Black History Month gives us an opportunity to raise awareness and act on mental health inequalities


Black History Month gives us an opportunity to raise awareness and act on mental health inequalities

Dr Mohinder Kapoor, consultant in old age psychiatry and associate medical director for research and development, shares some key facts about mental health inequalities in our BAME communities, and what might be done to break down barriers.  

A headshot photo of Dr Mohinder KapoorBlack History Month, marked in October each year, is an opportunity for everyone across our Trust to celebrate the contributions of our colleagues, to educate one another on the inequalities experienced by people from Black, Asian and Minority Ethnic (BAME) backgrounds and to inspire one another to maintain and further develop an inclusive and diverse culture which is supportive and welcoming for all.

The diverse population of the UK is represented by various ethnic groups, each with their own distinct cultural identities and health beliefs. It is documented that the rates at which people from BAME backgrounds experience mental health issues are sometimes greater than for the non-BAME population.

For example, in comparison to the non-BAME population:

  • Black women are more likely to experience a common mental illness such as anxiety disorder or depression.
  • Older South Asian women are an at-risk group for suicide.
  • Black men are more likely to experience psychosis.
  • Black people are four times more likely to be detained under the Mental Health Act.

Inequalities in the mental health and wellbeing of people from ethnic minority backgrounds have been well documented for a number of decades, with many research papers investigating cultural issues within communities and system issues in services. Even before the Covid-19 pandemic, there was evidence of mental health inequalities within the BAME population. This presents as both an over representation of BAME communities in acute mental health services, but also a lack of take-up of community mental health services by the BAME community. Evidence from recent study suggests that BAME communities were over-represented in occupied beds and referrals at the West London NHS Trust. This is especially stark for the Black community where a person is 1.6 times as likely to be referred and 3.1 times as likely to be admitted than a person from a White community. Communities are not engaging with mental health services until it is too late and a problem becomes acute or reaches crisis point. The Building Bridges programme in Liverpool recognised the under-representation of BAME children and families in preventative and early intervention services, and their over-representation in interventions like mental health detention, criminal justice and school exclusion.

The Covid-19 pandemic has brought health inequalities to the forefront more than ever before. Covid-19 has affected members of BAME communities at a shockingly disproportionate level. Public Health England’s report Beyond the data: Understanding the impact of Covid-19 on BAME groups highlighted the rate of infection and mortality as being much higher for those from particular BAME communities than for their non-BAME counterparts.

Before  the Covid-19 pandemic, there had been evidence demonstrating poorer health outcomes and experiences for ethnic minority groups compared with the overall population. Examples include (but are not limited to) poor access to services and higher rates of both mental health illness and metabolic illnesses such as type 2 diabetes and cardiovascular disease.

In the UK, primary care services are typically the initial point of contact in the healthcare system, acting as the front door for the NHS. A 2017 resource by NHS England highlighted that certain individuals, including those insecurely housed, refugees and asylum seekers, did not always experience easy access to general practice services, and subsequently did not experience the same health outcomes as the rest of the population.

The way that patients access primary care services fundamentally changed as a result of the Covid-19 pandemic. We witnessed the restructuring of the initial method of patient contact, moving from the majority of appointments being face to face to the majority being remote consultations. While this might have brought added convenience and efficiency on some levels, it also risks increasing some of the barriers in accessing services for the BAME community.  For example, language and cultural barriers can seemingly be more difficult to manage via remote consultations. We must also be mindful that there are people who do not have regular access to a computer or handheld device, or may not be  IT literate.  It is certainly too early to see the effects of these changes on our BAME communities, but it is an area that should be closely monitored to ensure safe and equitable access.

Mental health is primarily supported in the community, including medication, and talking therapies available through primary care services – with GPs often regarded as the primary source of information and support for those seeking help with their mental health. These services should therefore notably be a point of equal access for all in the community. However, research over the years has shown inadequate patient access and poor patient satisfaction among patients from ethnic minority backgrounds.

Events such as Black History Month give us a chance to reflect and look at how we can meet the needs of the whole population consistently and competently. There remains a great deal of work to ensure that all patients, regardless of their background, receive equitable access to healthcare. With  timely and appropriate access to primary care I am hopeful that we could see better mental health outcomes for BAME communities. This might further lead to reduction in number of acute referrals to mental health services and more appropriate admissions (including detentions) to mental health inpatient units. Further research needs to look at challenges/issues in accessing services, and differential treatment within those services. This research and outcomes could be used to inform policies and processes to tackle these issues, with ongoing quality research to further explore and monitor outcomes.

With increasing awareness of the mental health inequalities faced by our BAME communities I am hopeful that we can continue to drive change and improve the wellbeing and the quality of care we provide.


Black History Month gives us an opportunity to raise awareness and act on mental health inequalities

time to read: 4 min