BJPsych Bulletin is delighted to announce Dr Jonathan Monk-Cunliffe as the winner of the 2022 Praxis Editorial Award competition. Read his complementary blog post on his winning article: “How can we overcome health inequalities in psychiatry?“

Something that becomes obvious very quickly in psychiatry is that mental illness doesn’t affect everyone equally. Yes, anyone can become unwell, but some groups of people are much more likely to than others. Poverty and marginalisation cause mental illness, and being from a minoritised group means you’ll get different care and have different outcomes. This leads to the health inequalities we see in psychiatry, including the shameful fact that people with severe mental illness die, on average, 20 years younger than the general population.

It was finding an outlet for anger that made me want to write the article on how we can overcome this, and it didn’t take much research to realise that we already know how. Within psychiatry there are good resources on how to make it easier for people from minoritised groups to access services, how to improve the physical health of people with mental illness, and how to listen to and involve patients in shaping how things are run. But underfunding of services means we don’t have the time to think or the money to make the changes we need.  

Strategies for preventing mental illness at a population level are closely aligned to those that would improve health across the board – investing in early years, education, employment and a healthy standard of living would address health inequalities, not just in psychiatry. So why haven’t we done this?

It’s here that I think the answer gets a bit more complicated – politics. Keeping people in the conditions that make them sick is a political choice, and if we want that to change that then we have to find a way to engage in discussions about policy and priorities. One of the key points I wanted to make in the article is that there is no way we can do this on our own. As individuals we can do our bit, but if we want to address health inequalities in psychiatry we have to use our collective voice.

The college seems a good place to start, and we need leaders to advocate for psychiatrists and our patients, but the scale of the problem needs a louder voice than this. Ultimately we need to join a larger coalition for change, engaging with the public and other groups across society. Our skills as psychiatrists put us in a good place to distill and communicate the complexities involved.

I’m aware that none of my suggestions are particularly new, and there will be plenty of things I’ve missed out. I hope that the article can do something to keep addressing health inequalities in our conversation, and encourage us to think about where we can add our voice.

Read the 2022 Praxis Editorial Award winning article here.