The Intersections of Minority Mental Health: #BeyondStigma
Over the past two months or so, Identity International has been involved in a minority mental health project as part of our #BeyondStigma campaign. Through this, I've had the opportunity to have conversations regarding personal experiences as minorities suffering from mental health issues but also with experts in the field, giving their professional and personal thoughts on the matter. I'm now in the process of publishing an academic paper on this topic- you can view the pre-print here
It's no hidden fact that COVID-19 and the lockdowns of 2020 have had an enormous impact on our mental health as a global population, but as an ethnic minority- there's been the added sensationalisation of our exposure, burden and mortality from the pandemic which is disproportionate to those of white ethnic backgrounds. Understandably, this has had a toll on minority mental health in the UK, where BAME (black and ethnic minority) men were found to be suffering worse mental health outcomes compared to the rest of the UK population in 2020 (1,2). Within this, it's men of South Asian descent that are suffering the most. This was further emphasised in my conversations with both Dr Afzal and Judy who spoke about increasing mental health admissions over the lockdown periods and heightened fears from ethnic minorities about a potential genetic vulnerability to the disease.
In my paper(3), I highlighted the three key reasons why minority mental health needs more attention; discrimination, access stigma and quality of care. Below is a summary:
- Muslim populations in the UK have been known as a marginalised population from as early as 2001 and have “high concentrations in areas of multiple deprivation” (4)
- Since then, no other studies examining the spatial geographies and ethnicities of Muslims in Britain or London has been found.
- Those with stronger Muslim American identities had worse mental health consequences in the face of discrimination (5).
- Furthermore, discrimination was found to trigger PTSD symptoms directly and exacerbate PTSD symptoms related to traumatic events (6).
- This can be further compounded by racial biases, where the Care Quality Commission of 2018(7), suggested BAME groups are 4 times more likely to be involuntarily admitted to hospital for mental health issues, with Black ethnic groups at a higher risk (6).
- In the UK, so far-there are no governmental outreach campaigns to increase awareness of mental health support within these communities.
- Muslim communities specifically, (which have been proven to be a marginalised community both religiously, ethnically, racially and socioeconomically) are disempowered in the utilisation of these services (8,9).
- More than 60% of the British orthodox Jewish community stated that they don’t feel like any mental health professional would understand their situation (10).
- There is a need for much more research in this area that also focuses on barriers for men from varying ethnic backgrounds, specifically in Black African/Caribbean communities, undocumented migrants and refugees/asylum seekers.
Quality of Care
- The importance of mental health professionals being trained/aware of relevant cultural and religious beliefs when dealing with patients to ensure appropriate care needs more attention.
- Cultural and religious sensitive adaptations have also been suggested for effective school-based mental health education (11).
- There is also an importance in co-producing(12) mental health therapy plans, where patients can be as involved in their treatment as the therapists, doctors, nurses etc.
- Co-producing plans helps to empower patients so they can become well- actively, not just passively. It's of growing importance in minority mental health, where more two-way communication is essential for more consensual care.
Overall, some progress has been made in understanding the complicated intersections between being a minority group in not only ethnicity, but also religiously, sexually, and neurodevelopment-ally. However, the research is still very scarce. Dr Afzal(13), mentioned in our conversation that many times mental health is pushed aside in mainstream medicine which is partly the reason why minority mental health is also neglected. Recently, more papers have been coming out about BAME mental health due to the spread of COVID-19 exacerbating existing inequalities that many minority groups were facing pre-pandemic. More needs to be done to address why a disproportionate amount of ethnic minorities are being sectioned in the UK and why they are so often misdiagnosed for years (14).
John A, Pirkis J, Gunnell D, Appleby L, Morrissey J. Trends in suicide during the covid-19 pandemic. BMJ. 2020 Nov 12;371:m4352.
John A, Okolie C, Eyles E, Webb RT, Schmidt L, McGuiness LA, et al. The impact of the COVID-19 pandemic on self-harm and suicidal behaviour: a living systematic review. F1000Res. 2020 Sep 4;9:1097.
Iqbal, Neelam, Minority Mental Health: Intersections between faith and ethnicity (January 16, 2021). Available at SSRN: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3767398
Peach C. Muslims in the 2001 Census of England and Wales: Gender and economic disadvantage. Ethnic and Racial Studies. 2006 Jul 1;29(4):629–55.
Lowe SR, Tineo P, Young MN. Perceived Discrimination and Major Depression and Generalized Anxiety Symptoms: In Muslim American College Students. J Relig Health. 2019 Aug 1;58(4):1136–45.
Lowe SR, Tineo P, Bonumwezi JL, Bailey EJ. The trauma of discrimination: Posttraumatic stress in Muslim American college students. Traumatology. 2019;25(2):115–23.
Mental Health Act: The rise in the use of the MHA to detain people in England. [Internet]. Care Quality Commission; 2018 [cited 2021 Jan 16]. Available from: https://www.cqc.org.uk/sites/default/files/20180123_mhadetentions_report.pdf
Tanhan A, Francisco VT. Muslims and mental health concerns: A social ecological model perspective. Journal of Community Psychology. 2019;47(4):964–78.
Karasz A, Gany F, Escobar J, Flores C, Prasad L, Inman A, et al. Mental Health and Stress Among South Asians. J Immigrant Minority Health. 2019 Aug 1;21(1):7–14.
Kada R. Cultural adaptations of CBT for the British Jewish Orthodox community. the Cognitive Behaviour Therapist [Internet]. 2019 ed [cited 2021 Jan 16];12. Available from: https://www.cambridge.org/core/journals/the-cognitive-behaviour-therapist/article/cultural-adaptations-of-cbt-for-the-british-jewish-orthodox-community/6E04E6794651026CF5C7B323B78468F6
Estrada CAM, Lomboy MFTC, Gregorio ER, Amalia E, Leynes CR, Quizon RR, et al. Religious education can contribute to adolescent mental health in school settings. International Journal of Mental Health Systems. 2019 Apr 26;13(1):28.
Gault I, Pelle J, Chambers M. Co-production for service improvement: Developing a training programme for mental health professionals to enhance medication adherence in Black, Asian and Minority Ethnic Service Users. Health Expectations. 2019;22(4):813–23.
Identity International (2020). #Conversationswith Dr Afzal Javed. Available at: https://www.youtube.com/watch?v=xppaMYn0CRE&list=PLKO_c9ECXwPFsScwulisWJwYF4Wb2vN3b
Identity International (2021). #Conversationswith Nurse Judy Thomas: Part 1. Available at: https://www.youtube.com/watch?v=hFxbnVPQURI&list=PLKO_c9ECXwPFsScwulisWJwYF4Wb2vN3b&index=2