Black on both sides
Some reflections for Black History Month
Thinking back to my time on inpatient mental health wards as a young Psychiatrist of Nigerian descent, a number of things could not escape my attention. It was evident that a high proportion of the patients were of Afro-Caribbean heritage, often young men of a similar age to myself.
I could not help but wonder why so many young black men were ending up in this predicament and also wondered what it must be like for them to see a black Psychiatrist treating them. I contemplated whether they would they regard me as a friend or a foe.
It is now well established in the psychiatric literature that higher rates of severe and enduring mental illness - conditions such as Paranoid Schizophrenia, Bipolar Affective Disorder and severe Depressive Disorders – prevail amongst minority ethnic groups. This phenomenon is true across societies.
The AESOP study in the UK explored the high rate of psychosis in Afro-Caribbean populations in the UK. Similar studies have been conducted in other settings, including in Brazil and Northern Ireland. One of the major findings in the UK arm was that the incidence of psychosis is higher amongst Afro-Caribbean populations than their indigenous counterparts, particularly in urban settings.
Secondly, Afro-Caribbean people with severe mental illness were more likely to come into contact with mainstream mental health services through the criminal justice system and end up in secure hospital settings.
It is acknowledged that Afro-Caribbean people may have negative experiences of services, reducing their likelihood of engaging with the mental health support they require. A serious implication of this is that they do not receive treatment in timely fashion (a phenomenon referred to as duration of untreated psychosis) and thus the effectiveness of interventions – including the effects of psychotropic medication – may be reduced.
It has, however, been encouraging to see that initiatives are being rolled out to reduce stigma against hard to reach communities and plug in at-risk people into local mental health services.
One of my most positive recent experiences was the discovery that a barbers shop in Camden I have frequented for many years has developed a working relationship with local health commissioners to train the barbers in ‘Mental Health First Aid’.
The barbers shop is patronised by predominately young Afro-Caribbean clients and was identified as a place that young men go to on a regular basis and open up about their personal lives. It therefore made sense for the barbers to be trained to listen attentively, sensitively engage their clients in conversations about their mental health and develop confidence in signposting those felt to be at risk of more serious problems to the relevant services.
This brings me onto the role that the Church could play in being a similar beacon within the community to help address the stigma around mental ill-health and direct people to the support they require. Back to my roots….I am often struck by the fact that whilst the Church – particularly its evangelical branches – in Nigeria has gained a strong foothold in society and can be regarded as progressive in many respects, the understanding of mental illness broadly speaking remains very poor. I am sometimes left disappointed and underwhelmed by the level of ignorance amongst fellow Nigerians when discussing mental health issues with them.
Given the prominent role played by Nigerian-led churches in the UK, often within the Pentecostal movement, it is imperative that church leaders within such communities are equipped to address the mental health needs of their congregants. Unhelpful and misguided opinions about spiritual attributions of psychosis, for example, only serve to deepen the stigma associated with conditions such as Schizophrenia, which remains poorly understood.
A blueprint for successfully engaging marginalised groups now exists, as exemplified by initiatives such as the Camden Barbers project. I would encourage church leaders to engage in the conversation about mental health that is grabbing the public’s attention at this time, seek to be at the forefront of the movement to destigmatise mental illness and show compassion to those affected. An ever-growing list of resources is available to assist them in making this happen.
Dr Chi-Chi Obuaya is an NHS Consultant Psychiatrist