Our latest MQ Open Mind webinar was on Black mental health. We gathered experts on this vital subject from Diverse Cymru, Colourful Minds, as well as one of our MQ Ambassadors Andrea Corbett. Our webinar covered so much that our guests didn’t get a chance to answer all of your questions. Here are some of your questions from the Black mental health webinar.
Missed the webinar but still want to find out more? Catch it on our YouTube channel.[embedded content]
Q: Do you feel there is a problem with how Black people perceive NHS services, which acts as a barrier to the feeling like they can access support, for example, through primary care?
Dr Sam Oyekan from Colourful Minds, said:
I think there is definitely a mistrust of NHS services at times, which unfortunately follows the mistrust a lot of BAME individuals have across all environments. The racism experienced in some environments can lead to a pre-emptive closing off by BAME individuals towards all Caucasian people. When you remember that Caucasian people are the majority ethnic group in this country, and also make up the bulk of the management and leadership roles within the NHS, understandably, there will be some mistrust towards them.
I believe improving understanding of the cultural norms of the population in the area that access that particular NHS service can largely improve levels of people accessing that service and patient satisfaction. If people felt listened to and understood, then they will continue to engage with that service. So that might mean more patience with those who aren’t so familiar with certain aspects of healthcare services, improved access to translation services for those who may not have English as their first language, and more emphasis on showing how all-inclusive these services are.
Q: I’m curious about the respective race of client & practitioner in therapy. Some people would prefer to be treated by someone of their own culture or ethnicity, whereas others would feel uncomfortable with this due to stigma within their community. I wonder if therapy providers could offer a choice about this when providing support? Also, the responsibility for all therapists to make efforts to understand if clients do not have the same race, ethnicity, or culture as them.
This is a challenging question. We would always make every effort to make patients or clients as likely to engage, and that might include having preferences regarding who they see. But that needs to be based on an appropriate request. If someone has had a difficult experience with abuse, has cultural reasons or is incredibly anxious around other genders and would like to be seen by someone who is the same gender as them, then we will try our best to facilitate that. However, if someone doesn’t want to see someone in the team because of any characteristic, as they have preconceived opinions about whether they’ll be good enough or just not liking them, we can’t perpetuate that idea. We would always explore the basis of any requests like that, and if it’s not appropriate, we would explain why we can’t do it.
I think it is essential that any therapist or clinician is aware of the intricacies of someone’s background and culture as much as possible, but this is where building up a rapport with the patient or client can help to fill any gaps. We all make pre-judgements about people we don’t know. Still, once that treatment relationship is built up hopefully, most people will be able to see that support can come from any individual, even if they are not the person you would have initially picked.
Practitioners working in Universities are working with BAME students, mainly young adults who have been impacted by the impact of COVID-19 on family and community, the spotlight on racism, the Black Lives Matter movement’s response, and now another economic recession. What would be one thing can practitioners do to support this generation’s mental health?
Dr Charles Willie, the former CEO of Diverse Cymru, replied:
There is never just one thing which in itself deals with an issue like this. However, one thing that could be part of the solution is practitioners respectfully accepting and positively addressing the acknowledged inequality faced by BAME students across all public life sectors, and the interlinked mental health impact that this can have on students.
A starting is to positively and proactively address the specific cultural and religious needs of BAME students by practitioners ensuring that they have a full and proper understanding of culture and cultural difference and also of the impact of unconscious bias. This understanding will hopefully lead to the delivery of culturally competent services in the practitioner’s day-to-day practise, and as a consequence, improved outcomes for BAME students.
Q: Do you think Black or ethnic minorities are more likely to suffer mental health abuse than those of White Caucasians in society because of culture?
Suzanne Duval, BAME Mental Health Manager at Diverse Cymru, said:
Anyone can experience mental health problems, but our chances of having good or poor mental health are far from equal.
