Seeking help for mental health problems is hard enough, but for those of us who belong to a Black, Asian and Minority Ethnic (BAME) group, there are unique challenges.
The statistics tell us that if you fit into this demographic grouping, you’re less likely to reach out for help.
A recent survey reported that one in four BAME people would choose not to talk about their mental health problems with anyone, including professionals. Yet, those who do take the difficult and brave step of getting professional help often face more hurdles.
BAME individuals are not only more likely to get a poorer outcome from therapeutic treatment, but they are also more likely to disengage entirely from mental health services. Worryingly, the numbers show us that black people are more likely to be forcibly detained under the Mental Health Act (1983) than their white peers.
When black sufferers are being detained, they are also 30% more likely to be restrained against their will and 50% more likely to be placed in seclusion than a white sufferer. These alarming facts often escape the spotlight when conversations about the state of mental health services arise, but they do need to be questioned.
Why are BAME individuals disproportionately, and often violently, being sectioned under the Mental Health Act? And why are we as a population seemingly so reluctant to engage with mental health services?
As a woman of colour who also works in a mental health service, I’ve not been surprised to learn that the answers to these questions lie in the social and racial inequalities at play in British society.
Research is clear: we don’t get successful treatment outcomes because of barriers created by cultural and racial biases. Feedback from Traveller communities recently highlighted this: Travellers felt unable to engage with healthcare workers who misunderstood their cultural identity and needs. The Mental Health Foundation embellished on this, stating that mainstream mental health services are not equipped to fully understand the needs of BAME groups due to a lack of training and a lack of staff diversity. They particularly highlighted that there was a lack of understanding in services about how racism impacts wellbeing.
The British Psychological Society has reported that 91% of those entering the clinical psychology field in 2014 were white and of their registered psychologists, only 181 were Black in comparison to over 9000 white professionals. These statistics do matter because although you don’t have to have lived experience of racism to support someone who has endured the trauma of it, you do need to have some awareness of the existence of the problem. However, if you’re in an environment where very few people around you ever experience it, you won’t be cultivating this awareness.
From my own experiences, I know how important it is to feel understood when you seek support. Now, I know that no two people who seek help from mental health services will have the same circumstances, no matter what their race, age or sex might be. However, most of us will share a cultural framework with each other and this mutual understanding can be the key to a positive therapy outcome.
When it comes to attitudes towards mental health, there’s a lot of cultural variation. Mental health workers don’t need to come from the same background as the people they work with. In fact, just an appreciation of their patient’s cultural framework can go a long way. In my own South Asian community, mental health problems like depression and anxiety often aren’t considered to be real because there’s no physical injury, the invisibility of the illness renders it non-existent. In some instances, we’re told that if we prayed more, we’d find peace.
There’s also a taboo when it comes to mentally ill people, with fears that mental illness means someone is ‘out of control’ or ‘crazy’ which can lead to individuals being alienated from the community at large.
It’s crucial for therapists to understand these issues and currently, this isn’t happening because of a lack of diversity and training.
Although the current picture of BAME mental health provision looks worrying, it does seem that some change might be on the horizon within mainstream services. Many NHS mental health services are adopting BAME outreach programmes to try and improve engagement in these communities.
There are also a number of non-profit organisations across the UK that offer therapy tailored to the experiences and needs of BAME individuals, such as the Southall Black Sisters and the Chinese mental health association.
As a therapist, I know that we don’t just need resources in terms of staff diversity, we also need to be taught the sense of understanding the varying and diverse needs of others too. This is a fundamental principle in talking therapies but in the instances of racial and cultural diversity, it’s a need we’re not doing a good job of accommodating.