Structural racism persists in national mental health data

Just as worrying as the findings of the Adult Psychiatric Morbidity Survey are the methodological shortcomings of the survey itself, writes Sam Rodger, assistant director of policy and strategy at the RHO.

The Adult Psychiatric Morbidity Survey, published on 26 June 2025, provides the best picture we have of the prevalence of common mental health conditions in England. Run every 7 years (though delayed on this occasion due to COVID-19), the APMS is a survey of around 8,000 households, exploring rates of self-harm, depression, eating disorders and a handful of other conditions.

This iteration of the survey demonstrates a notable and worrying decline in the nation’s mental health. It highlights inequities in terms of deprivation, unemployment status; and presents concerning disparities for those living with physical health conditions.

The survey also surfaced some troubling results for ethnic minority communities, including that suicidal thoughts, suicide attempts, and PTSD prevalence were highest for the Mixed/multiple and other ethnic groups (30.8%, 11.0% and 8.1% respectively). These are concerning inequities and demand closer attention from policy makers, with a holistic view taken to the mental health inequities in access, experience, and outcomes that the Observatory has worked to shine a light on over the past few years through its research.

Just as concerning as these findings, however, are the methodological shortcomings of the survey itself. It has long been known that the sampling approach used for the APMS does not properly or robustly represent the ethnic diversity of the country. This is because the relatively small number of some ethnic groups means random household sampling will not achieve sufficiently large sample sizes to draw meaningful conclusions.

Having recognised this shortcoming, and taken representation from experts in this space, the National Centre for Social Research agreed to an Ethnic Minority Boost, a targeted oversampling of certain ethnic groups to make it possible to draw conclusions about ethnic difference in mental health disorders. Many organisations, including ourselves at the Observatory, worked hard to make the case for this boost.

However, as can be seen in the APMS report, the methodology of this boost was deemed too expensive and complicated to be ‘economically viable’ and, although further papers will be released outlining these methodological difficulties, the fact remains that once again, the APMS is not representative of the racial and ethnic diversity of the population and, therefore, its findings can only give us abstract indications of the inequities experienced by these communities.

Well-meaning though the organisers of this survey are, it’s hard to ignore the fact that these data and the conclusions of the paper, which will be used to inform policy for the next seven years, are unrepresentative and incomplete, embedding a skewed idea of how common mental health conditions are variously experienced by different ethnic groups.

The decision to discontinue the ethnicity boost will not have sat with any one person or committee, but will have been made incrementally, a series of non-decisions and pragmatic compromises that have, nonetheless, combined to fail ethnic minority communities. In this respect, we believe this is a stark illustration of structural racism in the NHS. In deciding that understanding the unique and disparate experiences of Black, Asian, and minority ethnic groups is not ‘economically viable’ is to decide what our healthcare service does and does not value.

This is precisely the sort of unacceptable and embedded race inequity that the Observatory was designed to tackle and eliminate. With funding at the centre being further tightened, and cuts being made to ICBs and Arm’s Length Bodies, those of us actively engaged in the fight against racism in health must remain alive to risk of similar compromises being made in the future that will further embed the entrenched racial inequities we see in our healthcare system. 

We urge the Department of Health and Social Care to ensure that the Ethnicity Boost is a regular feature of both the APMS and the equivalent survey for children and young people. Only then can we enable a genuine understanding of the prevalence of common mental health conditions across the life course and ensure that minoritised communities do not feel that, once again, cost saving has been prioritised over their right to equitable health and wellbeing.