Consensus on Culturally Competent Mental Health Services Recommendations: A Modified Delphi Consensus Study With...

People from ethnic minorities in the UK face barriers to appropriate mental health care, including cultural stigma, language barriers and discriminatory practices. Culturally competent mental health services are proposed as a way to reduce these disparities, but implementation is limited.

To establish consensus among ethnic minorities, carers, public advisors and health professionals on core components of culturally competent mental health services.

A three-stage Delphi process was conducted: two survey rounds followed by an online consensus workshop. Participants rated the importance of statements on a 9-point Likert scale covering lived experience, systemic challenges, cultural sensitivity and community-based support. Consensus was prespecified as ≥ 70% participants rating an item as important (scores of 7-9). Free-text responses in Round 1 and workshop discussions informed wording and grouping of recommendations.

Sixty-six took part in this study, including 34 service users, 3 carers, 3 public members and 26 professionals. Forty-seven items reached consensus across four sections: lived experience of isolation and stigma living with mental health, systemic challenges for people from ethnic minorities seeking health services support, improving cultural sensitivity and support in services, and community-based support. These were interpreted through four overarching themes in the workshop co-production: understanding mental health in cultural context, raising awareness through community engagement, equipping interpreters and health professionals for inclusive mental health support, and driving systemic change towards collaboration, cultural sensitivity, and continuity of mental health care.

This study co-developed 46 recommendations that can be used as a checklist to support the development, design and delivery of culturally competent mental health services. The findings suggest that improving cultural competence will need system-level and community-informed changes, including stronger peer support, mental health education, advocacy and co-production. The recommendations can guide commissioners and providers when reviewing service pathways and planning improvement work and offer a starting point for piloting and validating a practical checklist for routine use.

A project advisory group of four patient representatives and three team members met six times, reviewed and piloted survey materials, advised on recruitment, and contributed to analysis and final recommendations.