Studies have shown that systemic racism often means people of color and members of other marginalized ethnic groups are not getting the mental health support they need. In this special feature, we explore the impact of racism as a public health threat in the area of mental health.
Recently, Fiona Godlee — chief editor of the BMJ — wrote a column in which she called racism “the other pandemic.”
“Racism is suddenly and finally everyone’s business, and it is everyone’s responsibility to act against it,” she stresses.
Measures have been a long time coming. For years, studies from around the world have shown that systemic racism is blocking access to a healthy lifestyle and adequate healthcare for consistently marginalized groups — particularly people of color. Yet policymakers have done little to address these inequalities.
In some of our recent posts on Medical News Today — which are part of an ongoing series on race-based health inequalities — we discussed how and why the COVID-19 pandemic has disproportionately affected black communities and how the pandemic is likely to affect the mental health of Will affect people. of color.
Now let’s look at how racism has forever been a barrier that blocks people in marginalized ethnic groups from access to adequate formal mental health care.
We recognize that “people of color” is a very general term that encompasses numerous groups and identities, each of which was subjected to subtly different forms of racial discrimination. The same applies to the term marginalized ethnic groups.
However, the aim of this feature is to provide an introduction to the effects of racism on mental health care. Future contributions will explore how racism has particularly affected health and access to healthcare among various marginalized groups.
Health inequalities affect us all differently. Visit our dedicated hub for an in-depth look at social inequalities in healthcare and what we can do to correct them.
The impact of institutional racism
Many forms of racism can be very subtle. Microaggressions, such as making assumptions about a person in conversation, often go unnoticed except by the person or people on the receiving end.
In a personal essay titled “On Becoming a Psychologist,” which appears in The Colour Of Madness, a book that explores the relationship between people of color and mental health, psychologist Cassie Addai wrote about experiencing such forms of aggression.
“As a black girl growing up in a predominantly white city, I can vividly remember examples of overt racism, including being teased about my “fat lips,” and being told to “go back/where I came from,” she wrote.
Although people can recognize and invoke individual racist statements more easily and spontaneously once victims and allies have become familiar with the forms, this is more complicated in the case of institutional or systemic racism.
As Prof. Hannah Bradby, sociologist at Uppsala University in Sweden, explains in a 2010 article in Sociological Research Online:
“The distinction between individual and institutional racism emerged with the Black Power movement in the USA when it was described as subtle and less identifiable compared to individual racism. “Respectable” people can acquit themselves of guilt for individual racist acts, but still “support officials and institutions that perpetuate institutional racist policies.”
Institutional racism perpetuates misunderstandings and baseless assumptions about race and ethnicity and affects all official institutions, including those that provide mental health care.
In the UK, for example, a 2014 report commissioned by the Lankelly Chase Foundation, Mind, the Afiya Trust and the Centre for Mental Health found that while black people had lower rates of mental illness than other ethnic groups, “with more likely than any other group to be diagnosed with schizophrenia and […] three to five times more
likely than any other group to be diagnosed and hospitalized for schizophrenia.”
Involuntary commission rates in psychiatric hospitals were also 2.2 times higher than the average of black African people in the UK, 4.2 times higher for people in the Black Caribbean and 6.6 times higher for those who identified themselves as “black — other ethnicity.”
At the same time, black people were more likely to be treated poorly or downright harshly in mental health facilities than other community members than other community members.
“’Circles of Fear, ‘users and communities of black services continue to experience in relation to mainstream mental health services,” the report said.
“The treatment [for black people] is more severe or more compulsive than the treatment that white service users receive and is characterized by lower intake of primary care, therapeutic and psychological interventions,” it continues.
The same report finds that blacks and other marginalized groups had continued to struggle to access mental health care at first.
“Serious, unscrupulous inequalities”
Similar situations occur in the United States and elsewhere in the world.
“There are serious, unconscious differences in people of color’s access to mental health in America,” said Nathan Greene, Psy.D., one of MNT‘s expert advisors.
“African Americans, Latinx, and Asian Americans are treated 50 to 70% lower than white Americans in this country. This is the result of individual and systemic failures,” he added.
A 2019 study in the journal Health Services Research looked at data from 1,237 black adults in the US who said they had received no formal support for a mental health issue for which they needed support.
