Dr Tony Rao, Consultant Psychiatrist at South London and Maudsley NHS Foundation Trust, highlights stalled progress on tackling discrimination within the health service.

I never thought, as a Consultant of Asian ethnicity, that I would now be among the hundreds of thousands at higher risk of COVID-19. I have also just found out that I don’t have the antibodies in my blood that can fight future infection.

'Poor mental health in staff can have a knock-on effect on patients.'

But there is a broader problem that I can only call racism. It may not affect me, but it does affect many people from Black and Ethnic Minority Ethnic - BAME – backgrounds who work in the NHS. Three in every five healthcare staff who have died from COVID-19 are from a BAME backgrounds, but make up just one in 5 of the overall NHS workforce. In the UK as a whole, BAME populations have up to twice the death rate from COVID-19 compared to their white counterparts. The very people at risk are those providing frontline care to those already infected with coronavirus. But these deaths are not just explained by age, gender, health and living environments.

'Culture of inequality' 

In 2020, there remains a deep rooted culture of race inequality in our one million strong NHS workforce. 45 percent of doctors and 25 percent of nurses are from BAME backgrounds. So what has this got to do with mental health? Well, we know that an inclusive, valued and motivated workforce will be more productive, less stressed and healthier. The Workforce Race Equality Standard, known as WRES, was introduced to ensure equal access to career opportunities and fair treatment in the workplace for BAME staff. That is clearly not happening. Their 2019 report found that there has been no change in the overall proportion of reports across NHS Trusts concerning discrimination, bullying, harassment and abuse compared to the year before. Career progression also no showed no change.

Statistics of stagnation:

  • Across all NHS Trusts, 29 percent of BAME staff reported discrimination, bullying, harassment and abuse in the 2019 reporting period compared to 28 percent in the 2018 reporting period.
  • Across all NHS Trusts, 70 percent of BAME staff reported opportunities for career progression in the 2019 reporting period compared to 72 percent in the 2018 reporting period.

This points to a failure of our NHS to tackle behaviour that can only be construed as racism by any other name. Poor mental health in health care staff can have a knock-on effect on the people that they care for. Many of these people will themselves be BAME populations, with higher rates of mental health problems than White British populations. That’s a double whammy of a different kind.

So, what can we do now to make sure that the mental health of our health care staff is protected? The first port of call should be reducing exposure to COVID-19, based on individual risk profiles. But there is also the longer term. Staff need to feel valued by their employers so that they can progress in their careers. New initiatives to improve these opportunities such as the Stepping Up and Ready Now programmes are already in place in many Trusts.

Ground rules and direct challenges

We also need to challenge racist attitudes and behaviour linked to bullying, harassment and abuse. This needs a continuum of Intervention that uses a range of measures to ensure that any racism is addressed quickly and effectively.  Such an approach needs first to set ground rules for unacceptable behaviour. Sometimes, it may even mean referring back to Trust policy. In some cases, direct challenge may be the only way to address racism. It could just as well apply to the boardroom as the ward round or multi-disciplinary meeting. Support for monitoring long term conditions such as high blood pressure or diabetes will also help to improve mental health, as will mental health support from NHS Trusts to maintain mental wellbeing.

Perhaps it is now time for the NHS to finally admit that racism remains as an underlying cause of poor mental health in its BAME staff. Protecting BME staff from COVID-19 will help to reduce stress and anxiety, but Trusts need to go a step further. They need to acknowledge that it’s not just about COVID-19. Racism kills and it is everyone’s business to make sure that we stamp it out.

The author is Consultant Old Age Psychiatrist and Visiting Researcher, Institute of Psychiatry, Psychology and Neuroscience Psychological Medicine and Older Adults Directorate Lead for Dual Diagnosis in Older Adults at South London and Maudsley NHS Foundation Trust.