When English footballer Danny Rose revealed his depression battle, his bravery was celebrated by everyone, from the NHS to Prince William. In recent years, there has been a growing number of prominent black voices sharing their mental health struggles, which is no doubt a good thing. However, the experiences of everyday black people within the mental health system are quite the opposite, as research has shown.
Like many who suffer with mental health challenges, Rose stated that there was no singular cause of his depression. Dealing with long term football injuries, his uncle committing suicide, his mother suffering racial abuse and someone attempting to shoot his brother at their home, all contributed to his depression.
Rose’s candour will help improve the way depression is perceived and he is keen to help other sufferers when back from the Word Cup in Russia. However, the everyday black person in Great Britain facing similar battles finds themselves caught up in a mental health system which currently, isn’t set up to meet the needs of black people or fully understand how racism and cultural barriers can have an impact on mental health.
According to NHS England, the Improving Access to Psychological Therapies (IAPT) programme, which began in 2008 has “transformed treatment of adult depression in England.” However, a briefing paper by the House of Commons published in April, stated that of people completing an IAPT treatment course during 2016-7, black people were less likely to ‘move to recovery and to see an improvement in their condition’ compared to white people.
This followed a report from the mental health charity Mind in 2010 which stated, “People from BME communities have long been underserved in primary mental health services and are much less likely than other groups to be referred to psychological therapies”. Marcel Vige, head of equality improvement at Mind, believes black people are at a higher risk of experiencing mental health issues. Vige recounted anecdotes from black women describing how social situations can have impacted their mental health:
“Why do I have to change who I am so that people don’t find me intimidating or aggressive?” – Teacher
“I have to prove that I can do the same thing as a white person,” – Marketing Executive
“I can’t embrace who I am, fully….I need to make sure people are always comfortable with me.” – Personal Assistant
I spoke with a mental health social worker, (who wanted to remain anonymous) who gave some insight into the racial and gender dynamics black people are still dealing. While various factors affect the experiences of black people navigating the mental health system, race also plays a major role.
How long have you been in your role and what does it involve?
I’ve been a mental health social worker for 4 years in a diverse London borough, and will complete my training to become an Approved Mental Health Practitioner very soon. I support a lot of black women suffering from a range of mental health illnesses including, depression, bipolar disorder and schizophrenia. This involves monitoring their journey, while accessing therapy and taking medication.
How can the mental health system support black people properly?
There are so many factors involved, but it’s also important to have more black therapists (in all capacities) – this can have a big impact. I’ve had some patients say, they feel misunderstood because the therapist can’t identify with the black experience and how racism contributes to the way they feel.
In your professional opinion do you think there are any additional barriers of gender inequality black women face?
Some of my patients who have suffered trauma (involving a man), naturally do not want a male therapist, but in some teams the most relevant therapist available is a man. This extends the waiting time for these vulnerable women.
According to 2016-7 figures published by NHS Digital, the number of black people detained under the Mental Health Act (272 out of 100,000) is four times more, compared with white people (67 out of 100,000). Are you surprised by this?
No. Before someone is detained, the level of risk they present is documented during a Mental Health Act risk assessment. This makes note of various things; their appearance (including hairstyle e.g. if they have dreadlocks), their ability to make eye contact and how they communicate. In general, as black people we tend to be quite expressive in the way we speak; for someone undergoing assessment this is sometimes deemed as being aggressive.
Addressing mental health service inequalities
In 2016, the Mental Health Taskforce produced the “Five Year Forward View for mental Health” plan, focussing on tackling the inferior care provided to black and other ethnic groups; many of whom usually interact with mental health services after being arrested by police.
“The 5-year Delivering Race Equality programme concluded in 2010 that there had been no improvement in the experience of people from minority ethnic communities receiving mental health care. Data since shows little change. These inequalities must be prioritised for action….In particular, there are questions about the over-representation of black people in mental health settings and the use of force that features in some of their deaths.” The taskforce went on to state that NHS England should provide funding to improve mental health inequalities; with an update due in 2019-2020.
Mental health issues can arise from a myriad of personal experiences, but the impact of racism and discrimination should not be ignored. The NHS Digital report admitted that figures of detention rates for black people, “may be underestimated”, and black Caribbean people in particular, are still detained at significantly higher rates than other ethnic groups. Within all the recommendations made for improving the care given to black people, a system that understands the black experience is key for improving outcomes to levels experienced by white patients. This includes having more black professionals working in the system and more comprehensive research to fully understand the gravity of the problem.
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