BLACK-ARTS: a qualitative study exploring the insights of black young people with psychiatric disorders and the uses of creative arts therapies to improve mental well-being.

Abstract

Background: Black people experience persistent inequalities in mental health outcomes, access and care quality compared with their white counterparts. These disparities are compounded by structural racism and a lack of culturally competent care within National Health Service (NHS) services. Creative arts therapies (CATs), including music, art, dance and drama therapy, may offer culturally relevant, non-verbal approaches to mental health support for this population.

Objective: To explore how black young people with mental health challenges and NHS clinicians perceive the usefulness and cultural relevance of CATs and to examine their potential as culturally competent interventions for improving mental well-being.

Methods: A qualitative, multicentre study was conducted across five NHS Trusts in England. 20 black service users (aged 16-24) and 15 clinicians participated in 10 online focus groups (45-60 min each). Transcripts were analysed thematically using Braun and Clarke's six-step thematic analysis method constructed with NVivo V.12 software. Coding was led by the first author, with regular discussions with a second researcher to refine interpretations and develop themes.

Findings: Five overarching themes were identified: (1) creative arts as vehicles for emotional healing, identity and agency, (2) challenges and barriers to CAT implementation, (3) disconnection and mistrust within clinical encounters, (4) discovering therapeutic potential through creative experience and (5) creative expression as a bridge between culture and care. Participants viewed CATs as emotionally regulating, accessible and aligned with black cultural identity though limited by underfunding, stigma and insufficient cultural competence within the NHS.

Conclusions: CATs may provide a culturally congruent and emotionally accessible approach to mental healthcare for black youth. Embedding culturally competent, creative modalities within NHS pathways could enhance engagement, trust and equity in service outcomes.

Clinical implications: CATs should be integrated early in NHS pathways (eg, Child and Adolescent Mental Health Services, Talking Therapies) to improve engagement among black youth who may be hesitant to engage in verbally dominant therapies. However, scaled implementation requires meaningful coproduction with black communities, cultural competence training for multidisciplinary teams and recognition within NHS and National Institute for Health and Care Excellence frameworks.