It’s harder for BME women to access mental health care. Here’s why
Lack of cultural understanding, institutionalised racism, and the fear of being reduced to a diagnosis are limiting access to mental health services for women from ethnic minority communities in Britain.
Denial also makes it difficult for BME women to open up about mental health stressors, acting as a barrier to acceptance and subsequent treatment of psychological issues.1
The problem is largely institutional. Practitioner training often doesn’t take cultural differences and sensitivities into account, further driving a wedge between BME communities and the mental health services available to them.2
This may be because there is a distinct lack of research into the problems ethnic minority women face when accessing care, making it harder to create and enforce changes. A lack of data on specific ethnic groups and their experiences often leads to generalised results said to apply to all BME women as a whole.
“It is quite shocking that we do not collect systematic data on the use of mental health service by ethnicity,” consultant psychiatrist Prof Sashi Sashidharan told the BBC. “There is a huge gap in the data that is available. This prevents us from understanding the problem.”
One study found that BME groups are less likely to be referred to mental health services by their GP. It also found that they were more likely to be arrested by the police following a mental health crisis
While Prof Sashidharan refers specifically to Scotland, the situation across the wider UK is similar. According to UK charity Mental Health Foundation, mental health is underresearched in BME communities, even though they are considered to be at a higher risk of developing mental illnesses.
While studies have shown that BME groups are less likely to recognise and accept mental health issues, there is also evidence to suggest that GPs are less likely to spot mental health issues in BME individuals.
One study found that BME groups are less likely to be referred to mental health services by their GP.3 It also found that they were more likely to be arrested by the police following a mental health crisis, resulting in poorer health outcomes and often, experiences of coercive forms of care, including in locked wards.
Even when BME women are actively seeking mental health care, they face a disproportionate disadvantage in accessing the right care.
The 2014 Adult Psychiatric Morbidity Survey (APMS) found that the frequency and type of mental health problems experienced differed greatly by ethnic group for women. Statistics point towards there being a higher incidence of depression and anxiety among South Asian women at 63.5% when compared to white women at 28.5%.5 Although cultural stigma and fear of judgement may prevent South Asian women from seeking help from their GP initially, this is far from the whole story.
“When they finally overcome that barrier there are the difficulties in accessing proper care,” GP Dr Asif Khan told the BBC.
“Harsher psychiatric diagnoses are made, more patients end up being sectioned and there are worse outcomes”
Although BME groups are less likely to be referred to mental health services, when they are, there’s a bigger danger of overdiagnosis and unnecessary intensive treatment.
This is most likely to happen to black people suffering with a mental health issue, who are four times more likely to be sectioned under the Mental Health Act. Data shows that Black Caribbeans have the highest rate of detention.
While those from BME groups are most likely to experience difficulties in accessing mental health care, they are also most likely to be overtreated, adds Dr Asif.
He said: “Evidence shows that fewer individuals from the BME community are referred on for specialist help and when they are eventually referred they tend to be over-treated.”
“Harsher psychiatric diagnoses are made, more patients end up being sectioned and there are worse outcomes.”
Financial worries and cultural stigma surrounding mental health issues also play a part in making access to mental health care difficult for BME women.
A study with 26 participants, 13 of which were female, found that an inability to recognise and accept mental health issues, financing care, along with shame surrounding seeking help all negatively impacted the relationship between BME communities and the UK’s mental health services.6
The treatment of pre and postnatal depression in black women has also been found to be inadequate, leaving many of them feeling unsupported by health services mentally
The treatment of pre and postnatal depression in black women has also been found to be inadequate, leaving many of them feeling unsupported by health services mentally.
A study using a sample of 42 black women who had given birth or were about to found that while participants felt that practitioners often lacked a culturally sensitive approach, they expressed a want for multi ethnic group perinatal mental health care sessions.7
Among participants, there was a general feeling of their mental health not being a priority for their perinatal care team. Not wanting to bother healthcare providers with their emotional needs and not being treated as individual patients, but rather a monolith, were both given as reasons that prevented these women from accessing the perinatal mental health care they needed.
Black women are turning to community support groups as a form of therapeutic mental health care
One of the women in the study said, “‘I remember when she [health visitor] came to my place … she only talked about my baby – nothing about me. So I was thinking “maybe it’s nothing to do with the mothers, it’s just about the baby”. So, in my mind … if your baby is not well you can ring them, but nothing about you.”8
Another woman commented that it was “just leaflet, leaflet, leaflet, then see you later”.9
Black women are turning to community support groups as a form of therapeutic mental health care. The women in the study suggested that more community-based, collaborative mental health care models would be the most beneficial in increasing engagement with mental health services among black women and other ethnic minorities.10
There’s an overwhelming block preventing BME groups from accessing appropriate and culturally sensitive mental health care. BME people are often paired with therapists or practitioners that have a limited understanding of their background and the trauma that stems from this, including experiences with racism.11
The Black, African and Asian Therapy Network (BAATN) is tackling this by assisting BME women to find therapists that are of the same race. The Maya Centre also runs a black women’s group led by Dawn Estefan that aims to provide a safe and healing space for black women to talk through their experiences together.
The group covers and assesses behaviours to do with relationships, motherhood, depression, mental health, separation, loss, domestic violence, sexual abuse, body image and the negative connotations of the ‘strong black woman’ stereotype.
1. Memon, A., Taylor, K., Mohebati, L., Sundin, J., Cooper, M., Scanlon, T., & de Visser, R. (2016). Perceived barriers to accessing mental health services among black and minority ethnic (BME) communities: a qualitative study in Southeast England. BMJ Open, 6/11: e012337.
3. Arday, J. (2018). Understanding Mental Health: What Are the Issues for Black and Ethnic Minority Students at University?. Social Sciences, 7/10: 196.
6. Memon, A., Taylor, K., Mohebati, L., Sundin, J., Cooper, M., Scanlon, T., & de Visser, R. (2016). Perceived barriers to accessing mental health services among black and minority ethnic (BME) communities: a qualitative study in Southeast England. BMJ Open, 6/11: e012337.
7. Edge, D. (2011). ‘It’s leaflet, leaflet, leaflet then, “see you later”’: black Caribbean women’s perceptions of perinatal mental health care. British Journal of General Practice, 61/585: 256-262.
11. Arday, J. (2018). Understanding Mental Health: What Are the Issues for Black and Ethnic Minority Students at University?. Social Sciences, 7/10: 196.