The Racial Inequality in Mental Health Services by Guanlan Mao

When he was 23, the actor David Harewood was sectioned after suffering a psychotic breakdown. Since then, he has spoken widely about how he believes his experience of psychosis was linked to his identity: specifically, his identity as a black British man. 

In his article on the subject, David details the racism and violence he faced from an early age, which made him feel unwelcome and unsafe. This extended to his early career as an actor: a review of one performance as Romeo described him as looking “more like Mike Tyson than Romeo”. Over time, this pressure and feeling of isolation grew, contributing to him becoming unwell. But even when he became unwell he was not treated with the dignity you might expect. When he was sectioned he had six police officers wrestle him to the ground and sit on him for hours, and was given four times the legal limit of sedatives. On that day, David was close to being one of the many black men experiencing psychotic symptoms who have died whilst being restrained.

BAME individuals often have worse experiences of mental health services

David’s story is an illustration of the racial disparities which exist in the NHS when it comes to treatment for mental health conditions. Evidence suggests that BAME individuals are at higher risk of developing mental health problems in adulthood, but less likely to receive support for their mental health. Those that do are more likely to report worse experiences with mental health services. Here are four examples of ways that BAME individuals can have worse experiences of mental health services:

  • Being exposed to harsher treatments

BAME individuals can be subjected to harsher treatment within mental health services. For example, black people are four times more likely to be detained under the Mental Health Act than white people. They are also more likely to be subject to “restrictive interventions” such as being physically restrained and secluded, and less likely to be referred to talking therapy. The result of this, as the Mental Health Equalities Champion Jacqui Dyer notes, is that there is a belief in some Black communities that if you go into mental health services “it’s not that you get recovery, it’s that you die there”.

  • Lack of cultural sensitivity

In some mental health services, the staff may be lacking in racial diversity. This can mean that they lack the cultural knowledge and sensitivity required to work with clients from diverse ethnic groups. For example, staff may not be aware of different cultural beliefs or attitudes around mental health, and so engage with patients in ways that are seen as disrespectful or inappropriate. They may also misinterpret specific cultural expressions of distress, and therefore come to the wrong understanding of what is really bothering someone. 

  • Language Barriers

Many mental health services do not provide their support in languages other than English. As a result, those who do not speak English fluently can find it difficult to express themselves. This makes it more difficult for staff to properly understand what they are going through. Even when services use translators, not being able to converse directly can worsen the rapport between the patient and clinicians. 

  • Racism and stereotyping

BAME individuals can be subject to racist attitudes and stereotyping from healthcare staff. For example, in a study interviewing African and Afro-Caribbean users of mental health services several women reported racist attitudes from staff, including GPs asking “Why are all you Somalians in the UK? Why don’t you go home?”. These attitudes can cause BAME service users to be given a worse standard of care. For example, racist stereotypes around Black men being dangerous may influence staff to act in more restrictive ways, or to use force unnecessarily. Similarly, stereotypes linking some BAME communities with drugs may cause clinicians to minimise the mental health problems of people from those communities, and instead, attribute what they see to drug usage. Racism from staff can cause patients to feel worse than when they started, and discourage them from using mental health services in the future. 

 “Reaching out” can be harder for BAME communities 

A large amount of writing around BAME mental health focuses on the stigma existing in our communities. Often it aims to combat this stigma and encourage people to “reach out” to conventional services. Whilst this is definitely important, we should also look at what happens once people have taken that step. As we have seen, someone’s race can cause them to be treated in different and worse ways. Given this state of affairs, what can you do if you’re a BAME individual in need of mental healthcare? Here are four tips:

  • Try to access mainstream services earlier rather than later

This might seem like an odd piece of advice given the problems I’ve outlined above, but hear me out. One widely identified problem is that many BAME individuals put off engaging with mainstream services until later, due to lack of trust. Because of this, by the time they come to services they may be in crisis and so more likely to receive more restrictive kinds of care. This means that the best strategy for obtaining less restrictive care from conventional services is to try to access them as early as possible. You can self-refer to your local IAPT (Psychological Therapies) service, or speak to your GP. NHS services aren’t always perfect, but that doesn’t mean you won’t necessarily find something which does meet your needs. 

  • Find a culturally appropriate service near you

If you’ve had a look and decided that your local conventional service doesn’t meet your needs, that’s fair enough! Remember it isn’t your only option. There are groups all around the country dedicated to providing culturally appropriate services. These are often run by community groups or charities, and play a key role in supporting people where mainstream services are inadequate. For example, Black Minds Matter connects Black individuals and families to free mental health support provided by Black therapists. Taraki works with Punjabi communities: they hold events and forums around mental health for men, women and LGBTQ+ people. The Black, African and Asian Therapy Network has a directory of therapists of Black, African, Asian or Caribbean heritage. Have a look around, and see if there is something which sounds good to you.

  • Seek out community support 

Remember that something doesn’t have to be a specialised mental health service to benefit your mental health. Support networks can provide a powerful resource to draw on during hard times. Reach out to friends, family or others that you trust. Or you could see if there is a new group or community you’d like to join, perhaps one based on your interests. It doesn’t even have to be physical: there are many online communities on forums such as Reddit or Tumblr which can be a rich source of support, advice and solidarity.

  • Practice self-care 

The word self-care is thrown around a lot these days. It can be easy to forget that it has its roots in the work of the black, queer, feminist writer Audre Lorde. She understood that society wasn’t built to care for her, or for people like her. In the face of this hostile environment, she asserted that it was important for activists belonging to marginalised groups to recognise the importance of their own well-being. As BAME individuals, we know that we have to struggle against stereotypes, discrimination, and racism. We know that society wasn’t built with us in mind. That’s what makes it all the more important to be kind to ourselves, and to others in the same position as us. 

Bio:

Guan currently lives in London and works as an Assistant Psychologist across two mental health services, whilst serving as a research assistant for the Groups and Covid project at Sussex University. He is interested in the relationship between politics, economics and mental health, in particular public mental health and approaches to mental health treatment that acknowledge wider social processes and power structures. He holds a BA in PPE from the University of Oxford and a Master’s in Experimental Psychology from Sussex University.

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