Barriers to Mental Health Support for People of Colour and Migrants

Text on a colourful background reading: "Barriers to Mental Health Support for People of Colour and Migrants: Micha Frazer-Carroll"

The common refrain “mental health does not discriminate” might be intended to remind us that anyone can experience mental distress, but it doesn’t do justice to the fact that mental distress is political. For example, simply moving through this world as a racialised person takes its toll, making us more likely to experience various forms of mental distress. Relatedly, the violence of the border actively produces trauma, with over half of asylum seekers experiencing mental distress, and with migrants and their children being significantly more likely to be diagnosed with Post Traumatic Stress Disorder (PTSD). However, it is not only that racialised people and migrants experience disproportionate levels of mental distress—we also come up against racism when we seek various forms of care and support.

For example, Black people are more likely to receive a diagnosis of Schizophrenia. But the experiences that are commonly described as Schizophrenia are conceptualised differently across cultures, with a 2008 study finding that Black British people were less likely to think of these experiences as symptoms of an illness. In various non-Western cultures, people may make meaning of voices, visions and other sensations through spiritual or philosophical interpretations. However, contact with medical services means contact with a rigid medical model, which only holds space for a white, Western pathological approach to voices, visions and other realities. We should also consider the role of doctors’ own racism. A 2012 study found that clinicians who over-diagnosed Black American people with Schizophrenia were more likely to perceive their Black patients as being dishonest. All of these realities mean that Black people often find themselves alienated or harmed by the medical racism that they are met with in services.

Black people, who are four times more likely to be sectioned under the Mental Health Act, are also often aware of the trauma and racism found in psychiatric detention. While police (who routinely harm our communities) may restrain Black people during sectioning, Black people are also three times more likely to be physically restrained by staff on psychiatric wards. In some instances, restraint on wards by police or staff has resulted in death, like in the cases of Seni Lewis and Rocky Bennett. These racialised trends in detention and direct violence go at least some way to explaining why Black people are more likely to avoid mental health services when they are in distress, disproportionately making contact when they are in crisis, or through police force. For many years, the question has been framed as: “Why don’t Black people ‘reach out’ to NHS mental health services?” However, we should really turn the question around to ask why these services harm Black people. This involves looking at their ‘carceral’ nature—by which I mean that they embody the racist logics of incarceration and punishment.

People of colour and migrants also come up against the threat of state surveillance in services. For example, the NHS is complicit in enforcing the government’s counterterrorism programme, Prevent, which has been widely said to disproportionately target Muslims. It also collaborates with the Home Office, through ID checks, and by allowing immigration officials to access patients’ data in order to track, detain and deport them. This means that if you are a refugee, asylum seeker, ‘undocumented’ or amigrant, Muslim, and/or a person of colour, you are potentially opened up to the government’s racist counter-terror and immigration policies in NHS services. In recent years, some Muslims and migrants have been so terrified by the further expansion of policing and border violence into the NHS that they also avoid these arenas altogether. Bound up in the violent mechanisms of the state, psychiatric services therefore perpetuate state racism.

However, barriers to genuine support also manifest in arenas like therapy, where people of colour and migrants also often encounter racism and inaccessibility. When I was working on my students’ union at university, a number of students of colour told me that they felt alienated and misunderstood by their white therapists. However, we had to embark on a campaign to allow students access to therapists of colour. These issues are seen more broadly in the world of therapy, where people of colour often struggle, or are given no choice, to find a therapist who doesn’t perpetuate racism, who shares their understanding of racism, or one that doesn’t ask that they spend time explaining and justifying the reality of racism. Then there is the time that is often spent trying to contextualise your culture. If you do not speak English, or it is not your preferred language, support options become even more narrow. These limitations are, of course, more stringent for the majority who cannot fund their own therapy.

Racialised people and migrants experiencing mental distress often find person-centred support in spaces that are run for us, by us. There are local, community and charity initiatives for refugees, migrants and people of colour, and listening lines that operate in other languages, but we still need more. The community-led and person of colour-led organisation Healing Justice Ldn is a clear example of a space that is adopting a decolonial approach to healing, and also doesn’t enforce a binary separation between the mind and body. We are also increasingly seeing the emergence of networks and organisations that help us find support from other racialised people, like Black Minds Matter, the Black African and Asian Therapists’ Network and Nafsiyat. Beyond therapy, peer support groups and crisis houses are often less likely to enforce a narrow Western medical model of mental health, which is rigid, limited or actively harmful to many of us. Returning to the example of voices, visions, and perceptions that others might not share, groups like the Hearing Voices Network open up more possibilities around what these experiences can mean, and how people might relate to them. Crisis houses, which as Jennifer Reese discussed in another blog, more often operate on the basis of consent rather than coercion, meaning that they are also a clear alternative for our communities.

But I think it is important that our analysis doesn’t end at retrospectively remedying mental distress. As I mentioned at the beginning of this piece, structural realities like racism and borders actively produce mental distress. The current government is ramping up the Hostile Environment, a collection of policies and practices that render life in Britain unliveable for many racialised migrants. On the 14th June, we saw activists lie down in front of traffic to disrupt vehicles transporting asylum seekers to an airport where they were due to be deported to Rwanda, under the government’s new offshoring scheme. Huge crowds of people turned out to protest across the country. Only three days prior, hundreds of community members gathered on a street in Peckham to successfully block an immigration van that was removing a Black person from their home. Actions like this are about reducing distress in our communities, making sure that fewer people of colour and migrants are traumatised by racism and by the border, meaning fewer of us must seek out mental health support in the first place. Working to change these conditions is something we can all do, and we should all do, to support each other.