All of us have multiple layers of identity and belong to communities of geography, gender, ethnicity, social class and many more. And many of us experience forms of disadvantage resulting from poverty, homelessness, exclusion, discrimination or oppression. We have fewer choices, less of a voice, less power and fewer opportunities. The determinants of mental health interact with these inequalities in ways that put some people at a far higher risk of poor mental health than others. For example:
Men and women from African-Caribbean communities in the UK have higher rates of posttraumatic stress disorder and suicide risk and are more likely than average to be diagnosed with schizophrenia. (Source: Centre for Mental Health Commission for Equality January 2020)
There is an extensive literature on the impact of stress on health and illness.*
We all experience stress in our lives, but prolonged exposure has been shown to have an impact on health and to be correlated with depression, vulnerability to upper respiratory disease and exacerbation of autoimmune disease. Whatever their socioeconomic status, the quality of their housing, their income or national origin, all BME people in the UK suffer in common from a unique source of stress. Racism.
In commenting on research by Professor David Williams, the editor of the BMJ special issue on racism in medicine observed:
“People who experience everyday acts of discrimination—like getting poorer service in a bank or a restaurant, or being treated with less courtesy—will over time have worse health outcomes, including higher rates of heart disease, lower life expectancy, and greater infant mortality.”
*I am grateful to Thomas Cox for guiding me towards this literature. (Professor Robert Moore)
Q: What do you think is behind the disproportionate experience of BAME people’s experiences with Mental Health Trusts services in the higher diagnosis of psychosis, being sectioned etc. What can be done to change this and make experiences fair and equal?
Below is a report that is worth looking at.
Bad news travels fast, and that is the experience of BAME people with mental health services, which could explain why we as Black people, enter services at a late stage.
Not always understanding when we should seek help, not realising that our actions may sometimes be seen or accepted as ‘not right’; different belief systems seeing mental ill-health as a curse from God/Allah etc. Some people seek faith healers. Others are afraid that to have a mental health issue that we will be judged harshly by ourselves and others, especially if you consider arranged marriages and the connotations of that. Many are afraid to have anything to do with the services because of how we hear we are treated. There are too many deaths in custody. The list goes on. There is no one reason as we are not one group of people with the same beliefs or customs.
“There is a profound paradox at the centre of Black people’s experience of mental health services in England. Young Black men, in particular, are heavily over-represented in the most restrictive parts of the service, including secure services. And Black people generally have an overwhelmingly negative experience of mental health services. Yet these same communities are not accessing the primary care, mental health promotion and specialist community services which might prevent or lessen their mental health problems. They are getting the mental health services they don’t want but not the ones they do or might want.
We have reached a point in the relationship between the Black communities and mental health services where there are truly Circles of Fear. Black people mistrust and often fear services, and staff are often wary of the Black community, fearing criticism and not knowing how to respond, and fearful of young Black men. The cycle is fuelled by prejudice, misunderstanding, misconceptions and sometimes racism.”
There is a lack of cultural competence and un/conscious bias that plays a big part in people’s experiences.
What can be done to change this and make experiences fair and equal?
There are so many answers out there that can be sourced, but they have to be taken into account, practised and embedded. BAME people need to be equal partners in seeking advice or information. Experiences of one race are not the experiences of another race, we are not a homogenous group, so one size does not fit all.
An excellent piece of work that is currently taking place in Wales, but is working with southern Ireland on their Mental Health Reform and also enquiries from England is the Diverse Cymru BME Mental Health Workplace Good Practice Scheme. We are working with all seven Health Boards in Wales as well as Public Health Wales and various voluntary sector bodies. We have an excellent pedigree where the Welsh Parliament funds the Scheme, and the Royal College of Psychiatrists endorsed the Scheme. We are working with the United Kingdom Investor in Equality and Diversity (UKIED) who verify and certify the Scheme.
If you would like to find out more about the Scheme, please look on the Diverse Cymru Homepage.
If you missed the webinar, we would strongly recommend taking a moment to watch it. Catch it on our YouTube channel, alongside our other webinar about looking after our mental health as lockdown eases.