The impact of inequality on mental illness: thematic analysis on clinical notes

Purpose
The concept of inequality can be described as not being treated equally to everyone else in society. While previous studies have explored the concept of inequality and its impact on mental illness, these have been primarily quantitative. The details of experiences and potential impacts of inequalities by patients prior to admission into secure care have not been investigated comprehensively using a qualitative approach, which will identify individualised factors that may contribute to the development of mental ill-health. This study aims to explore whether those with multiple disadvantages are at greater risk of developing mental illness.

Design/methodology/approach
A qualitative study of patients’ clinical notes upon admission to a secure in-patient facility was conducted using a thematic analytical approach to investigate the key inequalities reported by patients with mental health problems. The topic of inequality was examined by assessing the clinical notes of 21 patients who were under treatment at the time of the study.

Findings
The majority of patients experienced multiple inequalities which impacted negatively on their mental health status. Three main themes that were identified were – a disrupted living environment, disturbed childhood and the importance of support. The thematic analysis has shown that the majority of the patients were exposed to numerous societal disadvantages in association with challenging life events in their early years and these have impacted significantly on their subsequent well-being.

Practical implications
When assessing the background to mental illness, it is important to gain a deep understanding of many inequalities that patients have faced prior to them developing their condition and, in particular, how these have combined to initiate the clinical manifestation. The study highlights the importance of raising awareness of how being treated unfairly, whether based on protected or non-protected characteristics, can contribute towards people becoming disadvantaged in society and ultimately making them more vulnerable to the development of mental health difficulties. Results of the study may inform the future use of inequalities as an integral component in the development of trauma-informed care.

Originality/value
This is the first study, to the authors’ knowledge, to consider intersectionality and admission to mental health units by adopting qualitative approach, specifically by reviewing patients’ clinical notes.