There’s a race problem in our mental health services
By MAYA GOODFELLOW
On 7 November 2014, Faiza Ahmed told staff at the job centre that she was three days late to sign on because she had been trying to commit suicide. Then she went home and rang the ambulance service. Police and an ambulance crew paid her a home visit and decided she wasn’t an immediate risk to herself – she was left alone and took her own life 40 minutes later. The day before her death, Faiza reported an alleged sexual assault to the police. But under new guidelines, the officers who attended to her case weren’t required to send in a specialist.
Faiza had a history of depression. In 2010 she was diagnosed with personality disorder. The next year she was sectioned. In 2013 and 2014 she had expressed suicidal thoughts. But when she reached out to three separate bodies in the last days of her life, she was let down by each of them. The prejudices were stacked against her: she was a black woman, a Muslim and living in a poor area. These factors, her family say, all contributed to the institutional neglect that, arguably, played a part in her death.
Faiza’s death should provoke a long-neglected debate about the colossal failings of the police, who have a history of failing victims of sexual assault and mistreating people of colour, the Department for Work and Pensions, which appears to have virtually no safeguards in place to help vulnerable people who come through its doors on a regular basis, and the Ambulance Service. Behind the lethal inadequacy of these three bodies lies another issue: the availability and effectiveness of mental health services for ethnic minorities.
Mental health issues affect people of all colours but evidence suggests ethnic minority groups are 60 per cent more likely to suffer from depression. Despite this people of colour, in particular black people, have an experience unique in its negativity if they encounter services supposedly designed to help. Mental health charities often make it clear there’s never one cause of suicide, but there are a plethora of identifiable reasons that mean ethnic minorities are one of the groups most likely to fall through the huge cracks in our mental health services.
The scant research on this subject makes for extremely worrying reading. Black, Asian and minority ethnic people (BAME) have a harder time accessing mental health services than their white counterparts. Thanks to the government’s swingeing cuts it’s hard enough to get mental health treatment in the UK but social stigma and distrust of institutions that have a history of discriminating against people from minority ethnic communities act as barriers to mental health services.
Mental health issues affect people of all colours but evidence suggests ethnic minority groups are 60 per cent more likely to suffer from depression
When people of colour overcome these obstacles – if they experience them to begin with – there’s a chance they won’t be treated with anything that resembles dignity. A 2002 report by the Sainsbury Centre for Mental Health found that black people “generally have an overwhelming negative experience of mental health services”. Damning evidence found “inhumane, unhelpful and inappropriate” treatment in overwhelmingly white mainstream services; black services users weren’t treated respectfully and their voices weren’t heard.
Fourteen years on and what’s changed? Not enough. A 2013 survey found BAME people are likely to experience two counts of discrimination: the first because of their race, the second due to their mental ill health. Discrimination on the grounds of their illness didn’t just come from wider society, 49 per cent of people asked said they experience discrimination from staff. Add to this a 2013 MIND report that found despite some good experiences, people of colour said staff weren’t diverse enough. There’s a race problem in our mental health services.
In addition to this, there’s an almost complete absence of understanding of the affects racism, in all of its pernicious forms, can have on mental ill health. The drip of evidence in recent years shows there’s widespread racism in the workplace, that our law enforcement has problems with institutional racism, that unemployment rates for people of colour are more than twice as high for white people, that minority ethnic people are more likely to live in poor households and in deprived neighbourhoods, and that black people are more disproportionately represented in prison here than in the US. Mental health issues aren’t just caused by racism, but for some it certainly plays a role.
Throw into this toxic mix microagressions. The everyday slights people of colour have to endure are thought to have an impact on mental health. Exhaustion, exclusion, wall-to-wall racism and the constant battle of trying to be heard take its toll. These insidious forms of racism and their impacts barely even register among some mental health practitioners; if anything it can be replicated by the system.
But help is out there. Organisations like the Black and Asian Therapist Network and Recovr cater to the particular needs of BAME people who are experiencing mental health issues. Yet the Conservative government have created an economy that makes it increasingly difficult for vital services like these to survive. At a time when budgets are being cut to the bone, it’s the marginalised who bleed the most.
Campaigns to take the stigma out of talking about mental health and to improve services, need to pay attention to the ways communities of colour are let down by the system. Racism, stigma, poverty, cuts a lack of nuance in understanding mental health and a dearth of diversity in mainstream institutions are factors that make life harder and mental health services more difficult to access. Faiza Ahmed should never have been left to suffer in her vulnerable state alone. The tragic events over the years before her death should act as a warning: we need change to stop people like Faiza falling through the cracks – because suicide is avoidable.
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