Man hiding his face in his crossed arms, sitting against a wall.

Researchers at the University of Birmingham, University of Oxford and Queen Mary University of London 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 receive more coercive care and medication rather than psychological support. Yet there continues to be little academic research on this issue.

We now need larger-scale studies to further investigate racialisation in the staff-patient relationships and its impact.

Dr Sarah-Jane Fenton, University of Birmingham

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.

Dr Sarah-Jane Fenton, Lecturer in Mental Health Policy for the Health Services Management Centre said:

“This research is useful in two ways – firstly the methods used advance our understanding of realist approaches to qualitative secondary data analysis, and secondly the model presented indicates how individuals' experience of care and racism impacted their ability to give authentic feedback. Developing a better understanding of such processes will facilitate more constructive conversations about racism and enable us to think of new ways to tackle poor experiences and improve the quality of care in inpatient mental health settings. We now need larger-scale studies to further investigate racialisation in the staff-patient relationships and its impact”

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.”

Dr Sania Shakoor 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.”

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.

Interviews were originally conducted with patients from four different geographically located NHS England mental health trusts between July and October 2017.