Covid-19 and BAME mental health

It is easy in a crisis to revert to familiar ways of working but, in our experience, institutions end up reinforcing structures of racial inequality. The Adhar Project is already seeing the signs that this pandemic will have a significant impact along ethnic lines. Leicester is one of the most diverse cities in England with nearly half the population of Leicester city from diverse ethnic and cultural communities. Black Asian and Minority Ethnic (BAME) citizens are disproportionately represented in mental health care services. BAME citizens are more likely to be diagnosed with a serious mental illness, such as schizophrenia, than their White counterparts. Research from a number of bodies has evidenced this. (Mental Health Foundation, MIND, Race Equality Foundation)

Small, local BAME charities are struggling to survive amid austerity cutbacks and the unabated shift to a contract culture. Staff turnover in the sector is rapid, mainly as a result of small charities only having the capacity to offer short-term contracts. Moreover, many small charities have been forced to make substantial changes to their services in order to match the funding conditions set by local authorities and other contract providers – often steering them away from their core mission. This shift in the priorities of funders has forced BAME groups to find ways to fit in with current policy fashions, drawing them away from their original aims and purpose to meet new requirements. Average funding for BAME organisations is around half the average, and surveys of BAME groups indicate they are experiencing more rapid reductions in their funds than mainstream charities. (Bridging the gap in funding for the BAME voluntary and community sector -Voice4Change England and The Baring Foundation July 2015).

There are very few small BAME specific mental health organisations that have managed to survive in this environment. A rare exception is the Adhar Project in Leicester. When people talk and think about mental health and the charitable sector, they often reference Mind, Rethink and other big national charities. However, it is the smaller BAME specific mental health charities that have the reach into these diverse communities, which are the most affected by serious mental health disorders. The effective work done by the Adhar Project often goes unnoticed and underfunded because the big national mental health charities dominate the public sphere, reducing the amount of funding available to small charities and drawing media coverage of mental health issues away from local concerns and good practice. These large charities attract money because they are in the public consciousness. And they can use the money they get to stay in the public consciousness.

National charities have the luxury of dedicated fund-raising teams, parliamentary liaison workers, press officers, media campaigners, business sponsorships, royal patronage and high-profile people on their boards. A report by NCVO and the Commission on Donor Experience suggests that total giving to charity hasn’t changed meaningfully over time, but that it is possible to secure a bigger slice of the fundraising pie if you push aggressively to get it. In other words, as the big charities have dedicated themselves to raising more money, they haven’t increased the amount donors give, but have drawn more to themselves.

This has effectively reduced the fundraising income of other smaller but equally valuable and often more accountable charities. (David Ainsworth, Civil Society 28th Oct 2016) This has created a pernicious self-perpetuating cycle of beneficial influence that small locally based charities cannot break, leaving many with no choice but to fold. In order to preserve the independence and uniqueness of the UK’s small BAME mental health charity sector, it is essential that BAME specific, sustainable, less conditional sources of funding are found.

It is also true that lack of BAME representation and leadership has also had an impact on BAME organisations, for example, if all those at the top of local authority leadership are white men and white women who award contracts or make key decisions of funding the voluntary sector it can also impact, sometimes negatively on isolated BAME specific charities. This has been happening for many years, in particular since 2012 Health and Care Act as Roger Klein’s research into discrimination in NHS leadership and impact on patients showed.( Snowy White Peaks paper) “when things get difficult, diversity and inclusion can go out of the window” (April 2020, Equality diversity and inclusion at time of crisis and beyond by Sam Allen, Dr Navina Evans and Rob Webster) therefore, BAME representation at leadership levels is essential to ensure equality does not fly out of the window but that a door is opened to allow us in… Local Authorities and Health do have Equality Officers but their work is often limited, they must be given departmental budgets to ensure that they make key decisions alongside with local Councillors and BAME service users to ensure BAME specific mental health provision is procured to meet the needs of the BAME communities.

We've been working extremely hard to address these historical disparities, Adhar has kept open throughout this crisis, immediately developed and increased out of hours support without additional funding. First two week of the lockdown we received 93 calls for mental health support, many BAME callers reporting they were unable to get access and support from elsewhere in Leicester and Leicestershire. We are not all in this together! While anxiety is a natural and widespread reaction, the impact of COVID-19 falls most heavily on those with the fewest social and economic resources to alleviate the effects of social restrictions. Enforced social isolation disproportionately affects those in:

• deprived neighbourhoods
• insecure jobs and/or low-income jobs
• insecure/ overcrowded housing
• single parent households
• abusive relationships/domestic violence
• Substance Misuse • Mental Health
• Physically disabled
• Trafficked and Modern Slavery

We know that these are all aggravating factors experienced by the majority of the people the Adhar Project supports. It also acutely affects those with existing mental health problems, whose symptoms may worsen when access to help is limited. This includes when contact with care workers – often the sole source of social contact – is reduced or lost altogether. The emergence of online resources, designed to help maintain good mental health during the current crisis, is essential, but is currently restricted to those with access to, and can afford the appropriate technology.

The Adhar Project is supporting with therapeutic treatment from mental health professionals, to manage the anxieties, fears and distress of people with existing mental health problems. We have seen an increased cry for help from BAME community for bereavement counselling and welfare benefits advice and advocacy. All of the Adhar Project team are working hard to adapt their practice to meet the unprecedented and ever-increasing demand in creative and innovative ways.

Yet, resources for black mental health are not prioritised, and we will struggle to meet the increased demand from our communities. So, as a society we need to do more. Because COVID-19 is damaging our social life and the communities in which we live and thrive, we need policy and community-level responses. Informed by robust research and funding these responses should reduce uncertainties in people’s lives restore and build social connections In short, we need policy- and community-level responses that promote and sustain mental health.

It is by responding appropriately and addressing these root causes that we will prevent understandable worry, sadness and distress from crystallising into more persistent anxieties, hopelessness, and depression.

The government will need to do so much more to reach communities who historically already have distrust of certain authorities. Implicit biases and structural discrimination in the healthcare system have stacked the odds against minority communities. There are pre-existing ethnic disparities and inequalities in health care outcomes and health care access. Although many people from BAME communities come into regular contact with the NHS, they do not necessarily trust it. They would be hesitant to take a coronavirus vaccine, at least initially. There is an urgent need to stop seeing the pandemic as a medical problem but to see it as a public health problem.

The impact of COVID-19 is unprecedented, and we will not know the full effects for some years. What is clear is that unless better policies and funding are put in place urgently, they could actually make disparities worse. Not only could BAME communities be at greater health risk in the short term, but they could feel the repercussions in less obvious ways for a long time into the future. A plethora of socio-economic and political factors exacerbate the impact of the virus on those who fall sick. The unequal consequences of Covid-19 in the BAME communities is a preventable bio-social injustice for which there will be far reaching consequences for society and policy makers alike.

Written by Harjit Sandhu, Susan Brennan, and Ivor Humphrey