Barts and The London School of Medicine and Dentistry

Race Equality in Mental Health

Summary

Prof. Bhui’s programme of research aims to understand and tackle ethnic inequalities in experiences and outcomes of mental illness in adults and adolescents. This includes identifying modifiable risk factors such as bullying and discrimination, and protective influences such as friendships and social support. His work has shown that access to care for black patients is through adverse pathways such as compulsory detention and treatment and the criminal justice system and less use of primary care. This research informs national practice, policy and reviews of legislation.

The science: understanding cultural influences on clinical delivery of mental health services

Research in adults shows persistently adverse pathways to care which affects Black Caribbean, Black African, Black British, and South Asian patients. The explanations included cultural influences on clinical assessment and treatment delivery and take up, and poorer access to services due to racism, failed communications, deprivation, area influences, and social determinants of illness. The evidence that Prof. Bhui’s team at Queen Mary’s Wolfson Institute of Preventative Medicine produced suggests violence and substance misuse do not explain criminal justice pathways among black patients with a first episode of psychosis.

Putting research into action: impact on the mental health act in the UK and clinical practice

A review of the mental health act is taking place in 2017/2018, including attention to ethnicity.

Prof. Bhui’s work on cultural competency of mental healthcare professionals has influenced the development of a manual which is now included in American and European cultural competency training and race equality strategies.  Prof. Bhui is also advising the World Health Organisation on how to shape diagnostic guidelines to include cultural perspectives, especially around psychosis and personality disorder.

Prof. Bhui’s findings of a cultural consultation show that patients needed less care three months after the intervention, with £497 saved per patient. The cost of the consultation was no greater than routine care. Clinicians said cultural consultation helped them improve the treatment plan (71%), engagement (50%), medication compliance (21%), and earlier discharge (7%).