Reducing ethnic inequalities in experiences and outcomes of mental illness: A realist informed national programme evaluation

Black and minority ethnic communities are more likely to receive coercive mental health care, and involuntary admissions via crisis and criminal justice agencies. Lived experience informed interventions may be better able to address structural determinants, overcome resistance, and motivate innovations. The Synergia Collaborative Centre (SCC) sought to drive systems reform through insights from lived experience data, evidence syntheses, co-design and creative communications.We report a qualitative study of the SCC, applying a realist-informed secondary analysis method to interview data from an independent evaluation. Twenty-four stakeholders’ transcripts were analysed alongside minutes of operational and advisory board meetings and project documents to discern how SCC was received by different stakeholders and how and whether it operated. Context-Mechanism-Outcome (CMO) configurations were generated drawing on ecological systems theory to enhance understanding of context, therefore, the findings were organised by eco-social levels. The programme successfully built confidence and leadership capacity, centring on lived experience, co-design and embedding local evidence-based actions through creative communications to motivate and engage partners. Power imbalances between established experts and new leaders risked disengagement of both; pessimism was born of historical failures of similar programmes and a lack of sustained resources; promoting policy makers and professional participants in the change process, alongside local community stakeholders were proposed for future traction. We distil facilitators and barriers to progressive change in community, health, and social systems as observed by stakeholders and as reported in their interviews as part of an evaluation of SCC.This research generated a refined programme theory exploring how the programme worked, to inform and generate recommendations for future programmes. We discuss strengths and limitations of using realist-informed secondary analysis methods for post-hoc assessment of complex programmes.