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Photography Imran Suleiman

Racism is rife in NHS mental health services, report finds

A new review has revealed the extent of ethnic inequalities in UK healthcare

Any person of colour knows that racism is rife in healthcare, but a new review commissioned by the NHS Race and Health Observatory has proven this beyond doubt. According to the review, racism, racial discrimination, barriers to accessing healthcare and a lack of data collection have “negatively impacted” the health of Black, Asian and minority ethnic people in England for years. Experts have said that “radical action” is urgently needed to tackle these shocking inequalities.

“Ethnic inequalities in health outcomes are evident at every stage throughout the life course, from birth to death,” the review reads. However, despite “convincing” evidence that people of colour are being failed by the system, no “significant change” has yet been made in the NHS.

The review painted a particularly bleak picture of mental healthcare. It found that minority ethnic groups were less likely than white British patients to be referred to Improving Access to Psychological Therapies (IAPT), a programme set up to aid the treatment of anxiety and depression in England.

Even when minority ethnic patients are referred, they are still less likely than white British patients to receive an assessment. Minority ethnic people with psychosis are also less likely to be referred for cognitive behavioural therapy (CBT), while Black patients on psychiatric wards were more likely to receive harsher treatment. Ultimately, the review concluded that these inequalities in the NHS “are rooted in experiences of structural, institutional and interpersonal racism”.

Christina*, 24, has experienced racism within the NHS firsthand. In 2017, she approached her GP to share her concerns about her mental health. “I explained to my doctor that I felt very low, quite suicidal. I just didn’t want to be alive anymore,” she explains. “I was asking what support and help I could get and he basically said to me ‘it seems like you’re bored.’ He didn’t understand because it seemed like there was nothing wrong in my life for me to be feeling that way, so he thought ‘maybe it’s just boredom.’”

Christina’s GP’s words had a profound, detrimental effect on her. “That was the worst thing that someone could say to me. As a result, I didn’t return to a GP for four years. I was very put off by that experience and didn’t really trust GPs as a result.” When Christina returned to a GP last year, she was finally diagnosed with depression, PTSD, and anxiety. “I do reckon that racism had an impact,” Christina says, reflecting on why it took so long to get her diagnosis. “I am Black and I think there is a kind of stereotype around Black women being strong.”

21-year-old Samira* has also struggled to access adequate mental healthcare through the NHS. “I’ve been struggling with my mental health since I was around 11 or 12. It has been notoriously difficult to get support from the NHS over the past decade,” she tells Dazed.

“I explained to my doctor that I felt very low, quite suicidal... I was asking what support and help I could get and he basically said to me ‘it seems like you’re bored” – Christina, 24

Samira – who is Asian – adds that she also believes racism made her experience more difficult. “I think nobody really expects someone like me to experience mental health issues and looking back, race was a big part of why I felt so awful all the time, especially growing up. I was never believed.”

“When I did finally get to go through the young people’s department for mental health, they kept dismissing me and almost gaslighting me about my problems even though I was saying ‘I’m severely suicidal,’” Samira recalls. “They’d just be like, ‘it’s normal for people at this age.’ But it’s not normal to want to die.”

Similarly, Zuva, 26, found it difficult to receive the treatment they needed. As a teenager they went to their GP for help with their mental health issues for the first time, opening up about their experience of physical and emotional abuse. “Although my GP was sympathetic, he did nothing,” Zuva recalls. “He also told me to report my parents to social services, which wasn't possible. After that point, I was very hesitant to seek mental health support. I felt that the mental health practitioners didn't get it.”

As a university student, they made another GP appointment to discuss the possibility that they had borderline personality disorder. “I was seen by a different female doctor who pretty much put all my feelings down to hysteria. She told me it was likely the issues I had were due to hormonal issues and that once I was settled, I would be fine. Bearing in mind I was 21 at this point,” Zuva says. They pushed for another appointment with another GP, who thankfully advised Zuva to see a psychiatrist and remain on the IAPT waiting list.

“Nobody really expects someone like me to experience mental health issues and looking back, race was a big part of why I felt so awful all the time... I was never believed” – Samira, 21

Ultimately, it was only after Zuva moved abroad to South Africa that they were finally diagnosed with inattentive ADHD. “When I was first diagnosed, I was incredibly angry that it had been missed by doctors and medical practitioners while I was in the UK. For me, ADHD wasn’t even an option, and I wasn't screened for it. But when you look at my history and issues, the symptoms are so clear,” they say. “I think with minorities, there is a lack of interest or care. Our symptoms are seen as misbehaviour or social issues rather than health issues that deserve care and attention.”

They continue: “The report, to me, isn't shocking. Yes, the NHS is struggling, but our issues are either criminalised or seen as social. No one seems to care about us. We shouldn't have to wait for that one good doctor to take our issues seriously.”

In response to the review, an NHS spokesperson said: “The pandemic has shone a stark light on health inequalities across the country and the NHS is already taking action to improve the experiences of patients and access to services. The NHS has set out what local health services should be focusing on over the next year so they can make these improvements in their local communities and is already working closely with the Race and Health Observatory to drive forward the recommendations set out in this report.”

However, the spokesperson did not specify what action the NHS was “already taking” on health inequalities nor explain which specific recommendations it would “drive forward.” Historically, the NHS has done little to improve healthcare inequalities for ethnic minorities, and evidently it’s still unclear how they intend to address this urgent issue. But as the review stresses: radical change is long overdue. 

*Names have been changed