Updated evidence on how people access mental healthcare in England reveals persisting – although not worsening – inequalities in health service use and referral methods for severe mental illness, with negative effects for patients from ethnic minority backgrounds. The findings are presented in a study published in the open access journal BMC Medicine.
A team of researchers led by Queen Mary University of London, UK, conducted a systematic review of 40 review articles mapping the evidence on ethnic inequalities in mental health care in England. They then supplemented this with up-to-date evidence from studies on pathways to care conducted in England between 2012 and 2017. They caution that inconsistency in the analysis or reporting of the included studies may mean that undetected factors have impacted the observed ethnic variations in access to care.
Professor Kamaldeep Bhui, corresponding author of the study, 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.”
The authors 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 same was found for patients identified as White Other, compared to White British patients. Compared to patients of any White background, those of any Black background were found to be less likely to have GP contact on their way into care, whereas those of South Asian background were more likely to have GP contact.
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 have not materialized.
Professor Bhui said: “The finding of inequalities in access to mental healthcare in England is consistent over many decades and has not got worse with austerity. Yet, the inequalities we have observed have persisted despite investment in community care, race equality programmes, and awareness that the Mental Health Act needs reform and better standards of practice that consider cultural background. 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.”
The authors hope that the findings of the present study may increase awareness and inform policy and practice.
Professor Bhui said: “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. 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. The lessons learned may be transferable to other national contexts. One of our challenges it that patients from ethnic minority backgrounds are less likely to enter research projects. More needs to be done to test interventions to reduce inequalities in populations as well as in care services.”
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Notes to editor:
1. Research article:
Ethnic inequalities and pathways to care in psychosis in England: A systematic review and meta-analysis
Halvorsrud et al
BMC Medicine 2018
DOI: 10.1186/s12916-018-1201-9
The article is available at the journal website.
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