These disproportionate impacts among racialized communities reflect pre-existing health inequities that are strongly determined by a range of social and economic factors (Dalsania et al., 2021; PHAC 2020). There is an increased likelihood that racialized individuals live in poverty, engage in precarious employment, and reside in neighbourhoods with intergenerational, overcrowded households and with inadequate access to health care services (Getachew et al. 2020; Gutmann et al. 2020; PHAC, 2020), which may pose greater exposure to COVID-19 (Dalsania et al., 2021). These populations also tend to be overrepresented in employment sectors hardest hit by the pandemic, including food and accommodation services (PHAC, 2020).
Also, evidence suggests that racialized populations may experience more substantial consequences of the COVID-19 pandemic on their mental health and well-being (McKnight-Eily et al,. 2021; Miconi et al., 2020). The COVID-19 pandemic aggravates stressors and vulnerabilities, such as job loss, housing instability, and food insecurity, which may lead to an increase in the need and demand for mental health supports and services (MHCC, 2020; PHAC, 2020). A report by Statistics Canada (2020) found that racialized Canadians reported poorer mental health outcomes compared to non-racialized Canadians. Additionally, previous evidence has suggested that racism and discrimination often worsen during public health emergencies (Shim and Starks, 2021). In August 2020, 47.6% of visible minorities reported experiences of discrimination compared to 28.2% of the general population (Statistics Canada, 2020), which can significantly impact mental health (Hackett, Ronaldson, Bhui, Steptoe, & Jackson, 2020; Miconi et al., 2020).
The direct impacts of COVID-19 include stressors relating to viral transmission and restrictions due to mandatory public health measures. But there is an entirely different aspect of the pandemic response and recovery efforts that requires further attention. This includes the consequences of power and politics and its influence on how one seeks support for their mental health and wellbeing. It is not solely about increasing culturally appropriate resources to improve mental health literacy at the community level, but instead the urgent need to address the long history of discriminatory practices against certain communities. Furthermore, a history of systemic racism and mistreatment have led to continued mistrust and fear of healthcare institutions that prevent members of racialized groups from accessing services and getting culturally appropriate care in a timely manner (PHAC, 2020).
Recommendations
- Improving health equity is to acknowledge and address underlying inequities racialized populations face through inclusive leadership approaches.
When working towards a more equitable future, we must address our own biases and prejudices which starts at the individual level. These biases can hold policies and practices in place that perpetuate power dynamics and withhold resources from those who may need them the most. This includes asking racialized individuals what meaningful engagement looks like for them and how they want to be engaged in community projects, including key decision-making processes for programming and policymaking. It also includes collecting critical data from these inquiries. When we make racialized groups feel wanted in the process rather than isolated, we create spaces for them to have their voices be heard in systems and thereby create a process of hope and recovery. Furthermore, it is critical to continually advocate for the long-lasting disparities in mental health outcomes facing racialized groups compared to the general population. This includes sharing opportunities for racialized populations who are often not equally represented in spaces of privilege to not only improve access to supports/services, but also to address other social and structural determinants impacting mental health.
- Strengthen community partnerships and tailor outreach efforts to better serve racialized populations in mental health program development, implementation, and evaluation.
The COVID-19 pandemic has shown the power in multisectoral collaboration, thus capacity to engage in timely research and dissemination of findings is critically needed to ensure that knowledge is efficiently implemented into practice. Despite current efforts by different levels of stakeholders to collect race-based and other sociodemographic data during the pandemic, there remain significant gaps in a collective space for capacity bridging and knowledge dissemination. There is a need to build a comprehensive system through which diverse organizations in the mental health sector and regional stakeholders can support one another’s varying capacities and resources in responding to the mental health needs. Lastly, it’s important to highlight grassroot organizations who do frontline mental health response with racialized communities and provide inclusive mediums by which their key lessons learned can be shared and applied to other organizations and institutions.
- Embed an intersectionality lens for systems-level data collection, analysis and application for targeted mental health centered programs and policies.
Moving forward, it is crucial to prioritize the collection and analysis of race-based data across the country and follow culturally responsive standards and practices when doing so. Community service workers providing mental health services/supports for racialized populations may wish to consult best practices using an intersectionality approach. To this end, it is essential to collect, link, disaggregate and apply data related to sociodemographic factors, like income, education, Indigenous status, racial and ethnic background, sex and gender, sexual orientation, age, disability status, occupation, and migratory status. Community outreach and consultation with racialized groups may also help overcome issues with representative sampling that can inform more meaningful programming, and policy responses.
Although inequities pre-dating and amplified by COVID-19 are increasingly well documented, a few studies have also explored the association between pandemic-specific discrimination and stigma on the mental health of racialized communities. There is a need to further understand similarities and differences in discrimination experiences both between and across different racialized groups in Canada, including how these experiences change over time. Further research can be used to better understand barriers to help-seeking and supports that are more accessible, trauma-informed, and culturally safe. Additionally, empirical tools such as validated, standardized screening and assessment tools are needed to capture accurate mental health related data, which will aid service providers and policymakers to better respond to the unmet psychological impacts of the COVID-19 pandemic now and in the future.
Eli’s Place will be a safe and welcoming place for all who seek help. We will continue to pay close attention to best practices in reducing barriers to care for racialized populations. As we develop programming for Eli’s Place, we will aim to embed these recommendations in our model of care.
References
City of Toronto, Mowat, D., & Rafi, S. (2020). COVID-19: Impacts and Opportunities.
Dalsania, A. K., Fastiggi, M. J., Kahlam, A., Shah, R., Patel, K., Shiau, S., … & DallaPiazza, M. (2021). The relationship between social determinants of health and racial disparities in COVID-19 mortality. Journal of racial and ethnic health disparities, 1-8.
McKnight-Eily, L. R., Okoro, C. A., Strine, T. W., Verlenden, J., Hollis, N. D., Njai, R., … & Thomas, C. (2021). Racial and ethnic disparities in the prevalence of stress and worry, mental health conditions, and increased substance use among adults during the COVID-19 pandemic—United States, April and May 2020. Morbidity and Mortality Weekly Report, 70(5), 162.
Mental Health Commission of Canada. (2020). COVID-19 and mental health: Policy responses and emerging issues [Environmental scan].
Public Health Agency of Canada. (2020, October). From risk to resilience: An equity approach to COVID-19. Government of Canada.
Shim, R. S., & Starks, S. M. (2021). COVID-19, Structural Racism, and Mental Health Inequities: Policy Implications for an Emerging Syndemic. Psychiatric Services. Published.
Statistics Canada. (2020, September). Experiences of discrimination during the COVID-19 pandemic. Government of Canada.
The Commonwealth Fund, Gatachew, Y., Zephyrin, L., & Abrams, M. K. (2020). Beyond the Case Count: the Wide-Ranging Disparities of COVID-19 in the United States.
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My name is Lucksini Raveendran and my interests are focused on improving equitable and sustainable access to health services for priority populations, including those facing homelessness, seniors, racialized communities, among others. I am a community advocate towards incorporating people with lived experiences through meaningful and inclusive engagements. Lastly, I’m interested in improving processes for the timely collection and application of sociodemographic data when developing and implementing policies for targeted populations at the local, provincial, and federal level.
