Skip to main content Accessibility help

Rehabilitation and recovery for ethnic minority patients with severe mental illness

  • Martin Rotenberg (a1)

There is growing evidence to support recovery and rehabilitation services and interventions for people with severe mental illness (SMI). However, those from ethnic minority communities face inequitable outcomes and access to mental health services and poorer functional outcomes. This article reviews the evidence and discusses facilitators and barriers in the recovery journey of people with SMI from ethnic minority groups. Although there is limited evidence for specific interventions for ethnic minority patients, areas for future study and action are discussed.


After reading this article you will be able to:

  • understand the scope of rehabilitation practices and interventions and evidence for use with ethnic minority patients with severe mental illness
  • describe differences and similarities in the conceptualisation of recovery by majority and minority ethnic communities
  • appreciate facilitators and barriers to rehabilitation and recovery for ethnic minority patients with SMI.



Corresponding author
Correspondence Dr Martin Rotenberg, Centre for Addiction and Mental Health, 33 Russell Street, Room 2017, Toronto, Ontario M5S 3B1, Canada. Email:
Hide All

A version of this article was presented at the annual meeting of the Royal College of Psychiatrists' Faculty of Rehabilitation and Social Psychiatry in Bournemouth, November 2017, and received the Douglas Bennett Prize.

Hide All
Agius, M, Shah, S, Ramkisson, R, et al. (2008) Three year outcomes in an early intervention service for psychosis in a multicultural and multiethnic population. Psychiatr Danub, 20: 494–9.
Ali, MK, Hack, SM, Brown, CH, et al. (2017) Racial differences in mental health recovery among veterans with serious mental illness. J Racial Ethn Health Disparities, 5: 235–42.
Anderson, KK, Cheng, J, Susser, E, et al. (2015) Incidence of psychotic disorders among first-generation immigrants and refugees in Ontario. CMAJ, 187: E279–86.
Bernal, G, Jiménez-Chafey, MI, Domenech Rodríguez, MM (2009) Cultural adaptation of treatments: a resource for considering culture in evidence-based practice. Prof Psychol Res Pr, 40: 361–8.
Bhugra, D, Ayonrinde, O, Butler, G, et al. (2011) A randomised controlled trial of assertive outreach v. treatment as usual for black people with severe mental illness. Epidemiol Psychiatr Sci, 20: 83–9.
Birchwood, M, Cochrane, R, Macmillan, F, et al. (1992) The influence of ethnicity and family structure on relapse in first-episode schizophrenia: a comparison of Asian, Afro-Caribbean, and white patients. Br J Psychiatry, 161: 783–90.
Bond, GR, Drake, RE, Mueser, KT, et al. (2001) Assertive community treatment for people with severe mental illness. Dis Manag Health Out, 9: 141–59.
Chow, W, Law, S, Andermann, L (2009a) ACT tailored for ethnocultural communities of metropolitan Toronto. Psychiatr Serv, 60(6): 847.
Cinnirella, M, Loewenthal, KM (1999) Religious and ethnic group influences on beliefs about mental illness: a qualitative interview study. Br J Med Psychol, 72: 505–24.
Department of Health (2005) Delivering Race Equality in Mental Health Care: An Action Plan for Reform Inside and Outside Services and the Government's Response to the Independent Inquiry into the Death of David Bennett. TSO (The Stationery Office).
Dieterich, M, Irving, CB, Bergman, H, et al. (2017) Intensive case management for severe mental illness. Cochrane Database Syst Rev, 1: CD007906 (doi: 10.1002/14651858.CD007906.pub3).
Eack, SM, Newhill, CE (2012) Racial disparities in mental health outcomes after psychiatric hospital discharge among individuals with severe mental illness. Soc Work Res, 36: 4152.
Kidd, SA, Virdee, G, Krupa, T, et al. (2013) The role of gender in housing for individuals with severe mental illness: a qualitative study of the Canadian service context. BMJ Open, 3(6): e002914.
Kidd, SA, Mckenzie, KJ, Virdee, G (2014) Mental health reform at a systems level: widening the lens on recovery-oriented care. Can J Psychiatry, 59: 243–9.
Killaspy, H, Bebbington, P, Blizard, R, et al. (2006) The REACT study: randomised evaluation of assertive community treatment in north London. BMJ, 332: 815–20.
Kinoshita, Y, Furukawa, TA, Kinoshita, K, et al. (2013) Supported employment for adults with severe mental illness. Cochrane Database Syst Rev, 9: CD008297 (doi: 10.1002/14651858.CD008297.pub2).
Knifton, L, Gervais, M, Newbigging, K, et al. (2010) Community conversation: addressing mental health stigma with ethnic minority communities. Soc Psychiatry Psychiatr Epidemiol, 45: 497504.
Lukyanova, VV, Balcazar, EF, Oberoi, AK, et al. (2014) Employment outcomes among African Americans and Whites with mental illness. Work, 48: 319–28.
Morgan, C, Mallett, R, Hutchinson, G, et al. (2004) Negative pathways to psychiatric care and ethnicity: the bridge between social science and psychiatry. Soc Sci Med, 58: 739–52.
Morgan, C, Fearon, P, Lappin, J, et al. (2017) Ethnicity and long-term course and outcome of psychotic disorders in a UK sample: the ÆSOP-10 study. Br J Psychiatry, 211: 8894.
Mueser, KT, Bond, GR, Essock, SM, et al. (2014) The effects of supported employment in Latino consumers with severe mental illness. Psychiatr Rehabil J, 37: 113–22.
Nagendra, A, Schooler, NR, Kane, JM, et al. (2017) Demographic, psychosocial, clinical, and neurocognitive baseline characteristics of Black Americans in the RAISE-ETP study. Schizophr Res, 193: 64–8.
Olney, MF, Kennedy, J (2002) Racial disparities in VR use and job placement rates for adults with disabilities. Rehabilitation Counseling Bulletin, 45: 177–85.
Revier, CJ, Reininghaus, U, Dutta, R, et al. (2015) Ten-year outcomes of first-episode psychoses in the MRC ÆSOP-10 study. J Nerv Ment Dis, 203: 379–86.
Rosenheck, R, Kasprow, W, Frisman, L, et al. (2003) Cost-effectiveness of supported housing for homeless persons with mental illness. Arch Gen Psychiatry, 60: 940–51.
Rotenberg, MA, Rudnick, A (2011) Reporting of ethics procedures in psychiatric rehabilitation peer-reviewed empirical research publications in the last decade. Am J Psychiatr Rehabil, 14: 97108.
Rotenberg, M, Rudnick, A (2017a) Recent developments in person-centered psychiatry: present and future psychiatric rehabilitation. Eur J Pers Cent Healthc, 5: 256–62.
Rotenberg, M, Tuck, A, McKenzie, K (2017b) Psychosocial stressors contributing to emergency psychiatric service utilization in a sample of ethno-culturally diverse clients with psychosis in Toronto. BMC Psychiatry, 17(1): 324.
Sass, B, Moffat, J, Bhui, K, et al. (2009) Enhancing pathways to care for black and minority ethnic populations: a systematic review. Int Rev Psychiatry, 21: 430–8.
Shank, JW, Iwasaki, Y, Coyle, C, et al. (2015) Experiences and meanings of leisure, active living, and recovery among culturally diverse community-dwelling adults with mental illness. Am J Psychiatr Rehabil, 18: 129–51.
Stergiopoulos, V, Gozdzik, A, Misir, V, et al. (2015) Effectiveness of Housing First with intensive case management in an ethnically diverse sample of homeless adults with mental illness: a randomized controlled trial. PLoS ONE, 10(7): e0130281.
Tondora, J, O'Connell, M, Miller, R, et al. (2010) A clinical trial of peer-based culturally responsive person-centered care for psychosis for African Americans and Latinos. Clinical Trials, 7: 368–79.
Whitley, R (2016) Ethno-racial variation in recovery from severe mental illness: a qualitative comparison. Can J Psychiatry, 61: 340–7.
Yamada, A, Brekke, J (2008) Addressing mental health disparities through clinical competence not just cultural competence: the need for assessment of sociocultural issues in the delivery of evidence-based psychosocial rehabilitation services. Clin Psychol Rev, 28: 1386–99.
Yang, J, Law, S, Chow, W, et al. (2005) Best practices: assertive community treatment for persons with severe and persistent mental illness in ethnic minority groups. Psychiatr Serv, 56: 1053–5.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Advances
  • ISSN: 2056-4678
  • EISSN: 2056-4686
  • URL: /core/journals/bjpsych-advances
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Rehabilitation and recovery for ethnic minority patients with severe mental illness

  • Martin Rotenberg (a1)
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *