Hostile environment policies linked to prolonged distress in people with Black Caribbean ancestry

Psychological distress increased among people with Black Caribbean heritage in the UK, relative to the White population, following the 2014 Immigration Act and the Windrush scandal, finds a new study led by UCL researchers.

The researchers say their findings, published in The Lancet Psychiatry, suggest a causal link between government policies and a subsequent decline in mental health.

They were investigating the impact of the Immigration Act 2014, requiring landlords, employers, the NHS, banks, and the police to check right-to-stay documentation. This was a key part of a set of measures known as the Home Office's hostile environment policy, seeking to target people without leave to remain in the UK.

The research team also specifically investigated the impact of the Windrush scandal after news reports from late 2017 onwards documented how the UK government had, over the preceding years, been wrongly detaining British subjects who had come over from the Caribbean or threatening them with deportation.

The research team used longitudinal data from 58,087 people in the Understanding Society cohort study, which has a diverse group of study participants, including over 2,000 people of Black Caribbean background. Participants regularly completed a questionnaire to screen for mental health problems, which was used in the study as a measure of overall psychological distress that includes symptoms of depression and anxiety.

The findings showed an increase in psychological distress in people of Black Caribbean heritage in the UK after 2014, relative to White study participants. This difference was a decline of 0.7 points on a mental well-being scale of 1-36, which is slightly larger than the declines in mental health seen across the whole UK population at the time of the first COVID-19 lockdown, but, unlike the lockdown impact, the increased psychological distress in the Black Caribbean population persisted for several years.

Black Caribbean study participants then experienced a further increase in psychological distress relative to the White population after the Windrush scandal was uncovered.

Further analysis revealed that the 2014 Act affected first-generation Black Caribbean migrants more, while media coverage of the Windrush scandal affected British people of Caribbean heritage more.

The researchers say their findings suggest there was a causal effect of the Government's policies and the Windrush scandal on greater psychological distress for people of Black Caribbean heritage in the UK.

The researchers did not find similar effects for other ethnic groups, even though the hostile environment policy might have similarly impacted some, but the researchers caution that the measure of psychological distress they used could have missed harms such as moral injury or psychosocial disempowerment.

Lead author Dr. Annie Jeffery (UCL Psychiatry) said, "Our study highlights the harms to mental health that the Government's hostile environment policy had on certain groups of people, in addition to other well-documented harms such as deportation, job loss, eviction, and discrimination.

"The mental health impacts may have stemmed from the direct impacts of such threats to people's homes and livelihoods, but could also have resulted from a wider, pervasive sense of racial injustice and bias, faced by a group already experiencing systemic and sometimes institutionalized racism and discrimination.

"When the Windrush scandal dominated the news, there may have been a risk of re-traumatization for some people, while even those not directly affected may have experienced a form of vicarious trauma or fear of what could happen to them."

Senior author Professor James Kirkbride (UCL Psychiatry) said, "Our findings show that government policies can produce, maintain, and exacerbate systemic inequities in mental health.

"Policymakers should consider the mental health impact of immigration policies, as they can impact not only prospective immigrants or people without leave to remain, but also those who are already settled legally in the country, and thus they should design them to minimize all harms including mental health inequalities."

Co-author Professor Gianluca Baio (UCL Statistical Science) said, "Our analysis is based on a combination of a quasi-experimental design (called interrupted time series) and suitable statistical methodology, which can robustly limit the impacts of potential confounders or biases. Thus, our results suggest a strong causal link between the political environment and subsequent mental health outcomes."