Psychotic disorders are more prevalent among minority ethnic groups in the UK. However, there is no research on how the British Sikh community understands and seeks help for psychosis. The way in which a community understands the nature, causes and treatment of psychosis can impact their duration of untreated psychosis, treatment pathways, experience and engagement with mental health services, and outcomes.

To explore the lay understandings of psychosis and associated help-seeking within the Sikh community in England, and how family, religion and culture influence these perspectives

An exploratory qualitative design, consisting of online semistructured interviews across the UK.

30 participants, 11 men and 19 women, ages ranged from 19 to 69, who identified as Sikh.

Thematic analysis revealed several common themes, including a lack of awareness and knowledge of psychosis, variety of causal beliefs held about psychosis, professional help-seeking being encouraged, religious practices regarded as helpful coping mechanisms, supernatural beliefs influencing alternative help-seeking, strong negative perceptions towards psychosis and general mental illness, the significant role of family and community, and conflicting religious and cultural beliefs.

Participants showed limited understanding of psychosis and mental illnesses, accompanied by widespread negative perceptions, potentially delaying help-seeking. Increasing awareness may prompt earlier help-seeking, enhancing outcomes and diminishing stigma.

(1) Identify the processes, staff time and labour costs associated with non-attendance at two physiotherapy outpatient clinics using time-driven activity-based costing; (2) estimate labour cost-burden of non-attendance response scenarios.

A six-step time-driven activity-based costing method was used, including scenario analyses.

Two tertiary hospital outpatient clinics.

Clinic non-attendance rates were determined from digital administrative records for participating clinics. Interviews and iterative discussions were conducted with 15 administrative and clinical staff to establish process maps and key parameters.

The primary outcome was health service labour cost associated with clinic non-attendance. Four key work processes were identified and costed (2023, A$).

Clinic non-attendance rates for the 2018–2021 period were 8% (Clinic 1) and 10% (Clinic 2). Complex triaging cases constituted greater costs than simple triaging cases. Projected annual costs of non-attendance were as high as A$114 827 for a single clinic. The most expensive referral and response scenario was internal referral with non-attendance that was converted to a telephone appointment (mean cost of A$113/appointment).

Non-attendance rates at participating clinics were at the lower end of values reported in prior literature; however, substantial healthcare resource waste was still evident. Findings highlighted the extent to which non-attendance at scheduled clinic appointments may not only impact patients’ welfare through lost treatment opportunity, but also carry substantial opportunity cost from wasted hospital resources that could have been allocated to other referred patients. Establishing the effectiveness and cost-effectiveness of interventions to reduce non-attendance remains a priority.