Minding Our Business: Supporting Black and minority ethnic well-being in the face of structural racism
For this year’s World Mental Health Day, Lucien Staddon Foster, Research Officer at the Coalition for Racial Equality and Rights, discusses mental health inequality, the reality of racial trauma, and how Scotland’s mental health services can better support our needs.
Black and minority ethnic voices are often missing from Scotland's big conversation on mental health, meaning the unique issues we face because of our race are not always understood when we discuss our well-being. Too often, we think of mental health as a purely individual issue treatable through mindfulness and prescription drugs without recognising the significant effect of our collective lived experiences and environmental circumstances. Because of this, we downplay the structural nature of mental health and therefore don't understand why some communities experience poor mental health disproportionately.
In Scotland, Black and minority ethnic populations disproportionately suffer from poor mental health due to increased exposure to poverty, adverse life experiences, and discrimination and are more likely to receive lower quality and less effective mental health support within the healthcare sector due to institutional racism. For instance, the Mental Welfare Commission reports that: Black and minority ethnic people in Scotland are 4.8x more likely to be compulsively sectioned during times of crisis than their white Scottish/British counterparts; they are more likely to be perceived as a greater risk to themselves and others - often contributing to a disparate use of physical restraint and sedatives in mental healthcare settings; and, unfortunately, this is exacerbated by gender, as practitioners in Scotland perceive 48.4% of detained Black women as a risk to themselves and others compared to just 33.8% of white Scottish women.
Every year, to draw attention to these racial inequalities and celebrate the work and achievements of Black mental health practitioners, a #BlackInMentalHealthWeek takes place. And in the UK, this year's campaign was more relevant than ever, as just a week earlier, UK-based mental health charity Mind issued the following statement regarding Chris Kaba, a young Black man recently killed by the Metropolitan Police in London.
Source: @MindCharity on Twitter
Racial trauma describes the condition resulting from the psychological, emotional, and physical suffering associated with experiencing or being exposed to racism. Typically, this is triggered by being the victim of a racist incident, recurrent exposure to microaggressions, or vicarious (or second-hand) trauma caused by witnessing the impacts of racism on others. As such, events like the death of Chris Kaba, their graphic depictions in media and social media, and broader patterns of systemic racialised violence have significant and well-documented collateral impacts on mental health and well-being within affected communities.
However, in Scotland, there is no officially recognised definition for racial trauma within the healthcare sector, meaning that clinical understanding of the condition and its impact depends entirely on practitioners' lived experiences or external training. As such, many Black and minority ethnic people seeking mental health support for their experiences of racism report that their circumstances are not understood or taken seriously by service providers. Further, practitioners are often unable to provide adequate support and solutions for the structural causes of poor mental health - you cannot medicate yourself out of poverty or avoid systemic discrimination through meditation. The system has got to start tackling poor and disparate mental health at its structural and material roots, rather than just band-aiding its public-facing symptoms.
But what would an improved system look like? How can Scotland's mental health services better provide for Black and minority ethnic populations?
If, as a society, we want to improve our mental health and eliminate the stigmas and inequalities surrounding it, the support provided by our services can no longer be one-note, unfocused, and exclusionary. Scotland's mental health services have got to be flexible and person-focused, tailored to the full range of their users' needs. Holistic services must be specifically designed to support the groups we continue to fail, recognising that no two experiences of mental health are the same and taking full consideration of our unique and structural circumstances.
There must be system-wide changes to how mental healthcare services conceptualise and support their service users; there must be a shift toward flexible, person-focused care responsive to a patient's needs and circumstances. Formal support, such as psychotherapy, must be made more widely accessible so that it is available through a diverse range of channels (in-person, phone-based, virtual etc.) and is open to varying degrees of commitment in line with the variability of mental fitness. Mental health services, and the healthcare service in general, must link to other public services to provide changes capable of tackling the material causes of a patient's poor mental health, such as insecurities in housing, finance, and employment.
The sector must also become explicitly and demonstrably anti-racist, ensuring that healthcare settings are free from discrimination and that both Black and minority staff and service users are sufficiently supported. A significant step towards achieving this would be the deployment of mandatory anti-racist training and capacity-building programmes for all new and existing frontline personnel. Such programmes must be co-produced by both Black and minority ethnic practitioners and those with service user experience, ensuring that training priorities reflect their lived experiences of racism within the sector. This improved racial literacy and inclusivity within the workforce will improve retention and recruitment prospects for Black and minority ethnic personnel and can help facilitate the development of much-needed specialist services, such as Racial Wellness Therapy for those suffering from racial trauma. Further, all generalist and specialist mental healthcare services must also be made available in the primary language of service users to ensure that people do not slip through the cracks, utilising a diverse and multi-lingual workforce or specifically trained interpreters. This shift towards culturally responsive services and a workforce composition reflective of the diverse populations they serve will help ensure Black and minority ethnic people's needs are understood and prioritised within the mental healthcare system.
We can also improve our mental healthcare services by encouraging better collaboration with third sector and community support networks. Grassroots community groups, which may include cultural, faith, support, outdoor leisure, and hobby-based groups, can help provide people with healthy ways of managing their well-being and can become invaluable preventative and early intervention services. The healthcare sector must recognise their value and ensure that adequate funding, resources and training services are made available for existing groups and provide seed money for the formation of new and intersectionality-focused wellness groups. A focus on intersectionality is essential, as those with multiple protected characteristics, such as Black Muslim women or Black queer folk, will encounter cumulative challenges to their well-being and often face the most extreme mental health inequalities. To achieve this, community-group funding systems must be changed, ensuring that adequate resources are made available in a sustainable manner and fairly allocated. Community-based link workers can also be used within healthcare settings to connect and refer patients to these support networks, thus providing more accessible and culturally responsive sources of support.
This World Mental Health Day marks a crucial time for action in Scotland, with Scottish Government working to review and revise its Mental Health and Wellbeing Strategy and mental health legislation going into 2023. CRER have input to both of the above consultations and will continue to push for systemic change and elimination of racial mental health inequalities.
Racism ruins lives and minds, and it’s about time our mental health system does something about it.
If you are struggling with mental health problems due to or exacerbated by racism, you can find more information and resources here: