2nd essay G AND L PDF

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Its an essay for the module of global and local perspectives in health. One topic was chosen and discussed how it affected globally and locally....

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Racism and stigma are dual challenges for BME populations in the United Kingdom suffering from Mental Health issues.

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Introduction Mental health is vital as it allows the social capacity of people around the world to think and co-operate in life (World Health Organization, 2018). Some groups of the population are at greater risk of mental disorders due to higher exposure and weakness due to gender, environmental, economic and social conditions (World Health Organization, 2018). Black Minorities Ethnic communities have reached disparities and inequalities in mental health in the United Kingdom (UK) to such a degree that it is regarded as a public health issue (Bennet and Keating, 2008). This essay will first provide a background of mental health in the UK. Following this, the essay will critically analyse if racism and stigma are dual challenges for Black Ethnic Minorities (BME) populations in the UK suffering from mental health issues. Then, the essay will conclude by summarising the key points.

Background In general, BME communities are regarded at an increased risk of developing mental health. British black women have 29.3% likely to have mental health problems whereas white British women were less likely (20.9%) (Mental Health Foundation, 2019). African Caribbean’s are 3 to 5 times more likely to be identified and hospitalised for schizophrenia than any other group (Mental Health Foundation, 2019). Appendix 1 shows inpatients per 100,000. The UK has created the Health Action Zones and the National Service Framework, to adequately address the needs of all ethnic groups (Bowl, 2007). Despite the framework, the cultural and institutional exclusion has an effect on the service ethnic 2

minorities receive, meaning that service providers stay insensitive to ethnic minorities particular needs (Bowl, 2007).

Racism and stigma Stigma is a leading reason of discrimination and marginalisation such as it influences the family relationships, ability to socialise and find jobs (World Health Organisation, 2019). Also, it discourages mental illnesses prevention and appropriate treatment and contributes abuse to human rights (World Health Organisation, 2019). Despite the fact, the community-based and voluntary institutions claimed that BME people have a lower knowledge of mental health, including appropriate care and the role of treatments (Singh et al., 2013). BME communities often receive insufficient requirement of mental health services (Knifton, 2012). Especially among Asian minorities, services do not attain or interact with communities where they are needed. However, this was linked with practitioners' racial prejudice and fear (Knifton, 2012). Also, research indicates that Western mental health treatment methods are often unacceptable and culturally inappropriate to Asian communities’ needs (Mental Health Foundation, 2019).

Stigma and racism may not be the only risk factors leading to challenges in mental illnesses. Subsequently, BME communities are more likely to face poverty, poorer educational outcomes and unemployment which trigger mental health illnesses (Royal College of Psychiatrics, 2018). For example, people from the minimum household income are 3 times more likely to have common mental health issues and 9 times more probably to have psychotic disorders (Centre for Social Justice, 2011).

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In addition, according to Mattheys (2015), government policies are also the top factors in the deteriorating of mental health in the UK by increasing social inequality (Mattheys, 2015). Therefore, given the seemingly strong legal and policy framework, progress towards equitable access, experiences and outcomes for minority ethnic people in England are limited (Salway et al., 2016). Therefore, the current new policies and practices, affect the mental health of patients (Royal College of Psychiatrics, 2018).

Stigma takes many aspects and is often associated with underlying causal cultural and religious beliefs (Knifton, 2012). For example, some believed that it was ‘gods punishment’, ‘black magic’ or ‘spirits’. While others thought that it was inherited from the family (Knifton, 2012). Stigma is reported to be more prevalent in communities living in disadvantaged areas (Knifton, 2012). For example, BME communities with education and language confidence were able to engage with mental health services (Knifton, 2012). This is important because language issues can also help stop minority clients from conveying their needs (Sorkin et al., 2009). Furthermore, mental health was often viewed as a subject socially unacceptable (Memon et al., 2016). For example, a female stated, “Stuff like that is never talked about” (Memon et al., 2016). Therefore, community stigma led individuals not able to recognise symptoms openly thereby limiting admission to services (Memon et al., 2016). Moreover, social stigma has led people to hesitate in seeking support on behalf of another member (Memon et al ., 2016). Furthermore, African Caribbean’s may not want to access mental health services because they are more likely to obtain medication rather than being supported by psychotherapy (Mental Health Foundation, 2019). A mother of black Caribbean men with mental health difficulties said “When he went into hospital,

