BMOTC: Understand the cultural backdrop and you will start to understand the stigmas and barriers

By Audrey James 

Here, in the UK, October is Black History Month. It is a time to promote and raise awareness of the often-overlooked history, culture, and accomplishments of the Black community in the UK. In addition, it is an opportunity to educate individuals about the experiences and struggles faced by members of the Black communities. As a Black psychotherapist, I’ve chosen to write a blog to highlight some of the ongoing challenges and struggles, around mental health, and why these challenges and struggles exist for us. 

Mental health is currently high on the agenda. Access to support can come with challenges but, within Black and ethnic minority communities, it can be harder still for individuals to seek out mental health support. Is it possible that other communities are more practiced at accessing therapy while we in Black communities are depriving ourselves due to shame and stigma? If so, might we be losing out?  

Traditionally, within Black communities, many of us have preferred to keep our difficulties concealed. Growing up, I was admonished by my mother “nah tark yuh bizniss” and I know this to be true in many Caribbean homes. So, we don’t “talk our business”.  For Black males this is even more pronounced. Black men are underrepresented when seeking mental health support – with fewer Black male therapists available and evidence to show that Black men are statistically the least likely of all groups to seek therapeutic support. Compared to other ethnic groups and even compared to Black women, on average, Black men take longer to access therapeutic support or may never do so.  

Mental health problems worsen without support, and so without addressing the root causes, the risk of crisis rises. Coming to therapy can often be triggered by a crisis, rather than being something more planned. Recent NHS research found that people from Black-African and Caribbean communities are “40% more likely than White-British people to come into contact with mental health services through the criminal justice system”.^[1]

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^[1] https://www.england.nhs.uk/wp-content/uploads/2020/10/00159-advancing-mental-health-equalities-strategy.pdf

These criminal associations add to an already existing stigma, and fear for seeking mental health support or accessing therapy. When a person in crisis is sectioned under the Mental Health Act, in some cases the police are called to the home – perpetuating negative associations around poor mental health further. 

Triggering memories and intergenerational traumas

Historical legacies of enslavement and ongoing systemic racism have had a profound impact on the mental health and wellbeing of individuals within the Black communities. Studies consistently highlight the inequities and mistreatment experienced in areas such as police relations, the justice system, healthcare, housing, education and employment.

Witnessing or hearing about acts of discrimination and aggression can be deeply triggering for individuals within black communities and can invoke historical and daily experiences of systemic racial inequities. The coverage of George Floyd’s brutal public murder by a White police officer kneeling on his neck was an incredibly distressing event that had a profound impact on people worldwide.

The video of George Floyd’s murder served as a stark example of vicarious trauma, where individuals, even if not directly involved, experience emotional distress and trauma by witnessing such acts. This incident sparked a global outcry for justice and ignited a renewed focus on addressing racial inequality and systemic racism. It highlighted the dehumanisation and mistreatment that Black individuals still face in some societies.

The tragedy of George Floyd’s murder gave a strong impetus to the Black Lives Matter movement, which aims to bring attention to and address the injustices faced by Black people. It mobilised millions of people to actively support the fight against systemic racism and advocate for policy changes that promote equality and justice.

It is important to recognise the impact of such incidents on individuals and communities. Ongoing efforts to educate, create awareness, and actively work towards dismantling systemic racism are crucial in order to create a society that values and respects the dignity and equality of all individuals, regardless of their race or ethnicity.

The toll of these experiences on the mental health of individuals is significant. Many individuals bear the burden of these traumas in silence, often leading to various mental health challenges including depression, anxiety, post-traumatic stress disorder (PTSD), and complex trauma. The consequences of these traumas not only affect individuals but also reverberate throughout the entire community.

It is crucial to acknowledge and address these traumas within Black communities. I have written more on this in my Triggering memories and intergenerational traumas blog, published on the 75th Windrush anniversary.

Providing access to mental health resources and support can help individuals heal and build resilience. Promoting equity and dismantling systemic oppression is also crucial in creating a society where these traumas are no longer perpetuated. By working together, we can create a more just and inclusive society for everyone.

What are the difficulties for black men to enter the therapy space? 

The shortage of Black therapists and counsellors makes it statistically inevitable that most Black clients will be seeing white therapists. A White therapist may not fully understand or appreciate the impact of racial micro-aggressions, everyday racism, or the unique experiences of being a person of colour in a predominantly white society. Without this understanding, they may inadvertently invalidate or dismiss the client’s experiences, leading to a breakdown in trust and inhibiting the therapeutic process. 

Furthermore, for Black clients, the presence of a White therapist may trigger feelings of mistrust, anxiety, or discomfort due to historical and contemporary power dynamics and the potential fear of being misunderstood or pathologised. The lack of shared racial and cultural experiences can create barriers to effective communication and hinder the establishment of a strong therapeutic alliance.   

How can stigma and barriers to mental health support be overcome? 

 As part of the organising team for ‘Black Men on the Couch’ I have been working on raising awareness on the specific challenges and inequalities faced by Black men accessing mental health care in the UK. Black Men on the Couch is a national programme seeking to diminish stigma and encourage Black men to seek therapy sooner – as well as enter the profession to address the stark shortage of Black male therapists in the industry. We want to start breaking these patterns, get rid of the secrets and create more opportunities earlier for interventions to promote mental health and encourage repair and equality. 

It is essential for White therapists working with Black clients to engage in ongoing self-reflection, cultural competence training, and education about systemic racism and its impact on mental health. They must actively work to create a safe and inclusive therapeutic environment, validate the client’s experiences, and be open to learning from their experiences and perspectives. 

However, it is also crucial to strive for increased representation and diversity within the mental health profession. Efforts should be made to address the shortage of Black therapists and counsellors through targeted recruitment, scholarships, and support for individuals from underrepresented communities to pursue careers in mental health. This will ultimately facilitate more culturally sensitive and effective therapy options for Black clients. 

There is so much more to be done, but we are proud to have started up this forum as a safe place to explore and evolve these issues, to begin to change the narrative. 

This is the start of a conversation. My hope is that it will be a conversation that continues until, within the Black communities, stigmas around our mental health are broken down; and we are all living in a more equitable society.

BMOTC Photo credits: Mervyn Roye Weir