Now more than ever we realise that the NHS, our cherished symbol of unity, is as fallible as the patients it exists to treat. Mental health services have long been the casualty of CCG budget cuts and fragmentation under geographic ‘postcode lotteries’, but fundamentally this crisis is one that disproportionately disadvantages patients in the BAME community. How systemic are these failings and why does a system envisioned to protect equity and empower patients seem to be at the epicentre of injustice?
Whenever I look to my medical school and then to my classmates, I see compassionate individuals determined to advocate our patient’s rights and needs. Explorations of the specific healthcare challenges surrounding race, religion, sexuality and disability are embedded into our curriculums. Yet despite efforts to produce empathetic and conscientious doctors, we still find our NHS riddled with inequalities. Undeniably, individual prejudice exists within the NHS with studies showing female patients are still more likely to be dismissed or undertreated. However, the wider threat to BAME communities lies rooted within institutional racism. This insidious form of racism reinforces barriers in accessibility and quality of health care, it is the unintentional collective failure of our NHS to tackle inequity and protect patients equally.
The causes of poorer mental health in BAME patients are complex yet ubiquitously found in our daily lives. One shared sentiment is that since our childhoods we quickly had to understand that we were different. We were the targets of negativity and attitudes that would attempt to undermine our individuality and resilience. Moving to the socioeconomic level, the dynamic is mirrored. Among 16-24-year olds, unemployment rates are highest for people from a Black background (26%) and from a Pakistani or Bangladeshi background (23%) in comparison to our White counterparts (11%). These communities also receive poorer educational opportunities and more contact with the criminal justice system. It is no secret that the key to social inclusion and justice are dependant on economic inclusion and economic justice. Without which, the depraved cycle will repeat, effectively silencing and demonising the BAME communities in our society.
Racism and micro-aggressions are chronic stressors to the mind, inevitably this consistent erosive negativity can lead to pessimism, and difficulties recovering from trauma. Strong evidence suggests that anger, substance misuse and depression are more likely in those exposed to racism with psychosis being 10 times more likely in black men than white. Compounding this suffering can be cultural stigma towards mental health that further hinders the preventative effects of a healthy support network. We need to do more to recognise the role of racism in the perpetuation of social exclusion and its subsequent health implications. This is especially pertinent in the context of mental wellbeing within our multicultural society.
This legacy of ignorance presents us with a profound paradox in which the communities most at risk of suffering from poor mental health are also those who consistently meet the sharper end of treatment paths. These groups experience less primary care and specialist management of their illnesses, instead we see Black people are 40% more likely to find access through forensic services or the criminal justice system under section 136 for risk assessment. The compulsory hospital admission (often referred to as sectioning) is also heavily over-represented by young Black men, a disempowering process involving forcible restraint and not-so-therapeutic treatments. MHA tribunals can appeal against these detentions but notably this has only opened more doors to racial bias. The mistrust and misconceptions unsurprisingly replicate the power dynamics held in broader society. Tangible change therefore demands the active construction of new and inclusive practises, policies and priorities. We must safeguard the health of our diverse communities and re-evaluate our relationships with organisations susceptible to the permeance of Institutionalised racism.