"I remember there was a thing a few years ago, with a lady picking rice. In Caribbean communities, there's a custom of picking the bad rice out of a batch; we sit and clean it like that before we make it," says Janet Clarke-Lewis, Director of Services at the the ACCI (African Caribbean Community Initiative), one of the country's leading community organisations dealing with mental health in the black and Asian community. "There was a situation some years ago, where someone had gone in and saw someone picking rice, and said she was counting the rice grain, and reported her behaviour."
Clarke-Lewis is in a room in a small building in Wolverhampton, absentmindedly looking at the pictures of Marcus Garvey on the wall – at the West African-print hangings coating the leather sofa – and recounting incidents that demonstrate how important it is that people from BME communities are provided mental health workers sensitive to cultural or religious idiosyncrasies.
"Now we're talking about it, I remember being involved with a lady being assessed about being able to care for herself, and I was the only black person in the group," she continues. "She would have to make tea, and she would sweeten it, because where we came from, at that time, when you made tea you sweetened it. I remember going to the ward review and they were saying, 'She doesn't take others people's needs into consideration' – because when she made the tea she didn't ask whether they wanted sugar. And, you know, I had to jump on them! I remember thinking, had I not been there to help articulate that on her behalf then there would have been an assessment on her."
We've just come out of a session titled "Hearing Voices", in which a group of women discussed their experiences of exactly that. During the consultation, one service user commented on how those cultural or religious traits can lead to perceptions of mental illness – that, "Everything from speaking in tongues to shouting is seen as us looking 'crazy'."
The ACCI was founded in 1987 because of concerns raised about the disproportionate amount of Afro-Caribbeans at risk – or already suffering – from mental illness. Now in its 30th year, it's become a true safe space for members of Wolverhampton's BME community, who feel like their mental health issues are distinctly outside of the mainstream discussion. "Culturally appropriate [treatment] means a specific service," says Clarke-Lewis. "As our director would say, we have this mental health service [throughout the UK] that she wouldn't use, and we have to develop a service that anyone should be able to use."
So effective is the ACCI that it's become a sort of catch-all advice service for multiple issues – immigration, money for taxis, housing benefit claims. The organisation provides supported housing and has "around 288 service users" on its books at present, including Syrian refugees, Iranians, Indians and a "new" influx of West Africans.
While the ACCI is clearly doing fantastic work, its mere existence is a reminder of how far the UK is yet to come when it comes to mental healthcare.
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In the last instalment of this column, I discussed statistics that illustrated why some communities might want to use their own tools and resources to deal with these kind of issues. As a reminder: according to NHS data, there is a clear disproportionality when it comes to race and mental health detentions. In 2015/16, of every 100,000 people in the UK, 69 detained under the Mental Health Act were white, compared to 93 Asian people and 310 black people. In short, you are almost five times more likely to be detained if you're black than if you're white.
These stats are significant because they flag up what has long been suspected: that marginalised groups aren't just anecdotally treated worse than their white counterparts, but that their "other" status translates to disproportionately more institutionalisations under the Mental Health Act, just as people from BME communities are over-represented in British prisons. In some of these cases, it can be cultural traits that make the difference between who does and doesn't get sectioned, and on what grounds.
Because of this over-representation, there seems to be an assumption that nothing is done about mental health among BME people – that communities like "mine" just "brush the issue under the carpet". But there's nothing more redundant than hearing people ask why "my" community doesn't talk about mental health; it's an assumption flawed for all sorts of reasons.
One: it assumes that no non-white communities discuss mental health, when – of course – they do. Two: it assumes that all white communities regularly discuss mental health, when – of course – they don't. Three: it fails to recognise the resources and campaigns that allow predominantly white communities to engage with mental health treatment. Four: it doesn't even begin to interrogate some of the reasons some people might not be rushing to assimilate into conventional mental health discourse, when the state has a record of punishing people who do just that.
Mental health in communities of colour spans a vast array of needs. From the debate around radicalisation as a mental health issue, to the long-standing western history of psychotherapy learned through the eyes of Jung and Freud (who still have very colonial ideas of race; even a look at how they discuss black bodies is worth interrogation). After Grenfell, the need for culturally-sensitive trauma counselling was clear and urgent (and still is), and must be extended to migrants fleeing trauma, conflict refugee migration, hate crime victims and beyond.
The lists are long, the solutions are short, the state must do more. But, for now, it's left to organisations like the ACCI to pick up the slack – a problem that's only likely to get worse in the face of continued government cuts to mental health services.
"Our counsellors don't have to ask questions about arranged marriage; they know how it happens."
Kulbir Randhawa is the director of the Ealing-based Asian Family Counselling service, which caters to families and individuals in the south Asian community dealing with mild mental health conditions. Randhawa impresses the importance of hiring counsellors – hers speak Hindi, Punjabi, Gujarati, Tamil and Urdu – who have pre-existing knowledge of cultural specifics.
On a phone call, when I ask her why it's important, she says: "Many might not read or write or speak English, but the ones who do may also lapse into their mother tongue when faced with emotional issues. They don't need to sit and explain stuff about arranged marriage or extended families. Our counsellors don't have to ask these questions; they know how it happens."
Eugene Ellis, Director of The Black, African and Asian Therapy Network, reinforces this point. "It's important to have a range of people, including therapists of colour," he says. "The therapy profession as a whole has a responsibility to people of colour and to other communities, which it has historically marginalised."
Hundreds of similarly crucial and under-resourced groups like this exist across the country – the Asian Family Counselling Service, the Asian Women's Resource Centre, the Chinese Mental Health Association, Jewish Women's Aid, Karma Nirvana, Nafsiyat Intercultural Therapy Centre and Southall Black Sisters, to name a few.
The idea that "we" don't talk about mental health needs to change; we clearly do, with very little help from those in charge. People must stop shaming people of colour to discuss their mental health until it is institutionally safe to do so.
Click here if you'd like to donate to the ACCI.
Previously on British Values: