King's College London

The research project analysed more than 50,000 records from primary and secondary mental health care to assess whether changes to services as a result of COVID-19 magnified inequalities in care pathways, and whether it was associated with more deaths in people with mental disorders and long-term conditions.

With the support of Black Thrive, a partnership for Black wellbeing, interviews have been held with mental health service users and carers across London, Birmingham and Manchester to understand their perspectives.

All recommendations resulting from the research have been co-produced with people with lived experience, informing health care delivery and improving patient safety.

Quantitative methodology

The project used the Clinical Record Interactive search system (CRIS), a platform permitting free text/ structured field searches of de-identified electronic health records (EHRs)of South London & Maudsley (SLaM) Trust, one of Europe’s largest secondary mental healthcare providers. Half of SLaM service-users are of an ethnic minority background.

The Clinical Practice Research Database (CPRD), is the world’s largest database of primary care EHRs. Prospective data from about 1,200 general practices across the United Kingdom from 1990-present, is available. CPRD includes information on diagnoses, specialist referrals, treatments, COVID-19 status, (testing/ clinical symptoms) and mortality. 78% of patients in CPRD have ethnicity recorded. This allowed researchers to assess trends in CPRD by regions.

The two datasets complement each other and permit assessment of care pathways. Whereas CRIS has provided naturalistic ethnically ‘boosted’ samples from southeast London, CPRD is nationally representative.

Qualitative methodology

Central to our approach was our collaboration with individuals who are involved in the Patient and Carer Race Equality Framework (PCREF) initiative. Dr Ocloo is a part of the national PCREF committee and Dr Jacqui Dyer (Chair of PCREF, the NHS England Mental Health Equalities Taskforce and Black Thrive) is also a collaborator on this study.

The project used a participatory action research (PAR) framework that seeks to effect improvement and to empower its research participants and to create more equal partnerships in the research process. Lived experience mental health service user researchers were recruited through the community partnership for Black mental health, Global Black Thrive, and worked together with researchers to conduct semi-structured telephone/online interviews, and to code and analyse all of the qualitative data.

The interviews explored the impact of COVID-19 on accessing/ barriers to care, discrimination within health services and health-seeking to shed light on potential mechanisms. Participants were purposively sampled from three sites across England (Lambeth, Manchester and Birmingham & Solihull), by ethnicity, diagnoses and comorbidities. These sites were selected because they are each a PCREF pilot site and they represent areas of high ethnic diversity which have also had high rates of COVID-19 infection.