Mental Health misdiagnosis in BAME communities

My first contact with mental health was at my first job when I moved back to England in July 2001. Working in a moderately secure unit was an education. Mental Health remains a taboo subject within the Black Asian and ethnic minority groups. The last 12 years of austerity has seen a decline in services in Social Care and NHS services. Inequity in housing and education affects these communities. The COVID pandemic demonstrated how frontline and lower-income workers are affected. Despite the awareness campaigns, mental health is still discussed in hush-hush tones or never discussed.

Stigma and suspicion mean that most people will access services when they get to the crisis point. Stereotypes like “black people are violent” result in some black people being sectioned. Myths include that once social services are involved, children will be taken away from you. This means when a child or an adult exhibits strange behaviour, the MO is to either keep quiet or speak to someone who may have little or no knowledge of mental health. A mother who may experience postpartum depression will not access the services as she does not understand her struggle. In some cases, persons exhibiting strange behaviour are deemed possessed or witchcraft is involved. Sadly in some cases, the pastor’s word is final, which can harm a person. Religious leaders, church and mental health services must work together for the well-being of an individual.

Efforts to create awareness in the communities, engaging with local authorities and Westminster, clearly is not enough. There are also not many BAME professionals in the fields of psychiatry and psychology. There is a need to educate professionals on BAME service users’ larger global politics, economic and cultural issues.

As the NHS celebrates 75 years of its great work, the diagnostic tools need to include presentations of these communities. Historically, stereotypes and racism have driven many cases of misdiagnosis. Today, there is concern that many young people in prison do not need custodial sentences but mental health support. According to research collated by the Mental Health Foundation

Black people are 4 times more likely to be sectioned under the Mental Health Act.
Refugees and asylum seekers are more likely to experience depression, anxiety or PTSD. This is particular to culture shock, living in detention centres or hostels for extended periods
In the workplace, black people are likely to experience micro and macro aggressions of racism, leading to first contact with mental health services with depression and anxiety.

An overview of the African continent shows pockets of high possible diagnosis of schizophrenia and psychosis due to genetic disposition and drug and alcohol addiction. In other areas, there is PTSD and depression due to extended wars and economic and social economic challenges due to lack of employment. The use of khat resulted in increased psychosis or schizophrenia diagnosis; the UK Khat service was set up specifically for a certain community. In war-torn nations, the use of rape as a tool of war has led to a large number of women and children with Complicated PTSD. These people migrate as asylum seekers and bring their language and culture with them.

My first contact as a service user was due to emotional stress; that was my opinion. I remember sitting across and arguing with my doctor, who diagnosed me with depression. In my opinion, I was not coping despite my symptoms demonstrating moderate depression. I was put on medication, and after 12 years, life has been more accessible. Talking therapies sometimes lacked an understanding that some English words were difficult to conceptualise as I speak 2 other languages. Being a high-functioning woman with depression, I am not a textbook case. I dress carefully and soft-spoken, and my makeup masks the internal pain. No one presents like the other, including Caucasians.

Training in Psychiatry, Psychology, Social Work and Community Psychiatric nurses is minimal. During training, professionals may have one module on BAME communities. Yet we are much more than that, with 2000 languages and 54 geopolitical countries.

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