Statistics demonstrate that one in four adults experiences at least one diagnosable mental health problem in any given year and mental health problems represent the largest single cause of disability in the UK. If we look at BME (Black Minority Ethnic) groups, however, the state of affairs is even worse. In fact, people in marginalised groups are at greater risk of being affected by Mental illness. Disproportionate rates of people from BME populations have been detained under the Mental Health Act 1983 and data suggests that a black man in the UK is 17 times more likely than a white man to be diagnosed with a serious mental health condition such as Schizophrenia or Bipolar disorder.
Many are aware that there is much stigma around mental ill health and although there is work being done to make change happen; there is still a long way to go. For the Black Muslim experiencing mental illness, however, there are multiple barriers to face. Of course, we need to take accountability as a community; on closer inspection, however, I have come to understand that the issue is multifaceted. It is not only about education, culture and religious practice. There are structural issues at play that require mental health services to work much more holistically and justly with our communities. According to the Mental Health foundation, people from black and minority ethnic groups living in the UK are:
- More likely to experience a poor outcome from mental health treatment
- More likely to disengage from mainstream mental health services, leading to social exclusion and a deterioration in their mental health.
There are socioeconomic circumstances that contribute to these conclusions but what is also apparent is the fact that there must be multiple failures by health services due to either structural racism or perhaps ignorance. I mention racism because many different studies by organisations such as the Care Quality Commission and other government bodies, show that black patients have a greater chance of being forcibly restrained and are more likely to be placed in seclusion.
When an individual is characterised as psychotic, medication isn’t far behind and black patients are given much higher doses of anti-psychotic medication. Much of this is also relating to perception as the public and mental health professionals are inclined to augment and overemphasise the likelihood that young black men in particular will be aggressive. In addition to these findings, according to the mental health statistics for England 2018 Briefing Paper, those identifying as Muslims were least likely to experience reliable improvement from the Improving Access to Psychological Therapies programme that was launched in 2008 in order to raise the quality and accessibility of mental health services in England.
Mind’s “We still need to talk” report highlights some of the challenges faced by IAPT. Among difficulties with waiting times and lack of choice when it comes to therapies offered; the report mentions that patients from BME backgrounds faced further adversities. The report explains that those from BME backgrounds often come into contact with mental health services at the acute stage of their condition. This means that minorities are not being supported at earlier stages, where perhaps much less invasive intervention could be provided. In the report, Mind continues to explain that:
“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. This group face significant barriers to accessing psychological therapies as often many local areas lack culturally sensitive and tailored services which meet the diverse needs of the local population.”
Intersectionality is a term that was coined by American professor Kimberlé Crenshaw in 1989 to describe the way multiple discriminations are experienced. As an example I am black, Muslim and a woman. These multiple identities may lead me to experience racism, Islamophobia and sexism so that is the intersection. Multiple oppressions are not encountered separately. They merge as a single combined experience. The combination creates something more sinister. Black Muslim individuals with mental ill health will also have multiple experiences of prejudice not only from their own communities, wider society but also health services that in essence should provide a safe space to promote healing.
Being able to work with diversity is crucial in any field but supporting individuals that already are vulnerable, stigmatised and have multiple disadvantages; it is essential to not only have the right training but right state of mind. If Muslims are least likely to experience reliable improvement from IAPT and black patients experience clear discrimination; I question whether health professionals are able to support Black Muslim clients suffering from mental ill health. Considering that building the right relationship with a professional in talking therapies is crucial; perhaps Black Muslim clients that would benefit from mental health support feel dissuaded from reaching out for help due to anxieties around potential negative experience that will further compromise their mental health.
We need continued education targeting BME communities and diverse government funded campaigns to tackle stigma. Having Black Muslim role models who openly discuss mental health is a critical first step. In conjunction with raising awareness, however, issues within mental health services must be addressed. There are barriers created by institutional racism and ignorance of cultural sensitivities, however, what is more frightening is the fact that even when a BME individual manages to tackle stigma and cultural impediments, the data shows that they are very likely to experience poor outcomes. In fact in his 2016 study on access to services of BME groups, Professor Anjum Memon (Chair in Epidemiology and Public Health Medicine at BSMS); explained:
“….healthcare providers need training and support in developing effective communication strategies to deliver individually tailored and culturally sensitive care. In order to improve mental health literacy, raise awareness of mental health conditions and combat stigma among BME communities, we need to improve information about services and access pathways for these groups.”
With public figures, talking about their struggles with mental illness and sharing their stories, awareness is being raised. Still, although we are doing more now than we have ever done before; we, as Black Muslims, do not talk about Mental Health enough. Nevertheless, I believe that a great onus lies with mental health services and I’m very concerned that they are not taking responsibility for their actions. Community leaders and faith leaders are becoming much more vocal about mental health but in order to create authentic and sustainable change, there has to be a comprehensive approach. Mental health services must take issues around institutional racism much more seriously and call for drastic change. As Lambeth Councillor Jacqui Dyer wisely affirmed in a 2017 BBC interview:
“We have to change the narrative, by actually changing the services”
Shukri Mohamed: On Black Muslim intersectionality and Mental HealthTweet