The study highlighted shared challenges in managing mental health across ethnic minority groups before, during and beyond the pandemic, including stigma and non-culturally sensitive services. These issues, compounded by pandemic restrictions, contributed to varied health outcomes and unmet service needs.

A conceptual model shown in figure 1 is developed to illustrate the experience of ethnic minorities living with mental health conditions as we observed them, and their interactions with health services. Our findings extend to previous research exploring mental health in ethnic minority populations,22–24 demonstrating the conflicts between cultural and religious traditions and the management of mental health. Cultural and religious communities serve as sources of comfort and reassurance, providing members with a sense of continuity and stability in a Western system new to them with cultural shocks and language barriers. However, mental health is not always recognised as a legitimate or accepted concept in many cultural and religious traditions. It has been viewed through alternative lenses for years, for example, spiritual or moral weakness instead of medical or psychological conditions. This perception creates barriers to seeking help due to fear of judgement or ostracisation. Consequently, individuals may avoid formal care, exacerbating mental health issues and potentially leading to severe outcomes such as self-harm. Changes around social norms and practices within these communities, during the pandemic, compounded such challenges.

Conceptual model of disconnected mental health services and ethnic minority community support.

This study sheds light on the experiences of ethnic minorities accessing and engaging with mental health services before, during and beyond the pandemic. Many people delay seeking care until a crisis occurs, often due to language barriers, cultural stigma and limited awareness of available support. Initial reliance on GPs and family members can lead to inconsistent information and further delays. When services fail to incorporate cultural perspectives, individuals turn to community settings for emotional support, where a sense of belonging positively impacts well-being, even if mental health needs remain unmet.

Building trust is seen as key to engagement, shaped not only by individual provider interactions but also by the broader healthcare system. Where individuals feel their cultural values are acknowledged and integrated into care, they are more likely to engage with services.25 However, language barriers and cultural stigma can create a dual challenge for ethnic minority communities, reducing trust and engagement with mental health services and healthcare professionals as well as limiting access to reliable mental health information. The lack of direct translations for medical terms reduces the effectiveness of translation services, while stigma prevents open discussions with community leaders or families. In addition, limited health literacy—especially among disadvantaged groups—exacerbates difficulties in navigating mental health services and communicating symptoms. Over 40% of UK adults struggle to understand general health information, with 60% facing challenges when numbers and statistics are involved, further hindering access.26

Culturally appropriate care27 extends beyond translation services to encompass an understanding of cultural beliefs, religious influences and family structures in treatment approaches. Evidence suggests that community-based models, peer support and faith-based initiatives enhance engagement and outcomes.28 Culturally responsive care should not be the sole responsibility of certain professionals, but must be embedded across the system. Training all clinicians and healthcare staff in cultural competence ensures services are inclusive, accessible and tailored to diverse populations. Collaborations between healthcare providers and ethnic minority communities are essential in designing and delivering culturally sensitive mental health services. Engaging community leaders, incorporating lived experiences and adapting services based on continuous feedback can reduce stigma, improve trust and enhance resource utilisation. A culturally informed approach is necessary to foster equitable mental health support that meets the diverse needs of all individuals.

Although we explored the impact of the pandemic on mental health service engagement, our findings did not reveal challenges for ethnic minority communities that were only specific to this period. Barriers such as long waiting times, accessibility issues and reliance on informal support were all features before the pandemic, and their ongoing nature reflects broader systemic shortcomings rather than pandemic-specific effects. Similar challenges are reported globally among ethnic minority communities,29 30 suggesting these issues stem from migration and systemic inequities rather than COVID-19, reinforcing the broader need for culturally responsive and accessible mental health services. Some of the barriers, such as access, remain a key issue post-pandemic, which was repeatedly highlighted by participants.

The geographical spread, multicultural backgrounds and range of mental health conditions of participants allowed for a wider range of experiences to be investigated. The study explored their interactions with mental health services, from seeking support, service access and admission to inpatient stay. Given that this is an under-represented group in clinical practice and that seeking mental health support is frequently an involuntary and distressing process, it is notable that there was a significant degree of consistency among participants. This suggests that the main issues and challenges have been robustly identified by this study.

Due to our efforts to interview participants from a range of ethnic groups, most were identified in community settings. Although we aimed to capture not only a diverse range of ethnic groups but also individuals with varied mental health conditions, the sample was heavily populated by individuals of African and South Asian heritage, which may limit the generalisability of our findings to other ethnic minority groups. Furthermore, all interviewed had existing mental health conditions pre-pandemic and interviews were conducted after the end of pandemic restrictions. While we used open-ended questions, prompts and follow-up discussions to aid memory recall and elicit detailed responses, this timing might have influenced their ability to recall and reflect in detail on their entire experience of accessing support during this period.

Several implications for clinical practice can be drawn from this study. Culturally appropriate care should be a fundamental aspect of all clinical practice. By integrating cultural competence training and practices, clinicians can develop more effective treatment plans and deliver person-centred care that is responsive to the diverse needs, values and preferences of individuals from various backgrounds. Ensuring that all healthcare providers are equipped with the skills and awareness to offer culturally responsive care promotes inclusivity, strengthens patient–provider relationships and improves the overall quality of mental health support.

Our findings also underscore the importance of initiating collaboration between mental health services and ethnic minority communities. This collaboration should focus on educating and disseminating knowledge, as well as providing accessible information to support individuals experiencing mental health conditions. Such a proactive approach can enhance the understanding of cultural needs and preferences, which in turn can guide more effective and tailored use of health resources as well as improved service delivery and better engagement.