What’s the relationship between ethnicity and the mental health income gap?

Last year, we launched our report Mind the income gap, which showed that people with common mental disorders, such as anxiety or depression, receive average annual incomes that are just two-thirds those of people without common mental health problems. But within those figures hides an even more worrying story, as the way people with mental health problems experience inequalities differs according to gender, age and ethnicity. 

For people from Black and Minority Ethnic (BAME) backgrounds, experiences of racism and discrimination, as well as social and economic inequalities, can contribute to mental health problems and impact the incomes people receive. In this blog, we’ll explore how ethnicity intersects with the mental health income gap and the overlapping nature of inequalities.

The prevalence of mental health problems in the English population is greater in some ethnicities than others. While data is not collected for transgender people or those who identify as non-binary, rates of mental health problems vary by gender too. For example, analysis of the 2014 Adult Psychiatric Morbidity Survey – the best source of mental health data in England – found that rates of common mental disorders, like anxiety and depression, were more prevalent in Black and Black British women (32%) than White British women (20%). 

Turning to more severe conditions, Black people were also most likely to be diagnosed with a long-term mental health problem, like bipolar, psychotic disorders or personality disorder. 

Despite the higher likelihood of experiencing and being diagnosed with a mental health problem, there are stark differences in the treatment people from different ethnic groups receive from mental health services too. 

Mental health treatments including therapy, medication or support in the community or in hospital – are often essential in supporting people to recover from mental illness and live fulfilling lives, including progressing in employment. However, not all people who experience a mental health problem receive treatment. Of those with a mental health problem, White British people were the ethnic group most likely to receive treatment (14.5%), compared with 7% of people in minority ethnic groups, and people in Black ethnic groups had the lowest treatment rates at 6.5%. 

While Black people are less likely to access or receive early intervention and timely treatment which can prevent mental health problems from worsening, people from minority ethnic groups are more likely to be subject to coercive treatment. Black men, in particular, are four times more likely to be sectioned under the Mental Health Act and three times more likely to be restrained in hospital. 

As well as leading to poorer mental health outcomes, differences in access to and receipt of treatment can affect someone’s ability to gain employment and progress in work, leading to lower incomes and worse living standards.

We know that access to appropriate and timely treatment is key to supporting people with mental health problems to remain in employment. However, stigma and discrimination in the workplace can be a barrier to disclosure and accessing support. People from BAME backgrounds who experience mental health problems can also face overlapping discrimination in work which can affect long-term employment prospects. 

While employment rates have steadily increased for every ethnic group in recent years, there remains a significant ethnicity employment gap of 12 percentage points. In October 2018 over three-quarters (77%) of White people were employed, compared with just under two-thirds (65%) of people from all other ethnic groups. 

Disability employment rates allow us to also understand how employment, ethnicity and disability intersect; only half (51%) of all working-age disabled people were in employment in 2018. Employment rates were highest for disabled people in the White (52%) or White Other (62%) ethnic group, and lower for disabled people in all other ethnic groups. For example, only 42% of disabled people in the Pakistani and Bangladeshi ethnic group, and 44% of people in the Black ethnic group were in employment in 2018.    

Employers can play a central role in supporting people from BAME backgrounds with mental health problems to secure employment and remain and progress in work. Employers can equip hiring and line managers with an understanding of the structural discrimination people face, and the knowledge and skills to challenge this in recruitment, retention and progression practices. 

The issues facing everyone with a mental health problem are not the same. Ethnicity and gender are central to understanding the diversity of people’s experiences. To close the mental health income gap policy-makers, health services and employers need to think not just about the support they offer, but who is accessing support, who the support is being delivered by, and whether support services are designed with everyone in mind. 

Closing the mental health income gap is a huge task and one that requires political will and action on a national, local and organisational level. It is also a journey that takes time and deliberate efforts. To ensure that no one is left behind, concerted and continual effort must be targeted at intersections of gender and ethnicity – to close the mental health income gap. 

Find out more about the work of our Mental Health and Income Commission here.