A digital therapy for persecutory delusions is getting a redesign to better serve Black and Bangladeshi communities, who face higher rates of psychosis but lower access to effective care. The problem is stark: rates of psychosis are markedly higher in Black and other ethnic minority groups, yet these groups do not enjoy equality of care. Feeling Safer, a guided online programme based on the most effective psychological therapy for persecutory delusions in psychosis, was designed with inclusivity in mind, but the researchers recognise they can and should do more. The current version features animations of thirteen people with lived experience and a single voiceover—a young White woman from southeast England. This project will produce fifteen new animations based on interviews with ten people from Bangladeshi, Black African, and Black Caribbean communities, and add three new voiceover options from women and men in those communities. It will also conduct an inclusiveness review with a diverse group of people with lived experience, improve the "bad day" crisis section by making it interactive with voiceovers, and run a qualitative study on user experiences with inclusivity as a key topic. If successful, the therapy will become more accessible and relevant to the communities that need it most, directly addressing a long-standing inequality in mental healthcare.
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Development work question Can we improve the inclusiveness of Feeling Safer, our pioneering digital treatment for people with persecutory delusions? Background Persecutory delusions are among the most severe mental health problems. Feeling Safer is a guided online program designed to help users return to everyday activities. It is based on our Feeling Safe programme, the most effective psychological therapy for patients experiencing these difficulties in the context of a diagnosis of psychosis. Feeling Safer is being tested in a case series, with a large randomised controlled trial to follow. Rates of psychosis are markedly higher in Black and other ethnic minority groups, but these groups do not enjoy equality of care. Inclusiveness has therefore been a design priority for Feeling Safer. However, we recognise that with additional resources we can and should do more. We wish now to develop this work to enhance its offer with respect to issues of EDI, in keeping with the NIHR s elevation of inclusion to one of its five key operating principles. The proposed work focuses on increasing the relevance of Feeling Safer to the Bangladeshi, Black African, and Black Caribbean communities. Aims and objectives 1. Increase the diversity of people with lived experience featured in Feeling Safer s animations. These animations present the voices and accounts of thirteen people with experience of persecutory delusions. We aim to produce another fifteen animations, based on interviews with ten people from our target communities. 2. Increase voiceover options. Feeling Safer includes voiceover functionality so that users can optionally hear the words on the screen being read out. The current version includes the voice of a young White woman from southeast England. We aim to add another three voices, including women and men from our target communities. 3. With a diverse group of people with lived experience, conduct an inclusiveness review of Feeling Safer. 4. Improve the usability of the "bad day" section. This section presents information on who to contact in times of crisis and lists suggestions from people with lived experience of activities that may help. We aim to add voiceovers and make the section interactive. 5. Conduct a qualitative study of users experiences with Feeling Safer, with inclusiveness as a key topic. Development work plan As well as seeking advice from our Patient Advisory Group, the work will be informed by several workshops with people from our target communities. We will also consult via email and/or phone/video calls. Orinoco Communications will develop the animations. Software changes will be made by our development partners, System C. Timelines for delivery 0-12 months for objectives 1-4. The qualitative study is already planned, with ethical approval in place, as part of the main programme grant. The currently proposed work will mean that inclusion will be an even greater focus of the study. Anticipated impact and dissemination These additions will significantly enhance inclusion, making Feeling Safer more accessible and relevant to people from the target communities. The project also represents a broadening of diversity, access, and participation in healthcare research.
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