Today is World Suicide Prevention Day and, along with recent conversations I’ve had with friends on the matter, and learning that two friends have been battling with suicidal thoughts, it has got me thinking about mental health among black people in the UK.
It is no secret that mental health – and mental illness – remains a somewhat taboo, or at best uncomfortable, topic within many BAME communities. But the statistics are shocking and, like it or not, demand that we shed the stigma within our communities to have candid conversations about mental health.
These are the facts:
In general, people from black and minority ethnic groups living in the UK are, more likely to be diagnosed with mental health problems; more likely to be diagnosed and admitted to hospital; more likely to experience a poor outcome from treatment; more likely to disengage from mainstream mental health services, leading to social exclusion and a deterioration in their mental health.
People from African and African Caribbean communities are more likely than others to be admitted to hospital for mental illness. The same is also true for people of white and black mixed ethnicity.
African-Caribbean people living in the UK have lower rates of common mental disorders than other ethnic groups but are more likely to be diagnosed with severe mental illness. African-Caribbean people are three to five times more likely than any other group to be diagnosed and admitted to hospital for schizophrenia.
African Caribbean people are also more likely to enter the mental health services via the courts or the police, rather than from primary care, which is the main route to treatment for most people. They are also more likely to be treated under a section of the Mental Health Act, are more likely to receive medication, rather than be offered talking treatments such as psychotherapy, and are over-represented in high and medium secure units and prisons.
Why are you 17 times more likely to be diagnosed with a serious mental health condition if you are a black man in Britain, and six times more likely than a white man to be an inpatient in a mental health unit? Furthermore, why have 56 percent of Black inpatients in mental health units been sectioned, more than any other ethnic group, and why are they much less likely to receive talking treatment but higher doses of medication? These are the questions which blogger and radio presenter Keith Dube, who has himself suffered from depression, sought answers to in BBC documentary Being Black, Going Crazy? which explored the current state of mental health in black Britain.
Keith Dube investigates black mental health in the UK - BBC
The stigmas and ignorance surrounding mental health are universal and do not only afflict black communities, so why is that black British people are disproportionately the sufferers of poor mental health and inadequate mental health treatment?
Well, first we must consider the factors that contribute to poor mental health. As the NHS website explains:
‘Most of us have problems at some time in our lives, such as money worries, stress at work or the death of a loved one, which can affect our mental health. But people from African and African Caribbean communities can face additional problems that may affect their mental health.
Everyday life has a big impact on mental health, and black communities in the UK are still more likely than others to experience problems such as bad housing, unemployment, stress and racism, all of which can make people ill.
Worldwide, it seems people who move from one country to another have a higher risk of mental illness. This is especially true for black people who move to predominantly white countries, and the risk is even higher for their children.’
Then there is the matter of racism, which can not only contribute to the creation of mental illness, but be a factor in determining the quality and type of care that black and ethnic minority mental health patients receive, in turn affecting the outcome of their treatment and chances of achieving improved mental well-being.
According to Mind charity, research consistently shows that young African and Caribbean men are more likely to face negative experiences when using mental health services, which means they have poorer mental health as a result. For this reason, charities including Mind and Time to Change have chosen to focus on working at an institutional level, addressing how minority mental health patients are dealt with by police and medical staff in some of their projects aimed at improving mental health among BAME communities.
One such project, 300 Voices, which ran from 2013-2016 was a working partnership between Time to Change, Birmingham and Solihull Mental Health NHS Foundation Trust and the West Midlands Police, also in the latter stages South London and Maudsley NHS Foundation Trust. It focussed on reducing the stigma and discrimination that can exist in statutory mental health settings and the police.
Indeed it was the death of black musician Sean Rigg in 2008, who died in the custody of Brixton police after being restrained when he had a schizophrenic episode, that led to the creation of the Lambeth Black Health and Wellbeing Commission in response to findings which had highlighted that the NHS and police had failed Mr Rigg.
BBC Newsnight investigates police treatment of those suffering from mental illness
Racism can also negatively impact on the level of care that minority people suffering from mental illness receive in less obvious ways. For example, the racial stereotype of the strong black woman has been repeatedly criticised as propagating the myth that black women are somehow less vulnerable to mental illness than their white counterparts or less in need of professional treatment when they are experiencing mental illness.
And then there is the matter of cultural and religious beliefs within Afro-Caribbean communities, which undeniably have a part to play in the aforementioned racial discrepancies we see when it comes to mental health.
With 69% of black Britons self-identifying as Christian during the last census the role of religion, in particular the church, in tackling the issues around mental health should not be underestimated. Whilst the church and spirituality help many people who are suffering from poor mental health, there is still the problem of false ideas being pushed by some churches and religious leaders – such as the idea that mental illness links you to the devil or that prayer alone will cure any mental illness.
In a poignant article for The Independent earlier this year Lateefah Jean-Baptiste recalls her experience of her faith becoming problematic when it came to her and her family making sense of mental health and getting the required medical help:
'Growing up in a Caribbean Christian household my cousins and I were told prayer was the answer to everything, but it wasn’t the answer to my family’s struggles with mental health.
