Racial inequalities in mental health help-seeking among young people in the covid-19 context.
COVID-19 PhD Scholarship 2022
Supervisors: Stephani Hatch and Gemma Knowles
Lay summary: Black and other racialised communities in the UK are at increased risk of severe mental illness and are disproportionately detained involuntarily under the Mental Health Act. They are also less likely to receive and to seek support for their mental health. Adolescence is the period in which most mental health problems first emerge, so early support and intervention for those experiencing mental distress in adolescence during teenage years may help prevent longer term problems. We know very little, though, about mental health help-seeking patterns among Black adolescents teenagers, and we know even less about the impacts of the pandemic on racial inequalities in help-seeking. This is important because we do know that Black (and other racialised) groups, particularly those in poverty, have been most impacted by the social, economic, and health consequences of the pandemic. Understanding and dismantling barriers to help-seeking among Black YP teenagers in the context of COVID-19, then, is a public health priority, but we lack high quality evidence on this topic. The proposed project will address this knowledge gap. Working together with Black YP and with schools, this project –It embedded within our ongoing cohort study of adolescent mental health in diverse urban areas, REACH – will generate important and robust information about (a) the extent and nature of, and barriers to, mental health help-seeking among young people teenagers from diverse racial and social backgrounds, before and during/after the COVID-19 pandemic, (b) whether racial inequalities in mental health help-seeking widened during the pandemic, and (c) what needs to change to reduce these inequalities. Working together with Black teenagers and with schools, the student will (1) analyse existing help-seeking data – 3 pre-pandemic and 3 mid-pandemic waves – from REACH (www.thereachstudy.com), our ongoing study of mental health among adolescents from diverse backgrounds in London, (2) conduct in-depth interviews and focus groups with Black teenagers to understand the barriers and facilitators to help seeking, and (3) co-develop and pilot a culturally sensitive toolkit for schools.
Aim: To examine patterns of mental health help-seeking, and barriers to mental health support, among Black YP, before and during/after the COVID-19 pandemic.
1. To estimate the prevalence and nature of, and inequalities in, mental health help-seeking in large, representative, racially diverse cohorts of secondary school students across 6 time points, 3 pre-covid (2016-19) and 3 mid/post covid (2020-22);
2. To explore, in-depth, the lived experience of Black YP in accessing and receiving mental health support across contexts (i.e., in school, the community, online, and clinical services);
3. To co-create with Black YP a culturally sensitive toolkit to be used in schools to improve understanding of and dismantle barriers to in-school mental health support.
H1. At all timepoints, Black YP will be less likely to seek and to receive help for their mental health compared with White YP, and this racial disparity will be greater among girls than among boys;
H2. During the pandemic, inequalities in help seeking between Black and White YP will (at least initially) widen, particularly among those living in low-income households (i.e., on free school meals);
H3. Social psychological factors such as in-group norms and discrimination are prominent barriers to help-seeking among Black YP.
Research Student: Esther Putzgruber
My name is Esther Putzgruber and I will be starting my PhD at King’s College London in October 2022.
I completed my BSc Criminology at the University of Derby and shortly after, completed a MSc in Forensic Mental Health at Nottingham Trent University. I then joined King’s College London at the Institute of Psychiatry, Psychology and Neuroscience in October 2020, where I was granted the opportunity to work as a Research Assistant on The Resilience, Ethnicity and AdolesCent Mental Health (REACH) Study. This study aims to understand the best ways to promote good mental health among young people from all backgrounds. Working with REACH has enabled me to continue to develop a strong understanding and interest in social and ethnic inequalities in mental health.
In the UK, rates of mental health difficulties amongst Black and minority ethnic groups are found to be disproportionately higher than their white counterparts, and additional disparities have been highlighted in the routes to mental health support for Black people. Where research into help-seeking disparities amongst Black adolescents is scarce, I am excited and grateful for the opportunity to be a part of this project; to help amplify Black young voices and work towards providing effective, culturally appropriate mental health support for adolescents from all ethnic communities.
Progress report year 1, 2023
This year, my focus has been around familiarising myself with current literature and research to identify gaps and refine my hypotheses. Additionally, I have submitted my ethics application of which was successfully approved (ethics reference number: HR/DP-22/23-35072). This will allow me to start conduct interviews, analysing secondary data from the REACH study, and collaborate with young peer researchers.
I have started consultations with Black young people who have already actively contributed to shaping the research direction. They have assisted in identifying the key issues that need to be addressed, inputting on interview guides and have also shared interpretations of current literature and research. To further assist with peer researchers, I applied for the Transdisciplinary Research for the Improvement of Youth Mental Public Health (TRIUMPH) Network engagement grant, and I am grateful to have won. This grant will be used to compensate peer researchers and participants during data collection (see more details: https://triumph.sphsu.gla.ac.uk/research/).
I have collaboratively created an animated introductory video featuring the voices and perspectives of Black young people during consultations about this research and in their opinion, why this research is important. Having their consent, this video will be disseminated to schools and utilised during participant recruitment. Along with the introductory video, I have started preparation for data collection and secondary data analyses as discussed below.
Preparation for interviews:
I have created consent forms, information sheets and email templates to gatekeepers in schools which I will use when recruiting participants. I have created a draft interview guide, informed by literature and consultations with young people. The advertising materials have been developed and will be reviewed by young peer researchers before distribution.
I am in the process of building relationships with gatekeepers at REACH partner schools for the upcoming academic year (starting September 2023) and I am concurrently exploring potential partnerships with additional South London schools and sixth forms that may have particular interest in this project.
Preparation for secondary data analyses:
I have spent time familiarising myself with REACH data and have been developing my skills by exploring the dataset across three timepoints (T1, T2, T3). I have identified the variables I will be focusing on and in further preparation, I have attended and completed a 10-week statistics module covering the fundamentals of statistics for epidemiological mental health research.
Have attended training courses including ‘Qualitative Interviewing’ and ‘Introduction to Statistics’
Participated as a panel member in the KCL Participatory Research and Lived Experience event.
Delivered a lecture on 'Engagement in Research' for the Global Mental Health MSc course at KCL
Helped to code qualitative data from community consultations and ~100 surveys for a project with Black Thrive for the Mayor’s Office for Policing and Crime
Attend the Wolfson Centre Summer School 2023 for Young People’s Mental Health
Attended the 7th BME Early Career Researcher Conference 2023