On the 31st of March, the government’s report, 'The Commission on Race and Ethnic Disparities' was published. This report followed an overwhelming outcry from both the public and from within government itself to address racism in the UK after the BLM movement of 2020. This much awaited report has been highly criticised for its stance on institutional racism, but what does it have to say about the relationship between racism and mental health?
The report’s perspective.
The commissioners for this report consisted of 11 members and was chaired by Tony Sewell, a British educational consultant. In the Foreword written by Sewell the stance of the report on the existence of institutional racism within the UK is immediately apparent.
When addressing the deeply felt trauma and distrust in Black and ethnic communities there is repeated language that suggests the responsibility to resolve these issues, lies on those who are oppressed, not on the wider powers and institutions that created and maintain that oppression.
Sewell states that 'communities could help themselves through their own agency, rather than wait for invisible external forces to assemble to do the job' and that overcoming 'obstacles; of racism within the UK 'becomes much harder if people from ethnic minority backgrounds absorb a fatalistic narrative that says the deck is permanently stacked against them.'
- See also: 'Meghan Markle, “racial gaslighting” and its re-traumatising effect on the Black population'
- See also: 'Inquest finds that significant police failures contributed to the death of Leon Briggs'
- See also: 'Racial discrimination still widely reported across mental healthcare services'
In this foreword, when analysing causes of the oppression, discrimination and prejudice in the UK, Sewell suggests 'The evidence shows that geography, family influence, socio-economic background, culture and religion have more significant impact on life chances than the existence of racism.'
Therefore, this report fails, from the outset to acknowledge that these factors all sit on their own intersections with race and as a result, when discussing Black and ethnic minority peoples they will always have an interaction with race and racism, be that on an interpersonal level or an institutional one. Sewell does follow this point up with an acknowledgment that 'we take the reality of racism seriously and we do not deny that it is a real force in the UK.'
Following on from the perspective that is established in the foreword, the section on Mental Health is particularly concerning.
On page 199, the report makes the claim that the evidence gathered suggests, 'there is no overwhelming evidence of racism in the treatment and diagnosis of mental health conditions' but admits that there is a need for more research to 'understand the impact of issues such as mistrust of the health services among some groups.'
The report also makes mention of the Wessely Review, that found 'Black people were 8 times more likely to be subjected to community treatment orders than White people, and 4 times more likely to be detained.'
The report continues 'Such disparity is often taken as evidence of racism' but then refutes this claim by providing evidence that instances of diagnosed schizophrenia among ethnic groups, particularly Black, are significantly higher.
This however, fails to acknowledge the causes of these higher rates of schizophrenia in Black and ethnic minority communities, and how they are entrenched in experiences of racism from a young age and institutional racism within Mental Health services, therapeutic approaches and psychiatry at large.
To give voice to the evidence that refutes these claims we asked the UK Council of Psychotherapy to comment.
On the over-representation of Black and Brown people within Mental Health services and specifically as this pertains to higher rates of diagnosed schizophrenia within these communities, Anthea Victoria Benjamin from the UK Council of Psychotherapy said, "Any changes to address this on-going over-representation within the mental health service and the criminal justice system needs to take into consideration the social, political, historical, and cultural context.”
Benjamin also noted that this over-representation reflects the longstanding exposure of Black and Brown people to overt and covert racism, linking this directly to the increased likelihood of developing mental health conditions such as schizophrenia.
Benjamin finished emphasising that, “To start to understand this issue without considering the impact of institutionalised and unconscious bias is unhelpful and the recent government report denies this important fact and in doing so this is an act of racial gaslighting… Racism cannot be separated from institutional processes or financial inequalities and other forms of oppression as it is individuals who make up that system”
We also spoke to Dawn Estefan, Psychodynamic Psychotherapist and expert in trauma. Estefan is also a writer and last year was awarded the 'Thought Leader Baton Award' for her work with women and diversity in mental health.
On institutional racism’s effects on mental health, Estefan noted a failure in the report to “acknowledge decades of peer reviewed research, previous government reports and independent reviews which have proved that racial disparities in health, particularly in mental health are driven (in part) by social inequality which is structurally determined.”
It is important to acknowledge the existence of institutional racism in order for us as a country, appropriately address how it effects Black and ethnic minority communities. This notion was very pertinent to Estefan.
Without this acknowledgement she stated that “we are left with no option than to continue with a system where race equality largely is left to be addressed by community organisations and the third sector rather than embedding it into legislation and the NHS.”
An aspect of how racism can affect mental health services that this report did not address, is the misdiagnosing of Black and ethnic minority peoples. On this issue, Dwight Turner from the UK Council of Psychotherapy said the report fails as a result of its “top down view of the requirements of the Black community” and that the section on the diagnosis of schizophrenia within these communities “fails to recognise the frequent misdiagnosis of black people as per reports by Mind and other organisations.”
Misdiagnosing someone due misunderstanding cultural differences, is an important aspect of how institutional racism impacts the experiences of Black and ethnic minority peoples at every stage of accessing mental health services.
This gap in understanding, from westernised therapeutic theory and ideologies to simply misinterpreting different cultural norms is upheld by institutional racism. As Dawn Estefan puts in her piece “Breaking Down Racism in Mental Health Care” for our site, “The assumption that one size fits all and that everyone has a similar experience is a failure to understand the existence of racial disparities.”
Similarly, on how the report fails to address the shortcomings of mental health services in their treatment of Black and ethnic minority peoples, Dwight Turner said the report “tries again to shoehorn cultural differences for black patients into a mental health system which was not designed for them, thereby ignoring the mental health needs of a disparate, and diverse population.”
'The Commission on Race and Ethnic Disparities' report, briefly mentions the evidence found by the Synergi Collaborative Centre, and its findings on how “there is a growing and convincing body of evidence that psychosis and depression…are more likely in those exposed to racism”. Although the report mentions this evidence, it fails to recognise the part institutional racism plays in upholding the very racism it admits to the existence of.
As demonstrated by the professional experience and insight that Anthea Victoria Benjamin, Dawn Estefan and Dwight Turner did kindly lend to this article, there is a misrepresentation of racism in the UK present in the report. This misrepresentation negates how exposure to racism informs the mental health of Black and ethnic minority people and of how it affects their experiences of accessing mental health services.