The colour of counselling

The monthly blog of the Public Mental Health Implementation Centre (PMHIC), 'Perspectives on public mental health', aims to highlight the voices of practitioners, patients, carers, and public health experts.

In our first blog post, Abiola Awojobi-Johnson shares her personal perspective on being a carer and the importance of diversity and representation in mental health care.

Caring for a loved one can be incredibly rewarding. It can also be incredibly challenging.

It’s therefore very important that carers take care of their own mental health as it can often take a toll. This has been my own experience during my many years as a carer, providing support around a range of health issues, and I know it is true, too, of my caring peers.

As a result, it’s often meant I’ve needed my own support so I can continue to be emotionally strong and resilient enough to continue to support those I am caring for. It’s often cyclical – you can carry on for a few years even and feel like you can take on the world, but then, there’s a dip, and you need support. I’ve recently been at this point.

What is different this time is that the face of my counsellor will be a lot more like mine, as will her skin tone. For the first time in my history of having mental health support, I’m about to meet and have the support of a counsellor from a diverse background. Although she won’t be from the exact ethnic background, the fact that she is a woman of colour (brown skin compared to my black skin) will be for me a unique experience.

I’m feeling a plethora of emotions – reassured, expectant, hesitant and hopeful. The colour of our skin and that of our clinicians should never make an impact or be a substitute for the quality of service we are provided. However, we know that our cultural and diverse experiences have an impact on how we view and experience the world.

While my new counsellor’s experiences of course won’t be the same as mine, and nor would they be even if she had the exact same ethnic profile as me, there is something comforting and refreshing about coming from a diverse background. Having some basic common experiences of being perceived as ‘other’ will help establish a good foundation. It’s not that the relationship will be perfect, and I don’t expect or need her to be an expert in my experience, but it’s definitely a positive starting point.

The impact of culture on mental health has been well documented. Intersectionality is better researched, acknowledged and understood than ever before. Buzzwords like ‘cultural competence’ and ‘culturally sensitive’ are now part of the mental health language landscape.

But too often they just stay at that, as buzzwords. Training can be transient and tired, rather than trailblazing and leading to tangible change. Well-meaning interventions can be limited and superficial.

‘Language differences’, too, are often scapegoated as being the main barrier and gateway to better provision. Services with interpreters are praised, but there is so much more to interpreting than just translating words.

I see the real key to success in interpreting is understanding the words that are not spoken, understanding the pauses. Being unafraid of the silence. It is often in these micro-interactions and nano-moments that the most profound communication is occurring. And the ability to notice this transcends culture.

Even when speaking the same language, there are so many subtle variations and nuances that can be missed if a person isn’t actively listening. And they need to be more than just culturally competent, but also class competent, and gender and neurodiverse aware.

The system needs to go far deeper into providing training and support so that service providers can have a better insight into some of the multifaceted challenges their diverse clientele may be experiencing, and not just view diversity as ‘a race thing’.

Usually, the presenting symptom is just the starting point. There may often be a wealth of undercurrent experiences, past and present, that contribute towards how a client feels and is presenting.

Although many of the causes of mental health problems may be at societal level and something that, for example, a 6- or 8-week course of IAPT (Improving Access to Psychological Therapies) may not be able to always find the underlying cause of, such therapies are at least a positive step in the right direction.

Many more of the seeds of mental health problems germinate in homes and families. Not because parents are to blame, but simply because that is how humans develop. Our childhood and family experiences make us and shape us. They can also define us, and sometimes destroy us.

And what of the homes where there are no words to describe what a person may be speaking? Or, if there are words, they are ones that ostracise and project stigma.

As a British Nigerian, even with my limited knowledge of my mother-tongue, Yoruba, there is only one word for anything remotely connected to mental health – we-re. It translates as mad. This one word cannot describe the vast portfolio of mental health conditions. And if you cannot articulate it, how can you explain it? How can you access meaningful help?

Intersectionality is real. And recognition of this has to be at the heart of any positive approach in providing a meaningful intervention that is culturally rich, sensitive and curious.

I hope that this new journey my counsellor and I are embarking on – for indeed it is as much her journey as it is mine – will be one that is mutually positive and productive. Only time will tell.

Abiola Awojobi-Johnson

Abiola Awojobi-Johnson worked for over 20 years as an award-winning BBC radio producer. Since 2011, she developed a career in mental health due to her own lived experience as a carer. She gained an MSc in Mental Healthcare from Queen Mary University of London in 2019, is a Community Befriender at the Mental Health charity Mind and currently provides wellbeing support for young people in a school setting. She is also a Trustee of Brent Carers’ Centre and has been a member of the Public Mental Health Implementation Centre (PMHIC) Advisory Board since Autumn 2021. Alongside her rich portfolio of experience, she says her biggest achievements and inspiration are her children, two daughters and a son.