CALL TO ACTION: The Mental Health of BAME Communities During COVID-19

Written by Nada Abou Seif, Amy Campbell, Angela Song Chase, Brian Chi Fung Ching, Jane Sungmin Hahn & Merle Maria Schlief. Co-produced with Zenni Enechi.

This blog aims to provide an overview of the impact of COVID-19 on BAME mental health. It has been written for a wide range of people, and as such, has been co-produced with a review panel of diverse ages, qualifications, and ethnicities.

As of the 15th of August 2020, there have been 41,361 deaths due to COVID-19 in the UK [1]. As we know, COVID-19 has had a significant impact on physical health across the world [1]. However, it has also had a large impact on mental health and will likely continue to do so [2]. With existing social and health disparities [3], this then raises the question of what impact this will have on the mental health of BAME communities specifically.

COVID-19 has resulted in health and financial concerns for people around the world, which has increased reported feelings of stress, anxiety, and depression [4-6]. One study showed that 21% more people reported poor mental health during the pandemic than before it [7]. Although lockdown and self-isolation measures have been implemented to protect us from COVID-19, they are also associated with negative mental health effects, such as anxiety, depression, loneliness, stress, confusion, and anger [8-10]. Certain factors may increase the risk of experiencing these mental health consequences, such as [4,10]:

• Being hospitalised for COVID-19

• Loss of loved ones and interrupted grieving (e.g. not being able to attend funerals)

• Higher exposure to infection (e.g. frontline work)

• Occupational factors (e.g. job loss)

• Social vulnerabilities and inequalities (e.g. poverty)

People from BAME communities are more likely to be exposed to these potentially traumatic risk factors. BAME populations are more likely to work on the COVID-19 frontline, with 20% of NHS employees being BAME [11], despite only making up 13% of the UK population [12]. BAME groups are also less likely to be able to work from home during the pandemic, with Black people being more likely to work in care roles than other groups, and Pakistani and Bangladeshi people being more likely to work in operative roles [13]. This is clearly translated into increased COVID-19 infection and death rates in BAME populations, as the Public Health England [14] report states that they are more likely to require admission to intensive care compared to White-British counterparts, and that being Black, Bangladeshi, Pakistani, or Indian increases the likelihood of dying from COVID-19 by 1.5-1.9x. Almost 35% of Black adults report knowing someone who has died or been hospitalised due to COVID-19 versus only 19% of Hispanic people and 18% of White people [15].

These greater rates of death and infection have a great impact on people’s anxieties during this pandemic - in comparison to White people, Black and Hispanic individuals are more likely to be concerned about contracting COVID-19, being hospitalised, and unknowingly spreading the virus [15]. BAME communities may be additionally fearful that members of the public may perceive them to be of high risk and thus, feared, avoided, or even mistreated, which may worsen well-being even further. Given their increased exposure to risk factors for poor mental health, it makes sense that BAME individuals report significant dismay and fear that they have been hit the worst by the pandemic [16].

The disproportionate impact of COVID-19 on the mental health of BAME people is also likely to worsen disparities that already exist in the way BAME individuals experience mental health care. People from BAME groups are less likely to seek help for their mental health [17,18]; this may be due to cultural stigmas associated with help-seeking [19], BAME people feeling that clinicians have a poor understanding of different cultural needs [20], and even expecting or experiencing racism within services [21]. Indeed, there is evidence that BAME people are less likely to be offered suitable therapies, and Black persons in particular are more likely to be involuntarily hospitalised or over-medicated in UK mental health services [17, 18]. If a BAME mental health crisis were to occur due to COVID-19, BAME people may not seek support from services which are currently ill-equipped to respond compassionately or appropriately.

CALL TO ACTION

Given that BAME communities experience greater exposure to risk factors for poor mental health, and the pandemic has emphasised social and health disparities in the UK which have been repeatedly linked to poorer mental health in BAME communities [35-40], attention and resources must be focused on understanding and protecting the mental health of BAME individuals. Where do we go from here?

1. It is crucial that we foster an environment where individuals of ethnic minorities are actively encouraged to take up space as mental health professionals, whether in a clinical or research capacity. They should be represented at all levels of the professional ladder, including leading roles.

2. The ability to explore and understand other cultures must be viewed as a vital skill. Therefore, all mental health professionals should undertake cultural competency training wherein their own biases are acknowledged and addressed. This should encompass an awareness of the disproportionate effects of COVID-19 on BAME groups that leads to compassionate, trauma-informed practice and treatment of BAME individuals both during and after the pandemic [37].

3. Future mental health research should aim to gain a rich understanding of BAME experiences primarily through active involvement of BAME people in designing and producing research and by engaging BAME individuals in qualitative research, such as interviews [41]. This could also serve to foster better relationships between the research community and ethnic minorities [37].

4. Moving forward, research should break down the “BAME” grouping and fully reflect all of the diversity within the people they are studying [42]. Current research often includes only a small number of BAME individuals, restricting researchers to the comparison of “White” vs “BAME”. This is unlikely to provide an accurate representation of BAME mental health [43], as homogenising the experiences of ethnic minorities results in a loss of nuance.

Applying these recommendations will allow us to better understand the social and political context that ethnic minorities live within and the potential traumas associated with it [44-46]. This understanding will enable us to develop and implement a mental health care system which works for every individual. Although our focus is on mental health, these recommendations are applicable to every discipline, and each discipline should strive to independently carry out inclusive and collaborative work. However, to build the most comprehensive understanding possible, disciplines should band together. We believe that the recommendations above should be the standard for future research and clinical work. Currently, addressing issues of ethnic minorities is generally a secondary aim, if an aim at all. However, the aim of research and clinical work is to understand and benefit the human experience. If we do not understand and benefit the experience of ethnic minorities, then this has not been achieved.

If you would like to learn and do more, here is a helpful list of accounts and websites to visit:

Instagram accounts to follow:

+ @blackmindsmatter.uk – Black mental health resources and therapy for Black trauma

+ @inclusivetherapists - A resource for accessible therapy for all identities, promoting BAME therapists and cultural affirmation, including training for therapists.

+ @diveinwell - An online community space for diversity in wellness.

Twitter accounts to follow:

+ @PsychSocChange - Psychologists for social change

+ @MinoritiesGroup - Supporting minoritised groups within clinical psychology

+ @Equalitytrust - A UK Charity aiming to improve quality of life by reducing socioeconomic inequality

Websites to visit:

+ https://www.mentalhealth.org.uk/a-to-z/b/black-asian-and-minority-ethnic-bame-communities

+ https://www.blackmindsmatteruk.com/

We would like to extend a big thank you to our panel of reviewers: Aarinola Ayo-Ipaye, Honey Ajisefini, Elymma Mensah, Jae Youn Jung, Kam Bering, Kanchelli Iman Yaa Iddrisu, Tasinda Bering & Teja Singh.

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