RCPsych response to the report of the Commission on Race and Ethnic Disparities
Yesterday, the Government’s Commission on Race and Ethnic Disparities (CRED) published its report suggesting that structural racism does not exist here in the UK. We see this as another wasted opportunity for the Government. We recognise that people from ethnic minority groups will likely feel let down, anger and sadness at the CRED report.
It is deeply disappointing that the report failed to take notice of the compelling evidence that racial disparities in health, and particularly in mental health, are driven in large part by social factors which are structurally determined.
The CRED report does a huge disservice to decades of research and work into all inequalities, in particular race and ethnic inequality. The report authors have chosen to invalidate a substantial body of research in this field as well as the lived experience of thousands of people from minority ethnic backgrounds. For example, the MBRRACE data shows that women from Black African and African-Caribbean backgrounds are almost five times more likely to die as a result of childbirth compared to White British women.
The government’s own data shows that people from ethnic minority backgrounds are far more likely to suffer worse outcomes with Covid-19 and last year’s report from Public Health England confirmed that this was related to social factors, such as the type of work ethnic minority people do and household overcrowding.
The widely available data showing significantly higher levels of unstable housing, precarious employment and poverty affecting certain ethnic minority groups, who are also those most likely to have worse outcomes in society, have been overlooked. The factors that keep these groups poor and marginalised are structurally driven.
The report implies that in the claimed absence of structural or institutional factors, individuals or families are to blame for the negative experiences and discrimination they face. This is dangerous to communities and goes against the weight of the evidence. The authors have relied on outdated information and selective review of the available evidence to make their recommendations, meaning the methodology, as well as the conclusions, are flawed.
As the Royal College of Psychiatrists, we are well aware of the distinction between individual overt racism, internalised racism and institutional and structural racism and how these lead to mental health problems. To this end, earlier this year we published our Equality Action Plan to address inequalities and discrimination that leads to mental health problems with a particular focus on racial inequalities.
We also developed the Advancing Mental Health Equalities Resource, and support the use of the Patient and Carer Race Equality Framework which was recommended in the review of the Mental Health Act by Sir Simon Wessely, which the report references. The College published a clear position statement on racism and mental health in 2018, which highlights the impact of structural and institutional racism on mental health.
Not recognising structural factors when studying racial disparity thwarts any meaningful efforts to tackle racism in all its forms. The societal cost of health inequalities to individuals and groups is continued lack of cohesion and the economic costs arising from the welfare burden; healthcare costs and the lack of productivity are estimated to be in the region of £57 billion per year in England.
We will keep working as a College to tackle inequalities and racism across mental health services and in the mental health workforce, always acknowledging the evidence and the structural, institutional, cultural and personal factors that impact our patients, colleagues and wider society.