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they didn’t ask him nothing, they just gave him drugs, they turn him fool...he just wanted some back up” (Centre for Social Justice, 2011). However, in cases like schizophrenia medication is needed to reduce anxiety, aggression and hallucinations (National

Health

Service,

2016).

Therefore,

antipsychotics

are

generally

recommended for the symptoms of an acute schizophrenic episode as the initial treatment (National Health Service, 2016).

BME communities in Britain especially black people are unreasonably grouped in criminal justice and mental health associations (Nacro, 2007). Such as black people are 40% greater than the average to be discussed through the criminal justice system (Nacro, 2007). Refer to Appendix 2 for admissions under the Mental Health Act. This can result from stigma and racism as service providers can see black men as “big, black and dangerous” (Knifton, 2012). Besides, in 2005 the Mental Health Act Commission and the National Institute for Mental Health in England confirmed that, regardless of the fact that black communities make up only 2.2% of the population according to official figures, about 9% of mental health patients were black (Nacro, 2007). This has resulted in stigma within BME in regards to the definition of mental health, it was described as serious mental illnesses including psychosis or dementia (Lwembe et al ., 2017). Likewise, high representation in criminal justice led people to think that mental health was about people being 'sectioned' (Lwembe et al ., 2017). This shows racism and stigma in mental health are dual factors that create challenges for BME communities. Whereas, a study in 2016 in the UK evaluating the 2007 assessments of the Mental Health Act argued that being disproportionality represented relates with higher rates of mental health

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circumstances and lower levels of social support, but not because of ethnicity (Mental Health Foundation, 2019).

Stigma and discrimination are dual challenges for BME populations suffering from mental health issues (Time to Change, 2012). Such as 26% of respondents has stated to want to quit on life since the attachment of stigma in their mental illness (Time to Change, 2012). This is a similar result as discrimination, 27% of respondents 25 years and under have stated that discrimination relinquishes the ambitions of their lives (Time to Change, 2012). Stigma comes from societal, community and individual levels. A participant stated that “mental illness is a social problem, I don’t think it’s necessarily an individual problem, it’s a social problem” (Rabiee and Smith, 2014). But although stigma and discrimination come from society as a whole, 32% also say their own communities have treated them less positively because of their mental disorder due to different social and cultural factors (Time to Change, 2014). Typically, mental illness was also considered negative by some individual perspectives, as stated a male respondent the services were considered to assist “crazy people only” (Memon et al., 2016). Therefore, Sandra Griffiths acknowledges

the

different

aspects

"Tackling

mental

health

stigma

and

discrimination experienced by Black and Minority Ethnic communities needs to be tackled at an individual, community and societal level. Without this strategic approach the double discrimination that Black and Minority Ethnic people with mental health problems face will continue" (Time to Change, 2014).

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Institutional racism has been seen as a factor that enables black people to receive inappropriate care and experience less service satisfaction than white people (Rabiee and Smith., 2014). For example, in the UK, BME communities often receive insufficient requirement of mental health services (Knifton, 2012). In some instances, especially among Asian minorities, services do not attain or interact with communities where they are needed. This was linked with practitioners' racial prejudice and fear (Knifton, 2012). A study undertaken by Rabiee and Smith (2014) indicated that several patients and caregivers, especially from African communities, expressed their fears about racism. For example, 4 women discussed racism as being part of their daily experience, from health providers (Rabiee and Smith, 2014). Two females even said they experienced GPs saying “Why are all you Somalians in the UK? Why don’t you go (home)?” (Rabiee and Smith, 2014). Even though ‘institutional racism’ was seen as a factor that resulted in high detentions within BME (Gajwani et al., 2016). There were several other factors that were seen to feature the high levels of compulsory detentions, for example: some BME populations were associated with service mistrust and delayed access to support (Gajwani et al., 2016). Also, other factors were misdiagnosis and lower overall recognition at the primary care level (Gajwani et al., 2016).

