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Ethnic inequalities persist for severe mental illness in England

There are persisting inequalities in health service use for severe mental illness, with negative effects for patients from ethnic minority backgrounds, according to research led by Queen Mary University of London.

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The findings are part of the emerging work of the Synergi Collaborative Centre, which is funded by Lankelly Chase, and published in the open access journal BMC Medicine.

Lead author Professor Kamaldeep Bhui from the Centre for Psychiatry at Queen Mary’s Wolfson Institute of Preventive Medicine said: “Our results suggest that Black Caribbean and Black African people are more likely to access treatment by compulsory admission to hospital, through contact with police and the criminal justice system, and less often through their GP. Some South Asian patients have similar experiences.”

“Action needs to be taken to better understand what drives inequalities in people’s access to mental health care and how they can be remedied, including how societal and institutional inequalities enter care systems.”

Higher rates of contact with the criminal justice system

The team conducted a systematic review of 40 research articles mapping the evidence on ethnic inequalities in mental health care in England. They then supplemented this with up-to-date evidence from studies conducted in England between 2012 and 2017.

They found that compared to people of White British ethnic backgrounds, Black Caribbean, Black African and South Asian patients had higher rates of compulsory admission. These include being detained under (civil) Section 2 of the Mental Health Act ― UK legislation that provides for a person to be detained in hospital, due to mental health concerns.

Compared to people of White ethnic backgrounds, black people had more police contact and criminal justice system involvement on their way into mental health care.

The authors found no variation in these outcomes over time, which suggests that, although inequalities do not seem to be improving, concerns that they may worsen in the wake of financial constraints and austerity have not materialised.

Decades of persistent inequality

Joy Francis, co-director of the Synergi Collaborative Centre, said: “This important study reinforces why the Synergi Collaborative Centre is so committed to tackling ethnic inequalities in severe mental illness. The finding that inequalities are not improving should be of concern to all those in mental health care.

"The study is timely in the wake of the Independent review of the Mental Health Act's recommendations as we believe that ethnic inequalities are most stark within mental health care. We hope that this study offers a necessary evidence-base to galvanise policymakers and politicians into action."

The authors hope that the findings of the present study may increase awareness and inform policy and practice.

“A policy and practice shift should concern not only these inequalities but also other, associated inequalities, such as socioeconomic and geographical factors, as well as gender and age,” added Professor Bhui.

“Inequalities that have been reported over many decades for patients from ethnic minorities need to be considered in the planning of any reform of the UK Mental Health Act, and future integrated care.”

More information

  • Find out more about postgraduate degrees in Mental Health at the Wolfson Institute of Preventive Medicine.
  • Research paper: ‘Ethnic inequalities and pathways to care in psychosis in England: a systematic review and meta-analysis’. Kristoffer Halvorsrud, James Nazroo, Michaela Otis, Eva Brown Hajdukova and Kamaldeep Bhui. BMC Medicine. DOI: 1186/s12916-018-1201-9
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