peer Reviewed
• Volume: 16
• Issue: 4
• Article Number: e0250367
• DOI: https://doi.org/10.1371/journal.pone.0250367
• Keywords: General Biochemistry, Genetics and Molecular Biology; General Agricultural and Biological Sciences; General Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/5463523
• Publisher URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0250367