Ethnicity

The Office of National Statistics (ONS) has highlighted that there is no true consensus on what defines an ethnic group, as identification to these is self-defined and subjectively meaningful to the individual²⁹. Ethnicity can include a variety of elements such as ancestry, culture, identity, religion, language, and physical appearance. However, it is generally accepted that ethnicity includes all of these aspects, and others, in combination. Under the Equality Act 2010, ethnicity includes colour, nationality and ethnic or national origins³⁰.

Research has shown that ethnic minority individuals have reporter poorer healthcare experiences when compared to White British individuals³¹. The lack of accessible information, language barriers, poorer knowledge about services and longer waits for appointments for ethnic minority individuals can all contribute to their access to health and social care³². Without the appropriate health and social care support, those who identify as an ethnic minority could be slower to recover from health issues when compared to their White British counterparts and delays to treatment can also lead to longer-term effects, such as limiting health in life³³.

Additionally, being exposed to racism can increase the risk of an individual presenting with poor mental health and those who experience a racial attack or verbal abuse are more likely to develop psychosis or depression³⁴. This can also support division between healthcare professionals and patients, with patients feeling that they may be treated different dependent on their ethnicity³⁵. The report Disparities in the risk and outcomes of COVID-19 highlights that the pandemic has replicated existing health inequalities, and in some cases has increased them.

It is important for organisations to understand the impact of ethnicity on mental health to ensure patients are experiencing equal access, outcomes and experiences of mental health services, and additionally to reduce fear and stigma that is often associated with mental health³⁶. The collection of ethnicity data is therefore crucial in increasing understanding of the inequalities faced by different ethnic groups in order to improve the planning and delivery of services for those who identify as an ethnic minority.

NHS organisations are mandated to use ethnic monitoring questions and response codes set out in the NHS data dictionary, which are based on the ONS 10-yearly Census. To ensure patients can fully describe their ethnic identity, it is recommended that these questions are asked alongside questions on national identity and religion. This allows for a richer understanding of an individual’s identity, both ethnically and culturally, which in turn leads to a more representative picture of the population³⁷.

Previous examples of good practice have highlighted that self-reporting is the most effective way of asking about an individual’s ethnic identity, particularly due to potential issues of stereotyping if determining ethnicity by observation³⁸. 

Collecting data on ethnic groups can be complex because of the subjective and multifaceted nature of the concepts, along with the changing nature of ethnic identification³⁹. Membership to each of the concepts is something that is self-defined and subjectively meaningful to an individual.

Research has shown there are a number of reported barriers in the collection of ethnicity data in the UK. This is mainly due to a lack of knowledge from staff about the importance and use of data, alongside patients’ perception of how data is used, specifically concerns that the information will be used to discriminate against them. One clear suggestion to improve this collection is to allow time for staff to attend ethnic monitoring training courses to understand how best to collect this information and why it is important to service provision, in turn giving them confidence to explain this importance to patients⁴⁰.

Best practice for recording ethnicity data in the MHSDS and IAPT Data Set states that this data should be collected in agreement and collaboration with the patient and if the ethnicity of a patient is unknown, it should not be assumed or inferred by the provider.

Table 6 identifies the data items required to record and flow this data to MHSDS and IAPT Data Set. A placeholder data item in these data sets, ‘Ethnic Category 2021’, is not yet in use but will be at a later date to align with the 2021 ONS Census.

Table 6

Extract from the Technical Output Specification; MHSDS table MHS001 and IAPT Table IDS001 - Master Patient Index

Data item name - ETHNIC CATEGORY

Intermediary Database (IDB) Element Name - EthnicCategory

Data item description - The ethnicity of a PERSON, as specified by the PERSON.