Women from African Caribbean backgrounds often find it difficult to speak up about mental health problems due to fears of stigma, but there are initiatives seeking to challenge this. Vic Motune reports.
After a tough upbringing in Jamaica, Necola Hall had dreamed of doing something with her life and providing for her family. She got that opportunity when she came to the UK in 2002 and joined the army as a private.
As a member of the 1 Black Watch Scottish Regiment in Warminster, Wiltshire, Hall’s army career took in a tour of Iraq during the Second Gulf War in 2004. But her dream career quickly ran into a major roadblock.
After Iraq, the unrelenting challenges of military life took their toll. Hall struggled with the pressures of her job in logistics and found the experience of taking the exams required as part of her training difficult. It was to be another five years before she was diagnosed with dyslexia.
Life didn't get any easier when Hall found out she was pregnant. Sadly, she miscarried at 20 weeks. Postnatal depression followed.
“They said that when I was in the hospital I was walking around crying out ‘my baby, my baby,’” Hall recalls. “I don’t remember that part. But what I do remember are the panic attacks I had after my miscarriage and feeling very down. I began to self-harm and when I went back home I felt as though green gremlin-like creatures were attacking me.”
After granting her a compassionate posting to another less demanding army base, army doctors prescribed a course of antidepressants, but Hall refused to take them.
Like many members of the armed forces she feared that taking a course of medication would force her to admit that her mental health had been affected which in turn would sink her army career. Also, her religious faith played a major role in her decision to sweep her problems under the carpet.
“When the doctors told me I needed antidepressants, I totally refused,” she recalls. “As a Christian, I felt that if I was depressed, I was spiritually weak. I was also afraid of the stigma in the black community, from my family and friends, if I admitted that I had mental health problems.”
Hall’s problems continued for another seven years, negatively affecting her performance on the job. However, she still felt unable to tell her supervising officers about what she was going through. They in turn thought she was being lazy and threatened her with dismissal.
Finally, in 2012 she was assigned a mental health nurse and Hall says that turned her life around. “It was the first time that I could really just talk to someone without the fear of being judged or stereotyped,” she says. “It was great to have someone who just believed me. She gave me a number of coping strategies and made interventions on my behalf, which meant that I wasn’t put back into stressful working situations.”
One of those coping strategies was to write a daily journal in which Hall was encouraged to get the feelings she was experiencing down on paper.
That process turned into a book, I Was A Soldier, in which she details her struggles with depression and some of the factors that prevented her from talking about it.
As a result of the book, Hall has become part of a new initiative led by Time to Change, England’s largest campaign to end mental health discrimination, to raise awareness of mental health issues among African Caribbean women.
The initiative has seen the organisation hold mental health awareness training sessions in faith communities in the West Midlands with plans being developed to hold them in other parts of the country.
One of the recent sessions, called Our Resilience, was held in a church in the region. The sessions give attendees not only the opportunity to share their stories but also explore more holistic approaches to mental health such as talking therapy and the role that religious faith can play in dealing with illness.
Sandra Griffiths, Time to Change regional co-ordinator, says the session marked a turning point for many of the attendees.
“It was an incredible event,” she says. “There were women there who spoke up about their mental health challenges for the first time, including the wife of a pastor who said that she’d been too scared to say anything before. She spoke about how difficult it had been just to stand up and share her story because of what people might think of her if she revealed her battle with depression.
“For many who were there it was enlightening because they didn’t know that the women they sat next to and saw every week in church could have had mental health problems. When you hear the stories of others in a forum like that it opens up a discussion where they can openly share their perceptions of what mental illness is and isn’t.
“That session led us to do further work with this church to help train their staff who wanted to know how they could make the church a more mental health friendly environment so people facing challenges were not in a space where they felt they couldn’t talk about it.”
Forgetting the label
Time to Change also targeted black women through a recent project called ‘Forget the label, just listen’.
Launched in partnership with Lambeth Council, Birmingham City Council and Birmingham and Solihull Mental Health Foundation Trust in November last year, it involved volunteers in London and Birmingham using social marketing techniques and distributing flyers and posters in a bid to create face-to-face conversations with people. Specially designed washroom panels in local venues and social media were also part of the campaign.
Its aim was to tackle the stigma surrounding mental health in black and minority ethnic communities by challenging commonly-held stereotypes about what mental health is as well as working with local organisations to develop innovative approaches to support women living with mental illness.
But initiatives such as this need to be accompanied by a wider debate among mental health professionals about how they can better engage African Caribbean women, according to Griffiths.
“Many of the mental health initiatives that focus on the African Caribbean experience still focus on the experiences of men,” she says. “That may be because they are over-represented in many of the health and penal institutions. These trends tend to be deemed more newsworthy than the stories of women who come into contact with mental health services in different ways.
“They may not have been in Necola’s situation in the army but often they become unwell because they are the sole carer of a family and that stress can cause you to have your own mental health problems. That’s made worse by the fact that many in this situation play into the stereotype of being the strong black woman who’s got to keep the family together. There’s the fear that their kids may be taken away or that they may never be seen again so they end up suffering in silence.”
Such fears were highlighted in a 2002 Sainsbury Centre for Mental Health report called Breaking the Circles of Fear: A review of the relationship between mental health services and African and Caribbean communities.
The report found that when acute care was discussed, service users expressed high levels of apprehension. It was clear that hospital care dominated thinking about mental health care as a whole.
One service user who was interviewed said: “I remember when I first went into hospital… I feared that I was going to die.”
However, Griffiths says that despite the need to adopt new approaches to reach this group and address their fears, getting professionals to consider using the methods adopted by Our Resilience and Forget the Label, just listen may be difficult.
She believes a major stumbling block is that mental health professionals often perceive non-medical interventions as less credible than a more clinical approach. This leads to holistic and less traditional approaches not receiving sufficient support.
“There is more work that needs to be done to get women to speak out about their problems across the different age groups. We need to have a dialogue about how can mental health services and GP practices be improved so they can spot problems sooner, tackle fears women may have and encourage them to come forward. There’s no point in encouraging women to come forward if services aren’t really ready to listen to them.”
Keating F, Robertson D & McCulloch A (2002) Breaking the Circles of Fear: A review of the relationship between mental health services and African and Caribbean communities. London: Sainsbury Centre for Mental Health.
About the author
Vic Motune is a freelance journalist
This article first appeared in the September/October 2015 edition of Mental Health Today.