The data in this study is from the National Survey on Drug Use and Health 2011—2015.
Its author, Sirry Alang, Ph.D., found that black people reported distrust of psychiatric systems due to experiences of racism.
Black respondents — particularly those who had completed higher education — said they had experienced stigma and that professionals had minimized their mental health symptoms. This resulted in a lack of access to adequate care.
On May 29, 2020, Daniel H. Gillison, Jr. — the CEO of the National Alliance on Mental Illness — released an official statement acknowledging the extent of inequalities in mental health care in communities of color in the US. “The
Effects of racism and racial trauma on mental health are real and cannot be ignored,” he said. “The inequality in access to mental health care in communities of color cannot be ignored. The inequality and lack of cultural competence in mental health treatment cannot be ignored.”
Stigma and cultural barriers
Stigmatizing mental health issues may further increase the impact of institutional racism on access to healthcare for black people and other marginalized communities. It is also true that institutional racism can reinforce internalized stigma.
In an article for Columbia University, psychologist Thomas Vance, Ph.D., writes about the connection between institutional racism and the stigmatization of mental health issues, particularly in the context of black communities.
“The therapist’s lack of cultural responsiveness, cultural mistrust, and potential negative views associated with stigma are impacting mental health care delivery in the black community,” Vance points out.
Speaking to MNT, psychologist Riya Patel, Ph.D.* — assistant professor at the Faculty Research Centre for Intelligent Healthcare at the University of Coventry in the UK — further explained the role of stigma associated with mental health issues in communities of color and marginalized, ethnic groups.
“The first important [barrier to access mental health care] relates to how mental health issues are experienced, shared and supported in different minority communities,” she told us.
“Shame and stigma about poor mental health are common in all societies, but these experiences can be amplified in some cultural environments and discourage people from getting help,” she added.
But cultural differences can also be barriers, Patel noted. Mental health professionals who do not understand communication patterns characteristic of specific cultural groups may not understand the issue and will not provide appropriate support.
“People from different backgrounds experience and describe symptoms of mental illness in different ways that don’t always fit with prevailing models of mental health care.”
— Riya Patel, PhD
She added: “People have the opportunity to get help in their own communities and may not see the need to access formal services.”
“When people experience systemic discrimination when using mainstream services, it can lead to secondary victimization, aggravate their mental health, and lead to mistrust between community members and healthcare providers,” says Patel.
Anti-racism for lasting change
There is only one solution to these problems: to combat forms of racism and anti-blackness at their root. This requires various steps.
a first step, Greene spoke about the importance of funding community-based mental health support programs.
“To improve access, we need to expand funding for community mental health programs that serve underserved communities and […] train clinicians to be anti-racist so they recognize and actively recognize bias and discrimination in themselves and in the systems they work in Can work against these forces,” he said.
But even more important is the need to focus on Blacks, Indigenous people, and people of color — as well as those who belong to other marginalized ethnic groups — to consult them about their communities’ mental health support needs, and for them as healthcare decision makers to promote contexts.
“Care must also be taken to improve and expand the recruitment, retention, and evaluation of clinicians of color at all levels of education and practice to create an inviting mental health space that reflects Americans’ cultural and linguistic diversity,” emphasized Green.
“A lot of work needs to be done working with the various minority communities, but I firmly believe that our priority should be to work more closely with people of color,” Patel also told MNT.
“Mental health providers and organizations that conduct research to inform healthcare […] need to understand what mental wellbeing and illness look like for people of different ethnicities and cultures.”
“What are their current strategies for dealing with mental illness and what is the coping situation in these communities? There are many negative stories about mental health; how can we start together to change these narratives and remove the obstacles they pose?
Advice for whites and allies
We also asked Patel what white people and allies can do to support and protect the psychological wellbeing of Black people and other people of color around the world.
“Reflecting on recent events worldwide and the relentless discrimination affecting members of minority communities around the world is time well spent,” she stressed.
“Links between inequalities and poor (mental) health must be recognized,” she added. “Likewise, health systems that are trauma-informed and culturally appealing and recognize the intersectionality of people’s lives are all prerequisites for the future design and provision of healthcare.”
Patel finally remarked: “Change initiatives must be led by people with lived experience. Show compassion, especially when in doubt.”
*Disclaimer: These are Riya Patel’s own views and they may not represent the views of her current employer.