This piece was written by one of our contributors; GP – Zirva Khan.
Awareness of mental health problems worldwide is at its peak. BAME (Black Asian and Minority Ethnic) communities are also victims of mental illness. Not only is it under-recognised in these communities, but under-recognised by society. So why is it not spoken about more?
In the UK around 1 in 4 adults a year will suffer from a mental health problems, and of these 1 in 8 adults are seeking help/treatment. (1)
These statistics are not perfect. But to some extent, we are past the days where talking about mental health was TOTALLY ‘hush hush’.
Or so we would think…
This analogy may apply to the majority of the UK population, but what is the real story within BAME communities?
The research so far suggests many interesting findings, and there are two reports that really break it down. These include the Mental Health Report by the Race Equality Foundation (2), and the most recent Marmot Review (3).
Outlined is what we know vs Caucasian population:
- Common mental health problems are more prevalent, particularly in the Pakistani population
- Depression is more common (particularly in women) (4)
- Up to 5 times more likely to be diagnosed and admitted for inpatient schizophrenia treatment
- Higher rates of suicide
Asylum Seekers/Refugees (2)
- 5 times more likely to have poor mental health but less likely to receive support
Why do these stats exist?
The reasons why ethnic minorities have a higher prevalence of mental illness is multifactorial. But where do we start?
The common general risk factors of developing mental illness would include (5):
- Deprivation or unemployment
- Health problems
- Addiction (which can be a cause/effect of mental illness)
- Social/environmental factors
- Obvious events including bereavement, trauma, head injury.
Each individual person will have their own individual factors contributing to them having a mental illness. For many people of ethnic minority backgrounds, many of these are amplified with very unique factors. These may include where that person fits into their community, their sense of identity, and their sense of belonging in society or the society that they want to be part of. Being aware of these helps us understand so much more.
For anyone who has followed the #blacklivesmatter (6) movement, will have (hopefully) learnt of the torture and trauma black people have endured historically, going at least as far back as the Slave Trade. Though we are centuries down the line and society has moved on hugely, the colour of their skin is still a big reason for prejudice. When speaking to many Black people, they will say they have always had to work that bit harder to be heard, and to be recognised.
The effects of British Colonialism are still deep rooted in the blood of ethnic minorities. We cannot ignore this. If you would like to learn more, below I have listed some great resources – I have learnt so much from these!
- ‘Why I’m No Longer Talking To White People About Race’ – Reni Eddo-Lodge
- ‘Me and White Supremacy’ – Layla F Saad
- ‘The Great Partition – Making of India and Pakistan’ – Yasmin Khan
- ‘Partition Voices: Untold British Stories’ – Kavita Puri
- ‘Inglorious Empire – What the British Did to India’ – Shashi Tharoor
- ‘We Need to Talk About the British Empire’ – Afua Hirsch (Audible)
- ‘About Race’ with Reni Eddo-Lodge
- ‘Partition Voices’ – BBC
Ethnic minorities are more likely to live in the 10% most deprived neighbourhoods in the country (3,7). The factors above then multiply with a phenomenon we know as “Health Inequalities”. Communities in the most deprived neighbourhoods are unfortunately disadvantaged in most respects. They are more likely to be poor, at higher risk of living in unsafe conditions, with reduced access to nutritional food, and of course at higher risk of substance and alcohol misuse.
Taboo, Stigma and Shame
Many people from ethnic minority backgrounds also have their native cultural and religious values to uphold. They may feel shame or embarrassment talking about how they feel, especially men (8). Many do not realise that what they are feeling is a mental illness. People may present to their doctor atypically also, i.e. with physical symptoms (9), and thus even further misunderstood.
If one does have insight and attempts to seek help, “the community” may not be helpful, which is a huge barrier alone to continue seeking help. Further from this, if one was able to access help, the systemic barriers of the mental health service are so ill equipped to meet the needs of the patient, that the Royal College of Psychiatry have acknowledged them as racist (10).
A cocktail for mental health destruction, right?
Is it all doom and gloom?
In short, help is definitely there, and no, it really is not all doom and gloom! Despite the facts and the evidence that the inequalities are gradually widening (3).
The awareness of the root causes is incredibly important in understanding what can be done to help. For one, if you have read this far you have already educated yourself significantly about this complex dilemma. And for this, I thank you.
How can help be accessed?
If you or someone you know is concerned about their mental health, whether or not you are from the BAME communities, check out the following 9 tips (adapted from the Rethink website11)
- Speak to someone you trust
This can be a family member, friend or a professional. Speak to them about how you feel. They may be able to help you or signpost you to where you can get help.
- You can take a trusted person to your appointment
Because of COVID the way we consult with professionals has changed, but whether it is a telephone or video consultation, your trusted person can be with you on loudspeaker/video.
If who you want to see is able to do face to face, explaining to them the need for your trusted person may help you have that support also.
- Ask for a professional who is from a similar native background
Some find it easier to speak to someone who is from the same background as them if they speak the same language as them. You can request this.
- Request aan Interpreter
Not everyone can have someone they at their appointments however professional interpreters can really helpful with communication.
- Tell the professional about your background and culture
Not everyone will know about your background, culture or lifestyle. It is important to be open as this may be relevant to your mental health problems. The environment is confidential and all your information will be private between yourself and the health professional, unless it is deemed a risk to the wider population.
- Ask that professionals speak to you in a way you understand
Professionals can often talk using words and phrases that are difficult to understand, and by simplifying it this may help you. Many professionals (I have been guilty of this) do not realise they are speaking jargon, so please make them aware of it!
- Make contact with services outside of the NHS
There are many charities and organisations tailored to the needs of ethnic minority populations, and they may be able to help you in very different ways to the NHS. These will be listed at the very end of the article.
- Educate others
You may be closely linked to family members or a community that does not know much about mental health problems or still believe in the stigma or taboo surrounding it. You may be someone that they can understand from better, and become educated about mental illness.
- Understand your legal rights
If you feel you have been discriminated against or have had difficulty with the services you have used, you have legal rights that you can explore. Please visit Rethink for more information.
- Mental illnesses affect everyone
- The BAME community have a complex network of factors from historical British Colonialism, to health inequalities and identity crises that significantly yet adversely affect to their mental health.
- The NHS has some resources to help however many independent resources exist now to support people from minority communities.
If you or a loved one is suffering from mental health problems and struggling, please seek advice from your registered GP or equivalent.
If you or a loved one is considering self harm, or have thoughts of ending your life, this is considered an emergency. Please call 999.
Black Thrive – for Black people with mental illness in the Lambeth Borough
The Black, African and Asian Therapy Network – a resource housing the largest community of Counsellors and Psychotherapists of the BAME community
South Asian Therapists – another resource housing relatable people who can provide psychological support
Taraki – working with Punjabi communities to reshape approaches to mental health
Sharing Voices Bradford – de-stigmatising mental health for black and ethnic minority communities in Bradford
Chinese Mental Health Association – mental health support for people from Chinese communities
Kindred Minds Southwark – a drop in group in Southwark for people aged 18 from BAME backgrounds experiencing difficulties with mental health.
Mind – one of the biggest mental health charities in the UK providing support to all including minority communities.
Rethink – another great charity that supports the lives of people affected by mental illness through their network of local groups and services.
(4) Karasz et al 2016