Rachel Dada discusses the necessary steps that must be taken in order to achieve equity for the mental health of Black, Asian and ethnic minority communities in the UK
The Repeated Assessment of Mental Health in Pandemics (RAMP) study focuses on assessing the effect of COVID-19 on the mental health and wellbeing of the population. Although responses so far have been encouraging and very insightful, it is clear that they do not represent the whole population. Black, Asian and ethnic minority groups are particularly underrepresented in this research study. This is an important issue to note, as data gathered from a wide demographic will produce more valuable and generalisable research representative of our society as a whole. When discussing and researching the impact of mental health on individuals and on our society and formulating strategies to tackle these issues, it is essential that we hear all voices. This means we must amplify the voices of those who are underrepresented, such as those from Black, Asian and ethnic minority communities. It should be noted that while this blog refers to issues pertinent to many UK ethnic minority communities, referring to the many communities collectively does not denote one homogenous grouping. The Mental Health Foundation note that ‘different ethnic groups have different experiences of mental health problems that reflect their culture and context’. To progress towards a healthcare system that tailors treatments to individuals and caters for the needs of everyone will require research into the causes and consequences of mental health problems in people from diverse backgrounds.
“We must amplify the voices of those who are underrepresented, such as those from Black, Asian and ethnic minority communities”
It is critical that more work is done exploring the role of social and demographic factors on mental health in individuals with different ethnic backgrounds. However, research shows that minority ethnic groups are underrepresented in clinical and health research. The Race Equality Foundation (2019) found that minority groups are less likely to seek mental health support in primary care (i.e. through their GP). Those identifying as Asian or Asian British are 14% less likely than average to be in contact with mental health or learning disability services. Studies show that this reluctance to seek professional help can be attributed to many factors. Communities and cultures have different approaches to mental health and stigma from within our own communities is common. More shockingly, minority groups report feeling like they will not be believed by the professionals they are supposed to confide in, and furthermore, are fearful of escalation, excessive force and death in detention. It is no wonder that these negative past experiences have led to a complete lack of trust in professional services. There needs to be considerable work towards regaining the trust of UK ethnic minority communities, to show that these services are there to help individuals and their families. This will require investment and innovation to improve inclusivity and support, in both research and in practice, or these communities will continue to suffer disproportionately.
“There needs to be considerable work towards regaining the trust of UK ethnic minority communities”
Numerous reports show that UK ethnic minority communities suffer disproportionately from mental health problems. For example, risk of psychosis is seven times higher in Black Caribbean communities than the general population. Furthermore, being of Black African, Black Caribbrean and South Asian ethnicities is a high risk factor for suicide, which is also the most common cause of death in young men. Research into the causes of these problems in individuals at risk is urgently needed and needs to be a research priority. Moreover, it is essential that individuals from such communities feel comfortable and confident to seek help when they are struggling. Racism and discrimination are key factors contributing to poor mental health in individuals from UK ethnic minority groups. Racism is perennial and is expressed in many different forms, from overt acts of aggression to covert, structural and systemic microaggressions. A YouGov poll found that 64% of Black, Asian and ethnic minority respondents have had a racial slur directly used against them. While most people, from all backgrounds, will agree that this is completely appalling, more work is required to expose and root out the covert, institutional and systemic racism and discrimination inflicted on people from ethnic minority backgrounds.
Indeed, those who experience racism are exposed to high levels of stress, which negatively affects their mental health. However, it could also be suggested that systemic racism has contributed to many coronavirus-related deaths in the essential workforce. As of 13 May, the number of Black, Asian and minority ethnic NHS staff who died after contracting COVID-19 is seven times higher than White staff members. These groups are also less likely to seek care when needed or voice their concerns about personal protective equipment or risk. Indeed, Black and minority ethnic workers make up a disproportionately large share (42%) of key or essential worker sectors in London.
“the number of Black, Asian and minority ethnic NHS staff who died after contracting COVID-19 is seven times higher than White staff members”
Socio-economic inequality plays a major role in the development of poor mental health amongst ethnic minorities. Minority groups are more likely to experience poverty and are systematically paid less money than their White counterparts. UK-born Black African, Caribbean and Black British employees are paid 7.7% less than their UK-born White British counterparts (ONS, 2018). Minority groups often find themselves in positions where they have no choice but to work long and excessive hours to make ends meet. This has never been more evident than during the COVID-19 pandemic. In my own community, I have personally spoken to key workers from Black and Asian communities who feel stressed and anxious about going to work and risking not only their own lives, but the lives of their loved ones as well.
