ReACH / Completed studies

Completed studies

Culturally-adapted Family Intervention (CaFI) for African and Caribbean People

ISRCTN Trial Registration: 12622538
Funder: National Institute for Health Research (NIHR), Health Technology Assessment (HTA) programme (Ref: 16/167/76)

Background

In the UK, people of Sub-Saharan African and Caribbean origin are more likely to be diagnosed with schizophrenia and psychosis than people from other ethnic groups. Black and Mixed heritage people also experience inferior care, including lack of access to psychological therapies and culturally informed treatment.

Culturally-adapted Family Intervention (‘CaFI’ for short) was developed to address these longstanding inequalities in psychosis care experienced by Black and Mixed heritage people. Although Family Intervention (FI) is recommended for psychosis by the National Institute for Health and Care Excellence (NICE), it is not always provided by NHS Mental Health Trusts and is rarely offered to Black and Mixed heritage families. FI and other talking treatments are not usually culturally appropriate, and NHS therapists receive little or no training in how to work in culturally sensitive ways.

This study explored whether CaFI could improve psychosis symptoms and people’s ability to function in comparison to the care they usually receive. We also wanted to find out what would increase CaFI’s chances of being taken up by NHS services and the things that make it less likely to become part of usual care. The research was conducted in the Northwest, Midlands, London, and South of England. The study was due to last 54 months but closed early.

Findings

The study closed early due to lack of funding. As we did not have enough people completing the research, we cannot say for certain that CaFI is any better than usual care.

However, our findings shows that people who received the CaFI therapy were less likely (27%) to relapse (become unwell again) than those who received usual care during the 12-month follow-up. Patients, carers, and family members were positive about CaFI. For instance, they said that CaFI created ‘safe spaces’ to talk about the negative effects of racism and discrimination on mental health. People also valued the opportunity to talk about faith and spirituality.

This is important because these things are rarely discussed in the NHS. Having their culture reflected in CaFI therapy materials was particularly welcome. People liked the colourful images of people who looked like them. The quality and clarity of images that reflected the diversity within Black communities was also praised.

After taking part in CaFI, two-thirds of the therapists (66%) felt more able to deal with issues of race and culture and more than half (53%) recognised that they needed further support.

Overall, findings from this and our previous study suggest that patients, families, carers, and healthcare professionals see the need for culturally informed psychological care. However, further research with bigger numbers and hearing from people about their experiences is needed to improve psychosis care for people of Sub-Saharan African and Caribbean backgrounds.

More information can be found on the CaFI website.

Selected publications

  • Keena, A., Edge, D., Morley, H., & Berry, K. (2025). Mental health beliefs and help-seeking in an African descended sample with experiences of psychosis. Journal of Mental Health, 1–8. (Published online) https://doi.org/10.1080/09638237.2025.2460115
  • Degnan, A., Berry, K., Crossley, N. & Edge, D., (2023). Social network characteristics of Black African and Caribbean people with psychosis in the UK. Journal of Psychiatric Research. 161: 62-70 https://doi.org/10.1016/j.jpsychires.2023.03.006
  • Bard, S., Degnan, A., Berry, K. & Edge, D. (2021). Exploring the relationships between illness beliefs and psychosis symptoms among Black African and Caribbean people with non-affective psychosis. Psychosis: Psychological, Social and Integrative Approaches. 13(3), 265-275. https://doi.org/10.1080/17522439.2020.1856173
  • Jensen, E., Rosie, C., Degnan, A., Berry, K. & Edge, D. (2021). Exploring service user and family perspectives of a Culturally-adapted Family Intervention (CaFI) for African-Caribbean people with psychosis: A qualitative study. British Journal of Clinical Psychology, 60(2):270-289. https://doi.org/10.1111/bjc.12273
  • Marsden, M., Nigam, J., Lemetyinen, H., & Edge, D. (2020). Investigating police officers’ perceptions of their role in pathways to mental healthcare. Health & Social Care in the Community, 28(3), 913-921. https://doi.org/10.1111/hsc.12922
  • Degnan, A., Berry, K., James, S., & Edge, D. (2018). Development, validation and cultural-adaptation of the knowledge about psychosis questionnaire for African-Caribbean people in the UK. Psychiatry Research, 263, 199-206. https://doi.org/10.1016/j.psychres.2018.03.013
  • Amos, R., Morris, L., Mansell, W., Edge, D. (2018) Clients’ experiences of one-to-one low intensity interventions for common mental health problems: An Interpretative Phenomenological Analysis. Psychology and Psychotherapy: Theory, Research and Practice. https://doi.org/10.1111/papt.12200
  • Lemetyinen, H., Onwumere, J., Drake, R., Abel, K.M, Haigh, C., Moulton, G., & Edge, D. (2018). Co-production and Evaluation of an E-learning Resource to Improve African-Caribbean Families’ Knowledge about Schizophrenia and Engagement with Services: A Pilot Randomised Controlled Trial Protocol. Pilot and Feasibility Studies, 4, 174. https://doi.org/10.1186/s40814-018-0368-3
  • Berry, K., Degnan, A., Seed, T., Mulligan, L., Day, C., Edge, D. (2018) Culturally-adapted Family Intervention (CaFI): Case examples from therapists’ perspectives. The Cognitive Behaviour Therapist, e13.https://doi.org/10.1017/S1754470X18000156
  • Degnan, A., Berry, K., Sweet, D., Abel, KM., Crossley, N., Edge, D. (2018). Social networks and symptomatic and functional outcomes in schizophrenia: A systematic review and meta-analysis. Social Psychiatry and Psychiatric Epidemiology, 53(9), 873-888. https://doi.org/10.1007/s00127-018-1552-8
  • Shattock, L., Berry, K., Degnan, A., Edge, D. (2018). Therapeutic alliance in psychological therapy for people with schizophrenia and related psychoses: a systematic review. Clinical Psychology & Psychotherapy, 25(1), e60-e85. https://doi.org/10.1002/cpp.2135
  • Degnan, A., Baker, S., Edge, D., Nottidge, W., Noke, M., Press, C. J., Husain, N., Rathod, S., & Drake, R. J. (2018). The nature and efficacy of culturally-adapted psychosocial interventions for schizophrenia: a systematic review and meta-analysis. Psychological Medicine, 48(5), 714-727. https://doi.org/10.1017/S0033291717002264

Contact

Dawn Edge
Email: dawn.edge@manchester.ac.uk

Culturally-appropriate Schizophrenia Psychological Education Resource (CaSPER)

The study team and families of African and Caribbean origin worked together to develop and test an online resource about schizophrenia. This study closed in August 2018.

CaFI feasibility study

The study team developed and tested effectiveness of a family intervention therapy to meet the needs of Black Caribbean people (diagnosed with schizophrenia) and their families. This study closed in August 2018.

Student projects

Gardner, P., Bunton, P., Edge, D., & Wittkowski, A. (2014). The experience of postnatal depression in West African mothers living in the United Kingdom: A qualitative study. Midwifery, 30(6), 756-576.

The University of Manchester