"When a community is constantly portrayed as strong and independent, individuals can internalise thoughts and view anything less as a sign of weakness," writes Kairo Maynard.
Over recent years, mental health issues and its stigmas have come to the forefront in the way we think about the world. However, for all the ways we think and talk about mental health, an area that is still overlooked is how mental health is perceived in the Black community. According to The Adult Psychiatric Morbidity Survey in 2016, Black people living in the UK are the least likely to receive treatment or adequate care and support for a common mental health disorder, despite being one of the highest groups to be diagnosed and sectioned (McManus et al, 2016). It’s no wonder then that Black communities are more likely to disengage from mental health services, leading to poorer treatment outcomes and quality of life.
Despite what we think of mental health, it doesn’t simply stay within the lines we draw for it. It can influence every aspect of our lives. Take pregnancy, for example. The World Health Organisation states that virtually all women can develop a mental health disorder during pregnancy. However, the risks are higher for women who experience poverty, migration, extreme stress and low social support. Given all that, and the status at which non-white women are placed within our society, it isn’t surprising that Black women are more prone to both physical and mental ill health.
- The highest rates of PTSD were observed in Black British participants, particularly women who are more likely to experience a higher number of sexual assaults; but have a lower number of reporting or seeking help for their trauma.
- Black African men are more likely to commit suicide compared to their White counterparts (Bhui KS et al., 2012).
- Black people were among some of the highest to be sectioned under the Mental Health Act 1983 (MHA), however they were in the lowest group to be offered social support.
- African-Caribbean people are three to five times more likely than any other group to be diagnosed and admitted to hospital for schizophrenia.
Stigma and change
It should be nothing short of shocking that the diagnosis rates of Black people are disproportionately higher than those receiving care. Major reform needs to be done within the mental health sector and wider society on how Black people are viewed, especially when poor mental health is involved.
As a Black therapist, I am conscious of the lack of action following the discussion of mental health in the Black community. My focus is entirely on action here as conversations have been happening and reports have been published on the need for cultural competence in professionals. However, given the lack of change and low percentage of Black therapists, I question who is leading this discussion, and representing the current voice? (Maynard, 2018). And where does the responsibility lie? Do training institutes or professional bodies need to take more accountability in how therapy courses are taught? Is it up to the individual professional or organisation to challenge this narrative? Is it society as a whole that needs to change the perception? Or do we simply need more Black health professionals at a senior level to demystify negative stigmas?
- See also: Breaking down racism in mental health care
- See also: Unfair British care: racial inequality in mental health underlined in EHRC report
The way society views Black people influences how we are seen by mental / health professionals. There are many medical myths that inform negative views of Black people, such as being more tolerant to pain or being the aggressor. All this does is reinforce the notion that we do not need the same level of care as other races. We are more likely to be offered a stricter medication regime vs therapy, are “four times more likely to be detained under the MHA 1983, and ten times more likely to be subjected to ‘community treatment orders’” compared to white counterparts (Alex Matthews-King, 2018).
It’s worth noting that this data could be skewed due to the fact that Black people are overrepresented in medium to high secure units compared to other races, usually because it is more common for admission to be via the courts or police and not through primary care such as the GP.
The lack of referrals via GP could be due to the lack of trust for health professionals, and how mental health is viewed by Black communities. A community which is constantly portrayed as strong, independent, and the aggressor can internalise these thoughts and view anything less as a sign of weakness. Additionally, addressing mental health through a cultural and/or religious lens can act as more of a hindrance rather than help due to the method of help being solely based on prayer.
The numerous studies and reviews mentioned above should be enough to show that Black people are receiving inadequate care when they are most in need of. It is important to note that these numbers may be higher for Black women and the Black LGBTQ+ community who are even more marginalised. Organisations, training institutes, professional bodies and individuals need to thoroughly address the stigmas that are informing how Black people are being treated for their mental health. Additionally, mental health needs to be normalised in these communities.
There are pockets of this discourse happening, but it is only when a nationwide shift occurs will we see true change.
One organisation that has set out to change these narratives is the Black, African and Asian Therapy Network (BAATN), home of the largest community of Counsellors and Psychotherapists of Black, African, Asian and Caribbean Heritage in the UK. Their aim is to address the inequality of access to psychological services, whilst also seeking to influence the integration of this approach into mainstream psychotherapy training, literature and practice. These are invaluable actions that need to be happening. However, this responsibility should not just fall on to BAATN or other individuals/ organisations that identify with the communities they are serving. It needs to be a collective process, something we all endeavour to do.
Dami Adeyeye, a 26 year old educator and actor from London created a documentary that centres young Black people and health professionals talking about their experiences of mental health. A Dark Mind aims to act as an open discussion and tool to dismantle the stigmas of mental health within and placed on the Black community.
A Dark Mind will be screened at the Rio Cinema on 16th May 2019. Tickets are available here: https://www.eventbrite.co.uk/e/film-screening-qa-a-dark-mind-tickets-60463142888
The Independent article can be found here: https://www.independent.co.uk/news/health/mental-health-act-detained-sectioned-ethnic-minority-bme-report-nhs-a8669246.html
The Black, African and Asian Therapy Network can be accessed here: https://www.baatn.org.uk/
Bhui, KS., Mckenzie, K., (2008) Rates and risk factors by ethnic groups for suicides within a year of contact with mental health services in England and Wales, in. Psychiatric Serv. 59:4 pp. 414-420)
Bhui, KS., Dinos, S., Mckenzie, K., (2012) Ethnicity and its influence on suicide rates and risk, in Ethn Health, 17:1 (pp. 141-148)
Centre for Mental Health, LSE Personal Social Services Research Unit. The costs of perinatal mental health problems – report summary (2015)
Maynard, K (2018): To be Black. To be a Woman. Can Dramatherapy help Black women to discover their true self despite racial and gender oppression? in Dramatherapy, London: Taylor and Francis
McManus S, Bebbington P, Jenkins R, Brugha T. (eds.) (2016) Mental health and
wellbeing in England: Adult Psychiatric Morbidity Survey 2014. Leeds: NHS Digital.
ONS - Office for National Statistics. Measuring national wellbeing: Life in the UK (2016), at ONS.gov.uk
WHO – World Health Organisation, https://www.who.int/mental_health/maternal-child/maternal_mental_health/en/)