Cultural stigma has been identified as approaching beyond the individual basis (Memon et al ., 2016). For example, the African and Caribbean group have defined it as “Dying of brain cells” (Parveen et al., 2016). Therefore, to reduce stigma, the development

of

social

capital

is

an

important

aspect

of

co-production

(Hatzidimitriadou et al., 2012). At community leaders will need to engage with NHS by building on current skills and designing new ones. In addition, the familiarity

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environments where services were distributed were an important benefit of coproduced services (Hatzidimitriadou et al., 2012). This is because it was vital in dealing with the stigma of mental illness as these sites were part peoples growing up also, instead of being medical (Hatzidimitriadou et al ., 2012). Impersonal locations where mental health services were generally delivered, they were correlated with ordinary life activities across generations (Hatzidimitriadou et al., 2012). Some ethnic minorities are more disappointed with NHS services (Kings Fund, 2006). Racism can occur with patients using the NHS (Royal College of Psychiatrics, 2018). This can result in significant inequalities in access to areas of psychiatric care, including admissions, detentions and readmission (Royal College of Psychiatrics, 2018). Also, people from ethnic backgrounds receive less support. For instance, in 2014 Adult Psychiatric Morbidity Survey found that while Black British adults had the largest average score for severity of symptoms of mental health, black British adults were much less likely to obtain mental illness treatment (Royal College of Psychiatrics, 2018). Therefore, a great effort is needed to increase literacy on the influence of racism in mental health (Royal College of Psychiatrics, 2018). Whereas, there may be many elements link inequalities faced by BME communities in accessing mental health, which can be linked to the principle of intersectionality (Seng et al., 2012). For example, for black man being black, male, older and not obtaining an education after high school was closely linked to the non - use of mental health support (Motley and Banks, 2018). Also, people may have family breakdown which is closely associated with poor mental health (Centre for Social Justice, 2011). On top of that BME communities may have financial issues as people had to pay to obtain extra treatment and therapy in the UK. A respondent mentioned, “If you want

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the alternatives you have to physically go and find them and you have to pay” (Memon et al., 2016).

Furthermore, the study undertaken by Wallace et al. (2016) demonstrates that prior contact to racial discrimination throughout the lifespan, or knowledge of racism experienced by others, may ultimately influence ethnic minority’s mental health even after early exposure to racial discrimination (Wallace et al., 2016). Nonetheless, the study has also found racism actually enhanced mental health levels of black African group compared to the White British group (Wallace et al., 2016). However, this statement was not supported by empirical data showing that it is bias and only an opinion. As an argument, a study undertaken by Rehman and Owen (2013) found that 73% of respondents with racism experience had effects on health (Rehman and Owen, 2013). Also, the greatest consequence of racism on the mental health of BME communities was the distress displayed through reporting feeling insecure or stay away from certain areas (Wallace et al., 2016).

In conclusion In conclusion, Stigma is a leading cause of discrimination and marginalisation. Institutional racism enables black people to receive inappropriate care and experience less service satisfaction than white people. For example, ethnic minorities were disappointed with NHS services. Also, Asian minorities did not attain or interact with communities where they are needed. This was linked to practitioners' racial prejudice and fear. For example, two females even said they experienced GPs saying “Why are all you Somalians in the UK? Why don’t you go (home)”? Stigma is

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seen as a barrier in the societal, cultural and individual levels. For example, a person stated, “Stuff like that is never talked about”. Stigma is reported to be more prevalent in communities living in disadvantaged areas. To summarise, racism and stigma can be dual challenges for BME populations suffering from mental health issues. However, there may be other factors involved such as poverty and education.

Reference

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