There is lots of work to be done to better understand why such disparities exist in society. The RAMP study is an opportunity to help research identify where things can be improved. It is important to hear from people from Black, Asian and minority backgrounds in order to highlight and understand the impact of COVID-19 on the mental health and wellbeing of different ethnic groups, so that health services can cater for everyone effectively. If you want to get involved in this effort, to amplify voices of minority groups in the discussion of mental health and treatments, then get in touch with the RAMP study researchers. I would also encourage you to take part in this research study. Please share with your family, friends, colleagues and contribute to an important and needed study.
About the author
Rachel Dada, Journalism BA and Public Policy MSc graduate, is a writer, aspiring researcher and the founder of Black Talent Space.
There are some great resources and support available for ethnic minority groups specifically:
Abraham, T., 2020. 84% Of BAME Britons Think The UK Is Still Very Or Somewhat Racist | Yougov. [online] Yougov.co.uk. Available at: <https://yougov.co.uk/topics/politics/articles-reports/2020/06/26/nine-ten-bame-britons-think-racism-exists-same-lev> [Accessed 6 July 2020].
BBC News. 2020. Racism ‘Could Play A Part In BAME Covid Deaths’. [online] Available at: <https://www.bbc.co.uk/news/health-53035054> [Accessed 24 June 2020].
Bhui, K. and McKenzie, K., 2008. Rates and Risk Factors by Ethnic Group for Suicides Within a Year of Contact With Mental Health Services in England and Wales. Psychiatric Services, 59(4), pp.414-420.
Fearon, P., Kirkbride, J., Morgan, C., Dazzan, P., Morgan, K., Lloyd, T., Hutchinson, G., Tarrant, J., Lun Alan Fung, W., Holloway, J., Mallett, R., Harrinson, G., Leff, J., Jones, P. and Murray, R., 2006. Incidence of schizophrenia and other psychoses in ethnic minority groups: results from the MRC AESOP Study. Psychological Medicine, 36(11), pp.1541-1550.
House of Commons Library, 2020. Mental Health Statistics: Prevalence, Services And Funding In England.
ITV News. 2020. ‘Discrimination’ On Frontline Of Coronavirus Outbreak May Be Factor In Disproportionate BAME Deaths Among NHS Staff. [online] Available at: <https://www.itv.com/news/2020-05-13/discrimination-frontline-coronavirus-covid19-black-minority-ethnic-bame-deaths-nhs-racism/> [Accessed 24 June 2020].
McManus, S. Bebbington, P. Jenkins, Brugha, T. 2016. Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014. Leeds: NHS Digital.
Mental Health Foundation. n.d. Black, Asian And Minority Ethnic (BAME) Communities. [online] Available at: <https://www.mentalhealth.org.uk/a-to-z/b/black-asian-and-minority-ethnic-bame-communities> [Accessed 24 June 2020].
ONS, 2018. Ethnicity Pay Gaps In Great Britain: 2018. [online] ONS. Available at: <https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/earningsandworkinghours/articles/ethnicitypaygapsingreatbritain/2018> [Accessed 6 July 2020].
Race Equality Foundation, 2015. [online] Available at: <http://raceequalityfoundation.org.uk/wp-content/uploads/2018/10/Better-practice-in-mental-health.pdf> [Accessed 24 June 2020].
Race Equality Foundation, 2019. Racial Disparities In Mental Health: Literature And Evidence Review. [online] Available at: <https://raceequalityfoundation.org.uk/wp-content/uploads/2020/03/mental-health-report-v5-2.pdf> [Accessed 24 June 2020].
Redwood, S. and Gill, P., 2013. Under-representation of minority ethnic groups in research — call for action. British Journal of General Practice, 63(612), pp.342-343.
The Health Foundation. 2020. Black And Minority Ethnic Workers Make Up A Disproportionately Large Share Of Key Worker Sectors In London | The Health Foundation. [online] Available at: <https://www.health.org.uk/chart/black-and-minority-ethnic-workers-make-up-a-disproportionately-large-share-of-key-worker> [Accessed 24 June 2020].