Staff writer Chloe Roger discusses inequality in mental health treatment in the UK.
Have you ever travelled to a foreign country, only to experience not only an unfamiliar language, but also a tangible cultural distinction?
The same issue arises in healthcare, whether it be physical or mental health.
Historically, many modern scientific and medical discoveries have been concentrated in the West. This is mostly due to access to opportunities and resources in these areas, particularly during colonialism.
However, these disparities between this predefined group and other ethnic groups have begun to gain more notice.
Depending on ethnic origins, the absorption of certain compounds or medications differ, making them more or less effective. However it should be noted this is more due to genetic ancestry and environmental factors rather than ethnicity itself.
Amended thresholds have been introduced for Black patients during eGFR blood tests, which measure how well the kidneys are functioning.
In 2021, the National Institute of Health and Care Excellence (NICE) updated their guidelines. They amending the previous recommendation that Black ethnic groups should have their eGFR multiplied by a factor of 1.159 due to erroneous ideas that people from Black backgrounds had higher creatine rates.
This belief led doctors to believe that Black patients have falsely low eGFR readings. Overlooking low readings means overlooking signs of kidney disease or failure.
A study from 2020 by James A. Diao and Gloria J. Wu measured that 29.1% of the Black adults with pre-existing chronic kidney disease should have been reclassified to more serious stages, once the ‘race factor’ was removed from the equation.
As an overall result, there was an observed delay in diagnosing chronic kidney disease, and transplant listing, severely affecting the care of these patients.
This is mostly due to clinical trials historically focusing mostly on one specific group of test subjects: white males.
Mental health treatment experiences the same problem: it cannot take a one-size-fits-all approach. Not only is each person dissimilar, but so is their cultural baggage.
Recently, Recovery Colleges, a school-like provider of educational courses and resources for mental health management, has expanded internationally and was exposed to a major problem: How do they make their content relatable to different audiences?
This question exposed a fundamental problem in healthcare: Most of our resources are developed by and for high income English-speaking countries.
However, Recovery Colleges are now established across six continents, and thirty-one countries, not all of which are mostly Anglophone. Most importantly, mental health consideration differs across six continents and dozens of cultural groups, some of which can be quite reticent to the very idea of struggling mentally.
A study by the National Library of Medicine on understanding ethnic inequalities in mental health care in the UK has studied the numbers and identified some of the main causes as ‘social exclusion’ coming from the stigma of weakness on a personal and community level, but also ‘not being allowed to’, originating from the constant transmission of the idea one must be strong, and disbelief in mental health.
These go to show the issues Recovery Colleges would have to tackle to make their courses more applicable to their desired demographic.
From this, a 20-country Delphi study by Yasuhiro Kotera and Sara Vilar-Lluch was conducted to check the cross-cultural applicability of the Recovery Colleges content.
Not only was it not applicable, but there was also a disparity in how certain terms and concepts were understood by the panelists. The study worked in two rounds, with the second round results seen as more culturally appropriate, whilst conserving the Recovery Colleges’ core values.
All human beings tend to make assumptions, to see things as universal when they are not. This is also known as the False Consensus Effect: a cognitive bias where people tend to use their own worldview and behaviour as a baseline for the general population.
This study goes to show that it is possible to make mental health accessible for different audiences, but that cultural differences need to be addressed appropriately in order to reach as many people as possible, and tackled with the group itself.
This should give all researchers and providers a bit of food for thought next time they’re designing something, notably at King’s College with their School of Mental Health and Psychological Sciences or their cutting edge research in the Institute of Psychiatry, Psychology and Neuroscience.
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