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Researchers at the University of Oxford, Queen Mary University of London and the University of Birmingham say the racism they found is perpetuated by a culture of silence.
The study in the British Medical Journal Mental Health, and funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration – North Thames, found experiences of racial discrimination exist on in-patient facilities and go both ways between staff and patients, creating a lack of cultural and psychological safety and an unhealthy atmosphere.
It is well documented that racialised groups are over-represented as patients in mental health services, among those detained under the Mental Health Act, and they tend to be receive more coercive care and medication rather than psychological support. Yet there continues to be little academic research on this issue.
Using a new approach, researchers scrutinised the deep experiences of 10 patients who reported racism in the EURIPIDES study of patient experiences in NHS mental health services.
They found patients reported:
- Strained communication and power imbalances shaped a process of mutual racialisation by patients and staff.
- An absence of safe spaces to discuss racialisation silenced and isolated patients.
- Not reporting racialisation and discrimination made patients feel ‘othered’, misunderstood, disempowered and fearful.
- This perpetuated racialisation, prevented authentic feedback from patients, and disrupted the formation of trusting therapeutic relationships.
The Chief Investigator, Professor Kam Bhui, from Oxford University’s Department of Psychiatry, said:
“These findings are alarming. When people feel unsafe on wards due to racism, they are silenced. We must be courageous and ask questions because if we don’t it hurts patients and staff, and costs lives, money, and quality of life. This must change if we want to have a genuinely modern, inclusive, and effective mental health service.
“Existing research on race, ethnicity and mental health does not address racism and discrimination, so we need new approaches. Staff and patients need support and guidance to make mental health wards a safe place for recovery. We need to be smarter and break the circles of fear and tackle structural, institutional, and interpersonal racism.”
Interviews were originally conducted with the patients from four different geographically located NHS England mental health trusts between July and October 2017.
Dr Sania Shakoor, co-lead author from the Wolfson Institute of Population Health at Queen Mary, said: “Our research emphasises the need for safe spaces to discuss racialisation and help improve strained communication and power imbalances between staff and patients.”
Co-lead author, Dr Phuong Hua from the Department of Psychiatry at Oxford and the Wolfson Institute of Population Health at Queen Mary, said: “NHS trusts could be more aware of how racialisation prevents authentic patient feedback, hindering improvement in the quality of services, and can weaken rapport between staff and patients.”
Co-lead author Dr Sarah-Jane Fenton, from the University of Birmingham, added: “We now need larger-scale studies to further investigate racialisation in the staff-patient relationships and its impact.”