NYAPRS Note: Institutionalized racism within mental health treatment is not solely an American problem, and neither are the ways that methods formed to address it are marginalized in policy and practice. As this article regarding treatment of disparate racial and ethnic groups in the UK notes, studies and interventions related to cultural diversities and competencies have the ability to target racial disparities, but are often neglected when policy officials design new programs. And, in periods of austerity (the commonly used European term for fiscal conservatism that impacts social programs, ie. the slashing of food stamp programs in the US last year), small community-run mental health programs are often the first to lose funding, and are in the neighborhoods hardest hit by other social cutbacks. As we face a shift in the way we deliver behavioral health services in NYS and around the country, policymakers must realize the risk involved with ignoring cultural, racial, and ethnic differences in the way care is delivered, and the perceptions and preferences around that treatment.
Mental Health and Race – the Blight of Dual Discrimination
- The Guardian; Mary O’Hara, 3/25/2014
Time to Change pop-up village at Leicester Caribbean carnival, where members of the public can talk to volunteer staff who have mental health problems. Evidence suggests contact is one of the most effective ways to break down stigma and improve attitudes. Photograph: Time to Change
An overwhelming majority of people from black and minority ethnic (BME) backgrounds in the UK living with mental health problems face regular discrimination because of their illness according to a new report from the anti-stigma organisation, Time to Change. In the first survey the organisation has conducted, exclusively of people from BME groups, 93% said they had experienced discrimination in everyday life due to their mental health difficulties.
Respondents also reported high levels of racial discrimination (73% had faced it at some point and 28% in the previous 12 months), leading the study’s authors to warn about the serious issue of “dual discrimination” blighting people’s lives. The research surveyed 740 people in 2013 from a mixture of African, Caribbean, Indian, Pakistani and Bangladeshi backgrounds in England with mental health issues. Most alarmingly, it found that almost half (49%) had faced discriminatory behaviour from mental health staff.
“Discrimination as a result of mental ill health is reported across a wide range of everyday activities,” the researchers found. “There are some slight variations across ethnic groups but the overall picture is constant: discrimination is everywhere.”
Areas of life where discrimination was common included employment, in communities, within families and during contact with mental health services. Only a fifth of people from BME communities said they felt able to speak to people about their mental health. “This suggests that most are functioning in social circles where one of the most important parts of their lives is left unspoken,” the report concluded.
There have been ongoing concerns about mental health care and discrimination for people from BME backgrounds. Some groups, such as young black men, are much more likely than the wider population to be subject to sectioning under the Mental Health Act, to be held in seclusion on mental health units, to be physically restrained (in many instances causing death) and to face discrimination due to what campaigners have argued are misguided perceptions of “dangerousness” or propensity to violence. Campaigners have consistently argued that there is institutional racism within mental health services, leading to poorer outcomes for numerous BME patients.
Raphael Shervington from Birmingham, recalls being treated “like some sort of criminal” on mental health wards. “Based on my own personal experience I’d say attitudes to people with mental health problems can be quite bad. I’d like to see a better understanding within the system of people from different cultural backgrounds,” he says.
He argues that understanding the degree of discrimination, and its various forms, is vital and attitudes both inside services and in wider society need to change.
Shervington, 25, who has a diagnosis of schizophrenia, has has been volunteering with some of Time to Change’s grassroots projects that work to reduce stigma and discrimination in statutory mental health settings and within the police towards young African and Caribbean men.
He says he has chosen to speak out because of the scale of the problem. “I want to help bring about a positive change overall,” he says.
The Count me in 2010 “census” on the experiences of inpatients between 2005 and 2010, exposed shocking levels of mental health discrimination experienced by BME populations and showed progress was not being made in the NHS.
The latest survey was commissioned to provide a “baseline understanding” of the degree of stigma and discrimination faced across a range of ethnic minority groups – both in wider society and when in contact with services, says Time to Change director, Sue Baker. “We need this baseline to accurately assess the impact of what we do [subsequently],” she says. “It looks at a wider range of experiences than previous research and [so far] suggests there is widespread discrimination.”
But campaign group Black Mental Health UK (BMHUK), says the Time to Change findings follow a long line of studies, reports and initiatives aimed at charting and tackling the problem, which are simply not doing enough. It argues that BME programmes are often regarded as “add-ons”, launched when tranches of funding are made available, but eventually disappearing, leaving people still suffering.
“Before Time to Change launched these issues were raised and ignored,” says BMHUK spokeswoman, Matilda McCatrum. “Suddenly they are back on the agenda. We need not make this an afterthought. Money should be given to the grassroots [BME] agencies that have been working in communities all along.”
Marcel Vige, interim chief executive, of the Afiya Trust, which since 1997 has been focused on health and social care issues for BME communities, says grassroots organisations urgently need greater support. “Services tailored to minority ethnic groups tend to emerge from within communities, addressing needs not met by larger providers. These organisations face a constant struggle to secure funding, leaving them particularly vulnerable when funding is curtailed, such as in the current period of austerity. Without alternative funding to draw on, such organisations are often the first to close. Unless measures are taken to address this, the consequence is increased unmet needs among some of the most vulnerable in society.”
Time to Change has allocated more than £730,000 in grant funding (from a total pot of just over £2.5m) to projects within BME communities over the past two years. “This is a long-term investment to track attitudes and levels of discrimination,” says Baker. “We need to know where the discrimination is coming from if we are to design a strategy to challenge it effectively.”