There is a lack of research on Black and Minority Ethnic/BME mental health and the ways in which the health care system is set up and challenged by some of the issues that arise from this area. The importance of considering and investing in preventative measures, and how they can benefit society, is an evolving and ongoing debate, and one that needs to be had – particularly where Black and Asian communities are concerned.
In this interview with psychologist Dr. Tina Mistry we discuss race in relation to mental health and the barriers Black and Asian ethnic minorities face as a result of this.
The Interview
Different ethnic groups have different rates and experiences of mental health problems. This reflects the difference in cultural and socio-economic influences experienced by these groups. How do these experiences compared to their white counterparts impact their access to culturally appropriate treatments?
The issues we have with statutory healthcare is that it is over-subscribed and under resourced. In order to offer ‘something’, people with mental health issues are offered treatments that are ‘effective’ for the ‘short term’. Many of these approaches do not have the ability to meet the needs of minorities or to understand the complexities of the melting pot that acculturation (assimilation to a different culture, typically the dominant one) creates.
Everyone has mental health, just as we have physical health. Mental health difficulties do not discriminate against race, ethnicity, class and gender. It affects everyone at some point. That being said, we know that particular minority groups are more likely to experience poor mental health than others. This is due to the invisible factors that influence the everyday functioning of a person. Over the years research has continually pointed to the impact of social economic deprivation and mental health. Unfortunately, many BME communities fall into this category. If we think about the communities with low SES (socio-economic status), they often have lower educational levels than the privileged and with that comes a limited awareness of mental health problems. To be specific, I give the example of first-generation non-English speaking migrants. These groups often access their GP for physical health issues but may not be able to articulate the underlying psychological cause of that. There is a growing body of literature that explains this further around Medically Unexplained Symptoms as it discusses how psychological trauma or Adverse Childhood Events (ACE’s) have directly impacted the brain and body. The consequences often result in physical health issues such as high blood pressure, chronic pain, susceptibility to diabetes and often poor coping strategies such as smoking and alcohol use. In children, ACE results in poor behaviour, mood disorders and poor academic achievement. Later in adulthood these factors then contribute to poorer lifestyle choices i.e. an impact on their ability to engage in employment and so forth. The cycle just continues.
People from BME communities are more likely to be diagnosed with mental health problems, are more likely to be admitted to hospital and experience a poor outcome from treatment and are also more likely to disengage from mainstream mental health services. It is reported that this leads to a deterioration in their mental well-being which in some cases can carry serious health risks (mentalhealth.org).
Based on your expertise and work experiences why do you find the above to be issues for ethnic minorities?
This is a huge issue for health service providers as this goes beyond individual psychological issues. It stems from racism and white supremacy. The difficulty we have in the UK and the USA is that psychological models have been drawn from Eurocentric research and participants. Therefore, the ideas that psychology offers is based on values adopted from white culture – for example the value of individualism vs collectivism. When a person of colour goes to see a therapist who will most likely be white (because the system is unfortunately geared to support those who have stable incomes and high academic attainment) that person will likely feel like their cultural needs are not being understood or met. As a result of this they may not connect to the therapist and the model offered and the person in need of support will soon disengage from the service. Their mental health problem becomes further entrenched and this can then result in hospitalisation of that individual.
We need to consider what mental health difficulties mean to minority groups. We need to consider their whole story and understand that mental health issues do not arise from nothing. They are often caused by a moment or experience which then interacts with genes and ones social environment. To add to this cocktail, we need to include intergenerational or transgenerational histories – which entails trauma, suffering, prejudice and patriarchy – add to that colonialism and its impact in a post-colonial society.
The list goes on.
In essence, mental health issues are not one dimensional. They are multifaceted. However, the complexity does not suggest hurdles, it offers opportunities for ‘out of the box’ thinking to enable us to support communities from diverse backgrounds. It encourages a multidisciplinary approach to mental wellbeing. Psychologists and therapists can only support one part of the healing, it is up to us as a community, a society and as a generation to help support each other. We need to create compassion around distress, pain and suffering.
What challenges can therapists face in the mental health sector when working with BME patients and why?
We need to be offering support when people need it the most and making it appropriate by being sensitive to the person and what they bring into the therapy room. I also think each therapist cannot serve everyone as they bring their own selves into the therapy room too. So, it is a matter of knowing what the therapist’s competencies are and to be aware of when the issues are beyond their expertise. As mental health care professionals we can only work with what we can work with, so if a person lives in a neighbourhood which feels unsafe, we are limited in helping to support them with this. This is a huge issue and often lies within socio-political parameters – something that is out of the control of a therapist.
As ethnic minorities with different cultural needs and experiences to the majority, what preventative measures can we take when caring for someone with a mental health problem?
As a starting point we need to raise more awareness and we need to research under researched areas. Education is key. Understanding someone’s culture and the impact this has on mental health is essential. We need to develop culturally sensitive services that meet the needs of particular groups. It has to be grass roots led, otherwise it will not meet the needs of minorities in need of support.
As with everyone we need to be attempting to engage in activities that give us a sense of joy, satisfaction and value when caring for our mental wellbeing. By acknowledging yourself, honouring your story and your generational legacy you can hypothesise why you are the way that you are. Accepting this is often the beginning and if therapy is helpful then engaging in a meaningful explorative discussion around trauma, pain and identity can be productive. For many South Asians religion, community and spirituality are all sources of education and we can use that to help create meaning for ourselves in our mental health journey.
I often hear people saying, ‘I don’t want counselling or therapy on my medical records – just in case. This concern is likely widespread and it deters individuals from attaining professional help. What advise do you have for someone considering therapy who may be worried about leaving a ‘footprint’ on their medical file and how does one seek the right therapist or counsellor for them?
I suggest going to the GP as the obvious source of support. However, for those that want a discreet service, there are many other options.
- If in employment then many employers will offer Employment Assistance Programs with a confidential counselling service.
- Conducting a Google search to find a therapist, psychologist or counsellor in your preferred location is another way. There are also many directories in which therapists will advertise their services and you can search for these fairly easily.
- Word of mouth or recommendation
- Social media – many therapists are now active on platforms so you can get a virtual sense of them.
What to look for is all based on what you need. Are you struggling with relationships? Anxiety? Low mood? Trauma? If you know what you are struggling with then look for someone who specialises in that area. Check their accreditations. Most therapists are accredited and governed by a regulatory body.
Is location important? Therapy is often weekly, so can you get there easily? Ask for a free brief consultation. Do you like how they sound? Do you connect to them?
How you connect to them is the most important factor for therapeutic outcomes, so make sure that *they understand you and that you trust them*.
This BBC film is an important watch. It looks at the taboo nature of talking about mental health as two parents discuss losing their child to a mental illness.
Dr. Tina Mistry aka @brownpsychologist is a Clinical Psychologist and founder of TherapySense – a private psychology practice based in Birmingham. Dr. Mistry works with adults and specialises in working with anxiety, PTSD, relational issues, intergenerational trauma and identity issues. Dr. Mistry is particularly passionate about working with South Asians and professionals who support them on their mental health journey.
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