We laud the aims of Emily Holmes and colleagues1 to highlight the impending mental health consequences of COVID-19, especially the call to ensure there is a joined-up multidisciplinary response. The authors note the impact of COVID-19 on vulnerable groups. For people from Black, Asian, and Minority Ethnic (BAME) groups, there are already significant mental health inequalities. These inequalities warrant a specific research response above and beyond that expressed in this report.
The Position Paper by Holmes and colleagues was informed by surveys from the health research charity MQ: Transforming Mental Health and Ipsos MORI. However, only 160 (8%) of 2000 respondents surveyed by the charity were from a BAME group, compared with around 14% in the UK population. These 160 people included about 20 respondents from Black or Black British backgrounds. Because those surveyed included carers and health professionals (40%) as well as people with direct experience of mental health problems (60%), it is probable that only 12 respondents were Black people who had lived experience of mental illness. Moreover, the Ipsos MORI survey, including 1099 people from the general population, did not report ethnicity. These unrepresentative surveys overlook a substantial section of the population that appears to be especially at risk of COVID-related complications, mental health sequelae, and death.2, 3, 4
Phoebe Barnett and colleagues5 found that researchers tended to aggregate heterogeneous BAME groups and appeared to entrench narratives of racial determinism. The authors argued that the nature and structures of the research process are subject to biases from the outset. Without a response that specifically aims to understand the mental health needs of different BAME people, inequalities will be sustained and widened.
In addition to specific research focusing on the post-COVID-19 mental health needs of the diverse range of people who are grouped under the abbreviated term BAME, we propose that at the outset of any research, there should be a race equality impact assessment applied to the research questions and the methodology. When reporting findings, authors should be expected to state how they think their research might affect those from ethnic minority groups. Funding bodies and journal editors should expect to see this race equality impact assessment, just as they now increasingly expect to see a Patient and Public Involvement statement and assessment. In doing so, mental health research is likely to become more relevant to those from ethnic minority backgrounds and to be more likely to provide effective interventions that have lasting positive effects on the mental health of BAME populations over time. Just as the inclusion of a Patient and Public Involvement element into all research has become standard practice, so should the inclusion of a race equality impact assessment.
Acknowledgments
JD-M reports grants from the Economic and Social Research Council, and grants from the Health Foundation and the Academy of Medical Sciences. NL reports personal fees from Xenzone Limited, and personal fees from the South London and Maudsley NHS Foundation Trust, outside the submitted work; and will soon become Chair of the Children's and Young People's Mental Health Coalition, outside the submitted work. SG reports non-financial support from Mind (National), non-financial support from Association of Mental Health Providers, non-financial support from University of Wolverhampton, non-financial support from the Public Health England and National Suicide Prevention Alliance, personal fees from the Department of Health & Social Care, personal fees from NHS England, personal fees from Care Quality Commission, from Royal College of Psychiatrists, personal fees from West Midlands Combined Authority, personal fees from 4 Mental Health, personal fees from Think Ahead, personal fees from Thalamos, personal fees from Xenzone, personal fees from National Collaborating Centre for Mental Health, personal fees from Mind, and personal fees from the Centre for Mental Health, outside the submitted work. SH reports grants from the Economic and Social Research Council, grants from the UK National Institute for Health Research, grants from Wellcome Trust, grants from Guy's and St Thomas' Charity, outside the submitted work; and is a member of the following advisory groups: NHS England/NHS Improvement Patient and Carers Race Equalities Framework Steering Group, NHS England/NHS Improvement, Advancing Mental Health Equalities Taskforce; Health Education England, Mental Health Workforce Equalities Subgroup; Maudsley Learning, Maudsley Learning Advisory Board South London and Maudsley NHS Foundation Trust; Independent Advisory Groups, the SLaM Partnership Group; Lambeth Public Health, Serious Youth Violence Public Health Task and Finish Group; NHS England, Workforce Race Equality Standard Advisory Group; Thrive London, Thrive London Advisory Board Black Thrive; and Black Thrive, Black Thrive Advisory Board. All other authors have nothing to disclose.
References
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