Black History Month 2024: Reclaiming a positive narrative about Black people navigating mental health services

This blog post was written for the College's celebration of Black History Month 2024.

The theme of this year’s Black History Month (BHM) is reclaiming narratives, and on my mind is how we reclaim a positive narrative about Black people navigating mental health services. A difficult and uncomfortable topic to discuss but honesty is needed to help in finding sustainable solutions. It’s a long arduous journey but we are on it and must persevere. It is about exploring our role both individually and collectively in improving equity of access, experience, and outcome.

We hear so much about the worrying data on Black men; increased referrals through the criminal justice route, over representation amongst people detained under the mental health act, increased use of prone restraint, poor outcomes following psychological therapies and the list goes on. Black women fare no better in services and are also disproportionately detained under the mental health act and are more likely to be victims of prone restraint when compared with women from other ethnic groups. We hear the stereotypes about the aggressive Black man or the angry Black woman, all potentially impacting on access to care and outcome.

Racism increases our risk of suffering from mental ill health and makes it more challenging to access mental health care. As a Black woman born and raised in Nigeria, I came to the United Kingdom without thinking too deeply about my skin colour. I knew I would be different, but I naively thought it would be fine. It’s only several years later that I realise that it’s not fine, all those micro-aggressions do chip away at one, affecting both our physical and mental health. I realise that it wasn’t okay for my children to be the only Black children in their various classes throughout their primary and secondary education. I thought, oh it will be fine because that’s all they have ever known, but it’s not. I’ve learnt to be more intentional and not take anything for granted.

As part of the Advancing Mental Health Equity QI collaborative, we spoke to Black people in our community to understand their experience of using mental health services. We heard how Black men feel that they are not respected or listened to within services. We heard that Black men feel they need to be tough because of the traditional male roles in Black families and so bottle up their emotions and may not seek help until they are in crisis. We heard about the isolation Black people feel because of their ethnicity increasing the risk of mental health problems. We heard about the stigma associated with mental illness and more so in Black communities which makes it even more difficult to seek help. In a lot of ways, we didn’t hear anything new. The question has always been, and so what? A lot of organisations are trying to make a difference, but progress is not happening fast enough.

New Zealand developed cultural safety to tackle the deep-rooted health inequities experienced by the Māori people tracing the roots to colonisation with some success. Australia has also adopted it. Cultural safety is understood as a decolonising intervention. It was initially described as providing a focus for the delivery of quality care through changes in thinking about power relationships and patients’ rights.

Cultural safety is a way of working with people from diverse cultural backgrounds that does not diminish, demean, or disempower them. It’s about making people feel safe with their cultural identify. A culturally safe service is defined by the individual receiving the service and not by the providers. As health professionals we need to reflect on how our own cultural beliefs, biases and privilege affect the relationship with our patients especially those who are already disadvantaged and likely to suffer from discrimination. There is already a power imbalance in the clinician-patient relationship which can be magnified in the clinician-disadvantaged patient relationship. How does this complex relationship lead to poorer outcomes for our Black patients and others from minority groups? Does the Black patient feel that they can tell their stories without feeling wrong or less important than others? Do we pause and reflect on our use of restrictive interventions on our Black patients?

As we celebrate Black History Month, let’s pledge to reflect on how our own intentional and unintentional biases may affect the quality of care that we provide to our Black patients and their families.

Organisations that provide mental health care have an even bigger role to play than the individual responsibility, so this is also calling on providers alike to pledge to ensure culturally safe services as defined by people who use our services. This is a process that is not resolved by a one-off cultural safety training but a continuous process of individual and organisational learning and reflection on privilege, biases, and power imbalances. It is also a process that involves tackling racism in the workplace so that staff are functioning at a level that allows them to focus on providing excellent care.

We are still a long way from achieving health equity for Black people and other minority groups, but we can constantly seek to understand, measure, and improve how culturally safe our services are through engaging with and listening to our Black patients and their families.

Let’s all join in changing the narrative to a positive one about excellent mental health outcomes for Black people.

Enjoy Black History Month.

By Dr Uju Ugochukwu, Consultant Psychiatrist