This framework developed here at Stride Mental Health UK, adapted from the Power Threat Meaning Framework (Boyle & Johnstone, 2020; Johnstone et al., 2019) focuses on how systemic power structures influence access to mental health services, treatment outcomes, and the overall experience of care. It will help providers critically examine their own practices and identify changes to improve equity, effectiveness, and accessibility.
Systemic Barriers and Power Impact Framework (SBPIF)
A framework to examine and deconstruct power structures in mental health services to improve access, quality, and systemic fairness.
Core Questions of the Framework
Rather than focusing on pathology or deficit-based models, the SBPIF can help your organisation ask:
1. Power:
• Who holds power within our organisation and systems?
• How does this power shape access to mental health care?
• Where do imbalances of power create barriers to care?
• How are service users’ voices, particularly marginalised voices, heard and valued?
2. Threat (Systemic Risks and Barriers):
• What systemic barriers prevent people from accessing timely and effective treatment?
• What organisational processes (e.g., long waiting lists, rigid referral criteria) reinforce exclusion and distress?
• How does the threat of surveillance, coercion, or control (e.g., risk assessments, forced hospitalisation) impact engagement with services?
3. Meaning (Impact and Interpretation):
• How do people make sense of their experiences within the mental health system?
• How do structural inequalities (e.g., poverty, racism, disability, gender identity) intersect with their experiences of care?
• How does the medicalisation of distress (e.g., diagnosis, medication) shape narratives about mental health?
4. Responses (Resistance, Survival, and Adaptation):
• How do people resist or adapt to the power structures in mental health care?
• How do service users and staff challenge or subvert harmful practices?
• What community-driven, anti-oppressive alternatives exist within or outside mainstream services?
5. Transformation (Structural Change & Accountability):
• What actions can be taken to redistribute power and make services more equitable?
• How can we move from ‘service user involvement’ as a tokenistic measure to real co-production?
• How do we hold organisations accountable for systemic harm while supporting meaningful change?
How the SBPIF Can Be Used in CAMHS & Mental Health Services
1. Service Audits & Reviews – Organisations could use this framework to critically examine policies, referral pathways, and treatment models to identify where power imbalances create barriers.
2. Staff Training – Workshops and reflective practice using the framework could help staff recognise their own role in power dynamics and shift towards trauma-informed, collaborative approaches.
3. Co-Production with Service Users – The framework could be applied in partnership with those who access services, ensuring their experiences inform systemic change.
4. Policy & Practice Reform – Findings from applying the framework could drive policy change, funding decisions, and advocacy for fairer mental health provision.
5. Accountability Measures – Organisations could use the SBPIF to set measurable goals for reducing systemic barriers and improving accessibility and cultural responsiveness.
More to come on all of this please watch this space….
Stride Mental Health 