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This content is taken from the Maudsley Learning & The Tavistock and Portman NHS Foundation Trust's online course, COVID-19: Psychological Impact, Wellbeing and Mental Health. Join the course to learn more.

Skip to 0 minutes and 0 secondsSo we've seen the increase in mortality in the population as a whole. I think that one of the things that we have to keep in mind, so if we go back to the idea of people from ethnic minority groups having this increased exposure to stressors right from a very young age, what Arlene Jeronimus talks about, he's done some fantastic work in this area, is how that then leads to a wearing down or a weathering over the lifetime, and so then you see these increase, knock on effects in terms of mental health but also physical health. And not just when one condition but in multiple conditions.

Skip to 0 minutes and 39 secondsSo we now talk about the phrase is used now is around multi- morbidity where we start to see these clustering of you know different physical health problems and mental health problems. So along with depression and anxiety you'll see hypertension. You may see Type 2 diabetes. You know the list sometimes goes on. And sort of thinking about how we then and now during this pandemic had a part of the population that was, you know, dealing with a heavy disease burden because of this multi-morbidity.

Skip to 1 minute and 19 secondsIt's not surprising then how they became more impacted, but they also became more impacted for social reasons and that is going back to what I was saying about the increased likelihood of them being in jobs and being exposed, having to work as key workers, having to be in occupations where they had more exposure to the virus. And then you know, once they go and then seek help, the question remains, were they treated in the same way. So you know, these are questions that need to be answered. So how should we as a society and as health care organisations, respond to these challenges? I think the first thing is recognising that there is a problem.

Skip to 2 minutes and 13 secondsI find when I discuss my research on discrimination, particularly with regards to the context of healthcare, there's often this denial about differential treatment based on these social characteristics, and you know in this case you know, looking at someone an immediate reaction, an allowing your biases to take over and to treat that person differently. You know every human being stratifies by some sort of social characteristics, it's almost we're sort of built in, we..., faced into a social situation, you immediately start thinking about what is the same about the people that you're interacting with and what's different about them. So that's not really where the issue lies.

Skip to 3 minutes and 7 secondsThe issue lies is when you allow those biases, whether they be conscious or unconscious to impact your behaviour and the way that you treat other people, and this is not to say that you know people have ill intentions all of the time, but sometimes they do. We have to recognize both sides of that, and I think having.., starting to have it open and frank conversations about the ways in which this occurs in healthcare settings is really important. And it's really important for us to address. I think it's important for us also to address that the discrimination that is experienced by health care workers.

Skip to 3 minutes and 52 secondsSo we know from the evidence that we have within health services research that health care practitioners themselves, they not only experience discrimination, but they witness high levels of discrimination. Oftentimes as a result of the treatment by their colleagues and their managers and witnessing differential treatment of patients so it's really creating a space where we can deal with this and then think about the what needs to be done. I think for healthcare organizations it's really time to start thinking about the training and interventions that go beyond unconscious bias training and cultural competency.

Skip to 4 minutes and 39 secondsReally starting to try and look for innovative ways in which we can get people to think about what it's actually like to walk in the shoes of someone from an ethnic minority group, whether that be in their jobs in terms of health care workers, but also thinking about what's going on in the communities, it's important to remember too, that these health care workers are members of our community, so the same way in which we look after our communities, we need to look after them as a part of those communities.

Skip to 5 minutes and 15 secondsI think COVID-19 and this pandemic has really shone a light on a problem that is only going to be exacerbated by this pandemic, and it just leaves us to question what are we going to do I think to remain inactive, it would be a real travesty going forward. So it's really important that we start these conversations, that we think of new ways of addressing these problems, because we clearly do not have all the answers.

Skip to 5 minutes and 42 secondsSo you are a part of that discussion and I hope that the thinking and the reading and the discussions that you engage with in this course will help you to feel a sense of empowerment to be a part of this, to be a part of finding the solutions and helping researchers such as myself to think of, and develop and implement new and innovative ways of addressing these problems.

Social identities and coping during COVID-19

Professor Hatch recaps some of the challenges faced by members of black and ethnic minority communities during COVID-19. The key point is that this pandemic is exacerbating the challenges people already face in society, which must be addressed. This applies more broadly to mental health too.

In terms of how to address the disproportionate impact on certain members of society, we heard about the importance of recognising the problem, checking biases, and addressing discrimination within society.

Recognising the problem

Professor Hatch highlights that even when there is clear evidence of differential treatment and outcomes for some members of society, denial remains. This demonstrates the importance of key voices and leaders in a society or organisation stepping forward to acknowledge these inequalities.

This can be achieved through clear and consistent communication, providing space and opportunity to reflect on this topic, and encouraging more conversations even when this can seem difficult.

Checking biases

As Professor Hatch highlighted, biases can be conscious or unconscious and can impact our behaviour. Think back to Week 1 and Susan’s experience of discrimination - the people purposefully avoiding her were allowing biases to drive their behaviour.

While these biases may be present in our minds for many reasons, the key is to stop these impacting our behaviour. The steps to support this include:

  • Education to understand biases, behaviour, and discrimination.
  • Initiatives to improve people’s attitudes towards social identities and characteristics.
  • Opportunities for discussion and reflection about these issues, in order to build self-awareness.
  • Dialogue to raise awareness at a systemic and societal level.

Addressing discrimination

Finally, when discrimination is seen towards any group in any setting, such as racism, there must be an approach to address this. This will be challenging, but to take the example of a workplace, a comprehensive approach is needed.

This will include a local process or system to identify and report discrimination. Designated responsibility for addressing issues should be transparent and sit with identifiable people. These issues should be taken forward seriously and sensitively to reach an appropriate conclusion.

This approach should be documented and endorsed by senior leadership, as well as being communicated clearly. Role modelling by management is important. The psychological impact on people who experience discrimination can be enormous and support can be provided in many ways.

Of course, addressing discrimination and social inequalities goes beyond the scope of this activity. However, we hope that the information outlined above can be a useful starting point to spark off your own thinking. We are learning more and more each week as the global pandemic progresses about the disproportionate impact on different groups. Please share any thoughts on this important topic in the discussion below.

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This video is from the free online course:

COVID-19: Psychological Impact, Wellbeing and Mental Health

Maudsley Learning