Skip to content
Search

Latest Stories

Talking about and tackling racism in mental health care

Talking about and tackling racism in mental health care

Racial justice is essential in all democracies and progressive societies, which seek to learn from historical examples of persecution, incarceration, and enslavement on the basis of race.

Anti-slavery and civil rights movements in the North America and Europe led to greater freedoms, alongside campaigns to tackle gender disadvantage and discrimination.


Healthcare is a product of generations of societal and institutional policies and wider sentiments in society which evolve with time.

History also shows many examples of scientific racism and the use of medical power and authority as an agent of the state. This is a worrisome possibility against which health professionals, professional regulators, charities, and membership societies battle.

Therefore, although it may be difficult to accept, racism is evident in medical and nursing training, in the current delivery of care, in knowledge production and research, and the formulation of our laws and policies and in NHS care.

The NHS leadership recently committed to an anti-racist strategic plan for medicine. Much is being done to tackle racism in these arenas, especially since we lived through COVID-19 and Black Lives Matter, dystopian reminders of how poorly we have understood or dismantled structural drives of inequalities, health inequalities, and racism specifically.

Yet racism and discrimination more generally are common, with up to a third of people in population survey accepting they discriminate against other on grounds of protected characteristics. There is often silence when racism is felt, or reported, so there is little research on how it manifests, and what we can do about it. Many public institutions repeatedly fail to put in placed sustained actions that accept and respond to racism, including police, education, criminal justice and in employing organisations. Furthermore, racism mostly affects those at the intersections of multiple disadvantages, and they are the most vulnerable to its pernicious effects on health.

Racism comes in many forms and is associated with poor physical and mental health, as well as social, financial, education, and societal consequence including likelihood of entanglement in the criminal justice system.

Racism in mental health care has been topical precisely because attempts to explain the racial and ethnic disparities in the incidence of mental health problems, psychosis specifically, and because racial and ethnic minorities are more likely to receive coercive care, for example, by detention and forced treatment under the powers of legislation (the mental health act), and less access to appropriate psychological and social therapies.

Given decades of data showing racial and ethnic disparities in mental health care, it is surprising little has shifted, in part as the structural drivers of racism have not been understood to taken seriously.

Talking about racism and responding to is not easy. Racism is experienced as thorny and sensitive topic; people fear offending each other and that their vocabularies and lived experiences are not conducive to empathising or understanding what it is like to be on the receiving end of racism. They fear racist attitudes and behaviours might be exposed and condemned, and they will be vilified.

Our new paper (from Oxford, QMUL and Birmingham and published in the British Medical Journal Mental Health, funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration – North Thames) looked at in-depth interviews with 10 people and identified some explanations for why and how racism persists on inpatient mental health. We used novel methods that are fully explained in the paper.

For methods experts and critics, we undertook secondary analysis of experience data, collected through qualitative interviews, and we applied critical realist methods to better understand how contexts trigger particular mechanisms, to produce particular outcomes in those contexts. Therefore, we expose common mechanisms by which racism is generated and persists. These should be the focus of future intervention and evaluation against health, social, and quality of life outcomes for patients and staff working in these challenging environments.

Our paper shows how racism manifests and persists on inpatient mental health units through the following mechanisms:

  • An absence of safe spaces to discuss racialisation which silenced and isolated patients
  • Strained communication and power imbalances produced mutual racialisation by patients and staff.
  • Non-reporting of racialisation and discrimination, which led to feeling othered, misunderstood, disempowered and fearful.
  • Furthermore, persistent racialisation prevented authentic feedback and staff-patient rapport and the opportunity to help recovery and respond to patients’ concerns.
  • Racialisation went both ways, between staff and patients, contributing to a toxic and unhealthy environment for both, given we know experiencing racism is bad for your health.

The findings are surprising given the emphasis in professional training and public institutions to stamp out discrimination. Therefore, people already in distress, and who may be detained or living on the inpatient unit voluntarily to receive care, are met with further traumatic experiences that hinder recovery. Our paper clearly shows opportunities for creating safer environments in which people who are suffering mental illness and are detained.

Racism is a public health problem given it is common and is known to affect health and wellbeing through interpersonal, institutional and structural manifestations. However, whenever there is an attempt to acknowledge and respond to racism, history shows many examples of resistance to such ideas. This comes in many forms: denial, personal objection and counter-claims of being vilified and ill-treated, government proclamations as well as institutional assertions of equity and fair principles in public institutions.

Changing the way racism is dealt with may help improve safety and recovery more generally, but policy makers, commissioners, managers and practitioners must commit to dismantle cultures of silence, improve training and skills in cultural capability, ensure reporting processes are known and taken seriously with visible actions. Particularly sad is people on inpatient mental health units are admitted in order to protect and promote their mental health, not to compound it, especially if they are there under the powers of the Mental Health Act, when they cannot leave.

CHiMES manifesto of proposed actions:

  • ‘You said – we did’ statements on racism on inpatient mental health units and throughout health and social care.
  • Detailed experiential, co-designed, participatory research to understanding how to support practitioners, and patients encountering racism.
  • All health, social care, and public policies need to be tested for equalities impacts, including race equality.
  • Development and implementation of co-designed experience driven systems interventions.
  • NHS Leadership Teams must put in place trauma-informed systems for reporting and responding to racism, discrimination, and gathering authentic experience data to improve safety and quality
  • Recruitment, training, and retention of staff needs to better recognise the knowledge, skills and attitudes required to combat racism in inpatient and community care, especially for those facing coercive care.
  • Public health actions, including curricula in schools, universities and apprenticeships, must embed the conceptual tools and skills to talk about and address injustice and inequity in society, including racism and mental health.

Prof. Kam Bhui CBE MD FRCPsych

CHiMES collaborative, University of Oxford.

Building interdisciplinary, creative, lived experience coalitions to protect and promote equity and mental health across the life course.

More For You

Chelsea Flower Show highlights Royal-inspired roses and eco-friendly innovation

King Charles III, patron of the Royal Horticultural Society, walks through the RHS and BBC Radio 2 Dog Garden during a visit to the RHS Chelsea Flower Show at Royal Hospital Chelsea on May 20, 2025 in London, England.

Getty Images

Chelsea Flower Show highlights Royal-inspired roses and eco-friendly innovation

Rashmita Solanki

This particular year at the Royal Horticultural Society’s Chelsea Flower Show, there have been two members of the Royal Family who have had roses named after them.

‘The King’s Rose’, named after King Charles III, and ‘Catherine’s Rose’, named after Catherine, Princess of Wales. Both roses have been grown by two of the most well-known rose growers in the United Kingdom.

Keep ReadingShow less
‘Going Dutch may be a solution to get the UK’s jobless into work’

The growing number of working-age adults not in jobs places a huge financial burden on Britain, according to recent reports

‘Going Dutch may be a solution to get the UK’s jobless into work’

Dr Nik Kotecha

ECONOMIC inactivity is a major obstacle to the UK’s productivity and competitiveness.

As a business owner and employer with over 30 years of experience, I have seen firsthand how this challenge has intensified as the economically inactive population approaches 10 million nationally - almost one million more than pre-pandemic.

Keep ReadingShow less
Understanding the Hindu Psyche: Averse to Confrontation?

Artistic depiction of Arjuna and Krishna with the chariot

Is Hindu psyche averse to confrontation?

Nitin Mehta

Over 5,000 years ago, on the battlefield of Kurukshetra, two armies comprising tens of thousands of men were ready to begin a war. The Pandavs were led by Arjuna, a warrior whose archery skills were unbeatable. At the last minute, before the war was to commence, Arjuna put down his weapons and declared to Krishna his decision not to fight. He reasoned that the war would kill tens of thousands of people all for a kingdom. It took the whole of the Bhagavad Gita to convince Arjuna to fight.

Even after Krishna destroyed all his doubts, Arjuna asked to see Krishna in his form as a supreme God. In short, Arjuna wanted to avoid confrontation at any cost.

Keep ReadingShow less
How Indian news channels used fake stories and AI to grab attention

The mainstream print media in India, both in English and regional languages, has remained largely responsible and sober

How Indian news channels used fake stories and AI to grab attention

MISINFORMATION and disinformation are not new in the age of social media, but India’s mainstream news channels peddling them during a time of war was a new low.

Hours after India launched Operation Sindoor, most channels went into overdrive with ‘breaking news’ meant to shock, or worse, excite.

Keep ReadingShow less
war and peace

A vivid depiction of the Kurukshetra battlefield, where Arjuna and Krishna stand amidst the chaos, embodying the eternal conflict between duty and morality

Artvee

War and Peace are two sides of the same coin

Nitin Mehta

War and peace have exercised the minds of human beings for as far back as history goes. It is no wonder then that the Mahabharata war, which took place over 5,000 years ago, became a moment of intense discussion between Lord Krishna and Arjuna.

Hundreds of thousands of people on either side were ready to begin battle on the site of Kurukshetra. Seeing the armies and his near and dear combatants, Arjuna lost the will to fight. How could he fight his grandfather Bhisma and his guru Dronacharya? He asked Krishna what all the bloodshed would achieve.

Keep ReadingShow less