Accessibility statement

GHH 143: Mental Health and Inequalities

Posted on 25 June 2020

Within public health, mental health is a neglected area of research and policy, despite a high prevalence of a disease that disproportionately affects disadvantaged groups of people. The Centre for Global Health Histories invited speakers to discuss how we can address inequalities in mental health service and research.

Dr Antonis Kousoulis is the Director of England and Wales at the Mental Health Foundation. Like other illnesses, he said, mental health tends to correspond to the “social gradient.” That is, less advantaged people are more likely to suffer from mental health problems. Prevention relies somewhat on access to healthcare, but mental health issues are also related to individuals’ circumstances or factors beyond their control. These are shaped by the distribution of power and resources. In terms of interventions, Dr Kousoulis said that they should be tailored to those living in poverty. “Asset-based” approaches that take advantage of what communities have to offer is proving successful, as are a number of interventions related to poverty such as debt relief, financial training, improving housing, and addressing substance abuse. Dr Kousoulis ended his talk by explaining that more comprehensive data is needed as most mental health studies are focused on women and minorities.


Dr Gerardo Antonio Zavala Gomez discussed his work with the IMPACT study at the University of York. He and his colleagues are investigating the multimorbidity of mental and physical health problems in Bangladesh, India, and Pakistan. People with physical illnesses, such as hypertension, diabetes, or obesity, as well as severe mental disorders tend to have lower life expectancies, he said. People who have mental illness and a chronic physical condition also tend to die at a younger age. Research and integrated physical and mental health services help to address this but are rare in low- and middle-income countries. Dr Gomez and his collaborators at mental health institutions across the three countries are aiming to correct this by generating evidence for the prevalence of these disorders. So far, their preliminary results show that mental health issues run alongside a high rate of obesity but that smoking rates are similar to the average population. They hope to expand their work nationally and to other developing countries.


Natalie Creary is the Director of Black Thrive, an organisation based in Lambeth that aims to improve black people’s access to mental health services. She urged that we broaden our understanding of racism and consider it a public health issue. Racism, she said, not only influences an individual’s access to health services, but as a form of discrimination it increases the risk of poor health. However, she said that current research is relatively silent on racism and she urged scholars to pay more attention to inherent bias in literature and to think about the mindset and agendas of researchers and funders. Black Thrive, she said, ensures its work is data-informed but not totally dependent data, which may not provide context nor include the voices of communities. She said this is essential; that black people have the opportunity to shape mental health agendas. This way, systematic interventions can be implemented and whole systems can change rather than only aspects of them.


A conversation with the audience followed the presentation. Among several topics, they discussed how researchers can more effectively involve study participants in the design and implementation of studies, and how today’s advances in technology can both boost and hinder efforts to improve the prevalence of mental health, which historically seems to have remained constant, if not increased.


A video of the recording can be found here.


We are extremely grateful to our speakers for leading a rich seminar. We thank the Wellcome Trust as always for making these gatherings possible.


Report by Alexandra Bradbury for CGHH.