Rahma Salia, Research Administrator
World Mental Health Day serves as an important reminder to reflect on the mental health challenges and inequalities many people face when seeking care. Severe mental illness (SMI), which includes psychological conditions like schizophrenia and bipolar disorder, significantly impacts a person’s ability to function in daily life (Public Health England, 2018). These illnesses not only affect mental wellbeing but are intricately interwoven with physical health. For example, individuals with SMIs have an increased risk of developing physical health conditions such as cardiovascular disease at a younger age and have a life expectancy up to 20 years shorter than the general population (O’Gallagher, 2022; Hayes et al, 2017). It is no surprise that people living with SMIs “face one of the greatest health equality gaps in England” (NHS England, 2024: 1)
Experiences of mental health services and treatment
Research has found that people from Black African and Black Caribbean backgrounds are disproportionately diagnosed with a SMI, with diagnostic rates of schizophrenia six times higher for Black African and Black Caribbean people compared to their White counterparts, while psychosis rates are nine times higher for Black Caribbean people (Degnan et al, 2022). Disparities in care and treatment can also be found in the pathways to mental health support.. Instead of receiving early intervention or community-based care, research shows that Black African and Black Caribbean people are more likely to come into contact with mental health services through crisis points (Walker et al, 2019; Bansal, 2022), such as police involvement (Bignall et al, 2019), and are four times more likely to be detained under the Mental Health Act compared to other ethnic groups (Care Quality Commission, 2018). Research also highlights that when Black African and Caribbean people are admitted to mental health facilities, they often feel uninformed about their treatment, with many reporting that staff fail to explain procedures (Lawrence et al, 2021).
Once diagnosed, Black African and Caribbean individuals are less likely to receive psychological support such as talking therapies compared to White patients and are instead more frequently prescribed antipsychotic medications (Bignall et al, 2019; Das-Munshi et al, 2018).This overreliance on medication, often imposed rather than discussed, fuels feelings of dehumanisation (Lawrence et al, 2021). Overmedication also has a damaging effect on physical health, as many antipsychotic drugs can increase the risk of conditions like obesity and diabetes, which are already more prevalent in these communities (Correll et al, 2011).
Our research has highlighted how structural and systemic racism shapes disparities in health and care outcomes. For instance, our co-produced research with people from Black African and Caribbean backgrounds who have a SMI found that participants had high levels of distrust towards mental health services. Negative past experiences, such as being overmedicated and fears of being sectioned, contributed to this distrust, exacerbating health inequalities and leading to shorter life expectancies.
Physical health checks as a preventative intervention
Addressing the physical health needs alongside mental health is crucial for people with SMI, particularly within Black African and Black Caribbean communities. The NHS provides a valuable intervention known as physical health checks (PHCs), designed to detect and address early signs of poor physical health in people with SMI. However, uptake of PHCs among Black, Asian, and minoritised ethnic communities remains low.
Between 2021 and 2024, the Race Equality Foundation conducted a series of projects to explore how aware Black African and Caribbean individuals with SMIs are of PHCs and their ability to access them. The Foundation worked closely with a co-production group composed of individuals with SMIs, carers and family members, and staff from voluntary organisations supporting this community.
These collaborative sessions revealed several critical insights. Participants noted a severe lack of visible promotion for PHCs, especially on social media platforms, limiting the reach to those who could benefit. There was also a strong call for clear, accessible information about PHCs. Many individuals with SMIs reported missed opportunities to learn about or attend these checks, partly due to a lack of understanding among staff in voluntary sector organisations.
Implementing recommendations
One of the co-production group’s key recommendations was to improve staff training on PHCs. In response, the Race Equality Foundation, with input from NHS England and the Department of Health and Social Care, developed a training package to raise awareness of PHCs and boost attendance among minoritised ethnic communities living with SMIs. This training was delivered to 12 voluntary organisations between December 2023 and April 2024.
By improving staff knowledge and awareness, PHCs have the potential to change the narrative for people living with SMIs from Black African and Caribbean backgrounds, helping to close the health disparity gap.
On World Mental Health Day, it is essential to recognise that we cannot address mental health without tackling the systemic barriers that prevent equal access to care. Initiatives like PHCs, which emphasise both mental and physical health, are vital steps toward a more equitable and inclusive mental health system for everyone.
Read our report here
Bibliography
Bansal, N., Bhopal, R., Netto, G., Lyons, D., Steiner, M. F., & Sashidharan, S. P. (2014) Disparate patterns of hospitalisation reflect unmet needs and persistent ethnic inequalities in mental health care: the Scottish health and ethnicity linkage study. Ethnicity & Health, 19(2), 217-239.
Bignall, T., Jeraj, S., Helsby, E. and Butt, J. (2019) Racial disparities in mental health: Literature and evidence review. London: Race Equality Foundation.
Care Quality Commission. (2018) Mental Health Act the Rise in the use of the MHA to Detain People in England. London: CQC.
Correll, C.U., Lencz, T. and Malhotra, A.K. (2011) Antipsychotic drugs and obesity. Trends in molecular medicine, 17(2), pp.97-107.
Das-Munshi, J., D. Bhugra, and M. J. Crawford. (2018) Ethnic Minority Inequalities in Access to Treatments for Schizophrenia and Schizoaffective Disorders: Findings from a Nationally Representative Cross-Sectional Study. BMC Medicine 16: 1.
Degnan, A., Berry, K., Vaughan, M., Crossley, N., & Edge, D. (2022) Engagement with services in Black African and Caribbean people with psychosis: The role of social networks, illness perceptions, internalised stigma, and perceived discrimination. British Journal of Clinical Psychology, 61(4), 1134-1153.
Hayes, J.F., Marston, L., Walters, K., King, M.B. and Osborn, D.P. (2017). Mortality gap for people with bipolar disorder and schizophrenia: UK-based cohort study 2000–2014. The British Journal of Psychiatry, 211(3), pp.175-181.
Lawrence, V., McCombie, C., Nikolakopoulos, G., & Morgan, C. (2021) Ethnicity and power in the mental health system: experiences of white British and black Caribbean people with psychosis. Epidemiology and Psychiatric Sciences, 30, e12.
NHS England. (2024) Improving the physical health of people living with severe mental illness. Available at: https://www.england.nhs.uk/long-read/improving-the-physical-health-of-people-livingwith-severe-mental-illness/
O’Gallagher, K., Teo, J. T., Shah, A. M., & Gaughran, F. (2022) Interaction Between Race, Ethnicity, Severe Mental Illness, and Cardiovascular Disease. Journal of the American Heart Association, 11(12), e025621. Article e025621.
Public Health England. (2018) Severe mental illness (SMI) and physical health inequalities briefing. Available at: https://www.gov.uk/government/publications/severe-mental-illnesssmi-physical-health-inequalities/severe-mental-illness-and-physicalhealth-inequalities-briefing#fn:1
Walker, S., Mackay, E., Barnett, P., Rains, L.S., Leverton, M., Dalton-Locke, C., Trevillion, K., Lloyd-Evans, B. and Johnson, S. (2019) Clinical and social factors associated with increased risk for involuntary psychiatric hospitalisation: a systematic review, meta-analysis, and narrative synthesis. The Lancet Psychiatry, 6(12), pp.1039-1053.