Understanding and responding to the drivers of inequalities in mental health

• Published in: BMJ mental health 2023-12, Vol.26 (1), p.e300921
• Main Authors: Bhui, Kamaldeep, Cipriani, Andrea
• Format: Article
• Language: English
• Subjects: adult psychiatry; Adverse childhood experiences; COVID-19; depression & mood disorders; Developing countries; Editorial; Ethics; Humans; Industrialized nations; Interdisciplinary aspects; LDCs; Medical ethics; Mental disorders; Mental Health; Minority & ethnic groups; Poverty; psychiatry; Psychosis; Psychotic Disorders; Schizophrenia; Schizophrenia & psychotic disorders; Trauma
• ISSN: 2755-9734; 2755-9734
• DOI: 10.1136/bmjment-2023-300921

Correspondence to Professor Kamaldeep Bhui, Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK; [e-mail] BMJ Mental Health is delighted to announce a new section called Experience, Ethics, Equity that seeks submissions of primary research, systematic reviews, and perspectives and commentaries. Causal complexity Mental illness affects the most vulnerable, those who have experienced multiple adversities from an early age, throughout their lives, where supports and coping styles no longer help.5 6 Some people are exposed to a greater number of adversities, risk factors for mental illness, including poverty and deprivation and violence, while others are vulnerable given disadvantaged early childhood and family environments and adverse childhood experiences.7–9 Poor mental health, and the lack to support and resource can be risk factors contributing to drifting into unemployment, poverty or housing crises. Across cultures and ethnicities, there are variations in explanatory models of causation and preferred care.10 Globally, there is differential investment and variations in resources to support people with mental illness, especially in low/middle-income countries where most people in the world live in poverty and investment in protections and care is minimal.11 There is a higher incidence of psychosis among ethnic minorities and refugees in the high-income countries, as well as among migrants more generally.12 13 There are also greater risks for women and children exposed to disadvantage and violence.14–16 Ethnic minorities and migrants receive more coercive care through crisis, emergency, police and criminal justice system contact, more risk of self-harm and suicide, with insufficient attention in prevention and treatment policy and practice.16 17 They are also less likely to receive effective healthcare such as cancer or cardiac care, so health systems in general need review and reform.18–20 Of course, intersectional and complex identities across vulnerable groups pose even greater risk as they are rendered invisible, not represented in routine data or ethnic and racial categories, or even in the full list of protected characteristics enshrined in law. Ethnic minority representation in UK COVID-19 trials: systematic review and meta-analysis.