Tackling the ‘impact of racism’ is the number one priority to reduce ethnic inequalities in severe mental illness, according to the findings of a national consultation conducted by the Synergi Collaborative Centre, released on World Mental Health Day 2019.
Drawing on the responses of 221 people, including service users and carers, the most pressing concern is with the multiple forms of racism experienced by ethnic minority people, particularly in encounters with public institutions, such as health services and the criminal justice system, resulting in adverse care pathways.
Covering 42 subject areas (from school exclusion to physical restraint), the second priority is to facilitate wider social support, coping strategies and measures of positivity, such as optimism and hope. Reducing stigma and societal disadvantages is the third priority identified in this consultation exercise. Participants also highlighted the interplay of multiple layers of disadvantage and marginalisation across, for example, migration and the immigration system, religion, gender, sexuality and disability.
A motivator for the national priority setting consultation, the first of its kind in the UK, is evidence which suggests that Black Caribbean patients with psychosis are more likely to be coercively treated under the powers of the Mental Health Act than White patients, and less likely to receive psychologically-based interventions. Also, Black patients are just over 50 per cent more likely to be prescribed injectable antipsychotic drugs than White patients.
Kamaldeep Bhui CBE, Synergi’s Director and Professor of Cultural Psychiatry & Epidemiology, Queen Mary University of London, said: “After 50 years of these persistent inequalities, we need a different approach as we are not getting it right as a society. People still don’t understand the importance of tackling ethnic inequalities in a healthy society, nor the causes as we have not listened to people with lived experience enough. Noticing the life stories and biographies of the excluded is crucial to our understanding, and shows the real challenges ethnic minority people face. Meanwhile, there continues to be disparity and inequality, which raises questions about the lack of action to counter social injustice. Our work responds to a lack of literacy and motivation that is present in all sectors.”
Deborah Coles, Director of INQUEST, the only charity providing expertise on state-related deaths and their investigation, said: “These findings resonate with INQUEST’s work with families bereaved by state-related deaths and the sharp end of institutional and structural racism. Services which are intended to keep people safe all too often cause harm, particularly against those already facing marginalisation and social disadvantage. Whether that is through the criminalisation of those with mental ill health, or disproportionately coercive and violent responses to distress.”
Sandra Griffiths, Co-Director, Catalyst 4 Change in Birmingham, said: “It’s disheartening that racism, a lack of social support and social disadvantage continue to be of concern to ethnic minority people experiencing severe mental illness. This chimes with Catalyst 4 Change’s own consultations with community groups, service users and carers on how we can improve the African and Caribbean mental health experience. Over the last 30 years, there have been lots of initiatives that have tried to tackle these issues, but they have been subject to short term funding. We have to build the capacity of ethnic minority service users and carers to help change this narrative.”
Pauline Witter, Mental Health Team Manager, African and Caribbean Mental Health Services in Manchester, said: “I am not surprised by Synergi’s findings. Therapeutic interventions are available, but if staff do not reflect the multicultural population of Britain, and their practice continues to be based on Eurocentric models, then ethnic minority people will not engage with services. This is compounded by institutional racism and stigma from their own and the wider communities. Services where African and African Caribbean people are able to speak to professionals who have some understanding of the difficulties that they face daily, and which are situated in the heart of the community, will inspire optimism, hope and engagement.”
James Nazroo, Synergi’s Co-Director and Professor of Sociology at the University of Manchester, said: “The consultation provides knowledge to underpin actions to improve the adverse outcomes experienced by ethnic minority people in relation to severe mental illness. Racism and discrimination are embedded in our society, meaning the voices of ethnic minority people who are experiencing severe mental illness remain unheard. Hearing their voices helps to promote a powerful collaborative movement to tackle ethnic inequalities in mental health and systems. We need to recognise that ethnic inequality is bad for health, for communities and for social and economic success.”
Synergi is shaping its research, knowledge and engagement programme around the top three priorities, and plan to launch a national campaign in 2020. The centre will use co-creation and co-production approaches to enable ethnic minority service users, carers and those with lived experience to influence and design actions to reduce ethnic inequalities.
You can access a PDF copy of the findings here.