Last week, the Children's Commissioner for England reported that referrals to NHS child and adolescent mental health services have surpassed one million a year – almost double the number recorded five years ago. Demand has continued to rise faster than the system's capacity to respond, leaving many children and young people waiting months, and in some cases years, for support.
These figures tell us something important about the state of mental health services. They also raise a more difficult question: when services are under increasing pressure, who is most likely to experience the consequences?
As Minority Mental Health Month begins, the conversation should extend beyond awareness. Mental health inequalities affecting minority communities have been consistently documented in international research and policy reports, including the WHO Mental Health Atlas (World Health Organization, 2024) and the OECD's Understanding and Addressing Inequalities in Mental Health (OECD, 2025). The more pressing question is why these disparities persist despite growing awareness and repeated policy commitments.
Recent findings from the Commonwealth Fund's 2026 State Health Disparities Report reinforce this point. Examining health system performance across racial and ethnic groups, the report found that disparities in access, quality of care, and health outcomes persist across every U.S. state. It argues that these differences are not simply explained by individual behaviour or health literacy but also by the way healthcare systems are designed, funded, and experienced. States such as Connecticut, Maryland, Massachusetts, New York, and Rhode Island perform comparatively well overall, yet continue to demonstrate disparities in access, quality, and health outcomes across ethnic groups (Maksut et al., 2026).
The way these inequalities are understood has also evolved. For many years, efforts focused on reducing stigma and encouraging people from minority communities to seek support. Those remain important priorities, but they are only part of the picture. Recent evidence suggests that access alone does not guarantee equitable care. Whether people continue to engage with services often depends on whether those services feel culturally responsive, trustworthy, and relevant to their experiences.
Trust has become an important part of this discussion. Previous experiences of discrimination, communication barriers, and cultural misunderstanding can shape whether someone feels confident seeking support in the future. For many people, trust is not simply an outcome of good care, it is a condition for accessing care in the first place. Expanding services, while essential, may not be enough if those services are not experienced as safe, inclusive, and responsive.
Digital mental health adds another dimension to this conversation. Digital platforms are often presented as a way to widen access by reducing geographical and logistical barriers, and in many respects they do. Yet accessibility is not the same as equity. Research suggests that digital literacy, language, cultural relevance, trust, and socioeconomic circumstances all influence who benefits from digital mental health interventions (World Health Organization, 2024; OECD, 2025). As digital tools become more integrated into routine care, ensuring they are designed with diverse populations in mind will be essential if they are to reduce rather than reinforce existing inequalities.
This has practical implications for the way digital services are developed. Success should not be measured solely by how many people a platform reaches, but by who benefits once they arrive. Equity cannot be treated as something to address after a product has been developed; it needs to be considered throughout the design process.
Minority Mental Health Month provides an opportunity to move the conversation beyond awareness and towards the way mental health services are designed. If similar disparities continue to emerge across countries, healthcare systems, and models of care, the issue is unlikely to be awareness alone. It is also about whether services, both clinical and digital, are built with equity as a guiding principle.
The evidence is clear. The challenge now is to translate that evidence into services that people from all communities can access, trust, and continue to use.
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