Throughout my childhood my mum suffered with chronic depression. […] It took my mum over a decade to speak to a professional. When my mum would try to talk about her depression, my nan would only have one response: go and pray. My mum knew this approach was never really going to work, because no matter how many times she prayed she still ended up feeling down.
In our church, leaders believed that mental illness was caused by evil spirits that can be demolished through prayer. I remember during one Pentecostal Church service, the priest suggested that depression is for non-believers and true Christians do not suffer with mental illnesses because they are associated with the devil’s doings.
When I began to suffer with depression, I refused to seek help at church, even though it was a place of community, where we all looked after one another. I too feared being told to pray it away. I was also afraid of being told that I was being contacted by the devil and needed deliverance, as some of my friends had been told.
It’s not just an issue in the Caribbean community, Africans Unite Against Child Abuse have warned that children who have a challenging behaviour are particularly vulnerable to being branded as witches. The use of exorcisms within some churches, as a treatment for children with challenging behaviour or mental illness, deters many from coming forward as adults and seeking help.
Luckily I sought out professional help, but it is about time we stopped telling young black adults to turn to prayer as a cure for severe mental health problems and start educating our community on how to actively seek professional help.'
As part of his research for the previously mentioned documentary, Keith Dube found that 67 percent of black people with mental health difficulties have been stigmatised and treated unfairly by their own families. "That's dangerous, and that messed with me as well. I didn't speak to my parents, to my dad, for a very long time about my mental health issues – not until this year, essentially, when I decided to do this film,” said Dube. Although, Dube does also note that it is important that the entire community isn’t painted with the same brush; by no means are all first generation (or other) British Afro-Caribbean people of the opinion that mental health is a taboo topic or one alien to their culture and community. As Dube recounts, “When we did have the conversation about mental health, dad was very understanding. I thought, 'wow, if I hadn't put him in a box and decided for myself how he'd treat this, I could've spoken to him years ago.'"
To some extent then, the problem can be addressed from within the community, by ensuring that community leaders – including religious leaders – are properly informed about mental health (causes, treatment etc.) and are creating safe spaces where people feel that they can have open conversations about it.
Last year a group of black barbers in Camden decided to do just this with the kind of initiative that we need to see more of if the statistics are to change. Undergoing training in Mental Health First Aid, a course equipping them with the skills to identify warning signs of mental illness and how to approach that, the barbers set about breaking down the stigma attached to mental health and helping their customers.
One of the barbers, Steve, said: “We want people to talk about it - to know it’s normal. Mental health is something everyone has. It’s just like physical health. Sometimes it’s good, other times not so good. Anyone can get the flu and anyone can get depressed or anxious. If we talk about it, hopefully other guys will too. They can get help, stop it from getting worse.”
Last year also saw curator Nicole Crentsil bring together black artists to create the exhibition Unmasked Women, using art to shine a light on mental health in the black British community; another example of how at a local level a movement for change is beginning.
Art by Kirsty Latoya, part of the Unmasked Women exhibition
Charities too are acknowledging that effective change can come from within black communities. Following on from the findings of a report carried out into BAME mental health, Sandra Griffiths, Time to Change Black and Minority Ethnic Equalities Coordinator, recognised that a broad approach is necessary to improve the current state of affairs. "Tackling mental health stigma and discrimination experienced by Black and Minority Ethnic communities needs to be tackled at an individual, community and societal level. Without this strategic approach the double discrimination that Black and Minority Ethnic people with mental health problems face will continue,” said Griffiths.
Projects which have been carried out off the back of the report’s findings and using a grassroots method include ‘Changing Perspectives through Church Champions,’ a project using drama presentations and testimonials to engage congregations in African faith settings throughout England about the topic of mental health.
The Southwark Clinical Commissioning Group has reported on the success of an NHS project which saw faith leaders in BME communities receive training on mental health to help their congregations. The review found that:
'The project has concretely demonstrated the impact of taking a dual approach (spirituality and medicinal practice) to addressing mental illness within the BME community. The mental health courses on the pilot for local faith groups were oversubscribed, and the conference held to celebrate the completion of the courses and discuss the issue of spirituality and mental health attracted over 130 local people from BME communities and highlighted the need for more training in mental health issues within faith groups.
Pastors have spoken eloquently about how they have “seen the light” following the mental health awareness training. Armed with a better understanding of the causes and cures of mental illness, they have been able to provide a far better and pragmatic pastoral care for those in their congregation. The biggest change that these trained Pastors have initiated is that they no longer take the approach to mental illness as a form of demonic possession, but that members of the congregation must see a health professional, take their medication and that the church will also continue to support them spiritually.’
With people at local and organisational levels working hard on these kinds of programmes there is hope that in the years to come the statistics on mental health won’t be so racially skewed as black people in the UK will feel that they can speak out about the difficulties they are experiencing with their mental wellbeing, know where to look for support and – crucially – feel comfortable seeking help from the appropriate channels without fearing that they will be judged, misunderstood or treated as a villain rather than a victim.
Let’s keep the conversation going because talking about mental health with friends and family in itself is a key part of the process of dismantling the existing stigmatisation and the silence that it shrouds itself in.