The UK Mental Health Care System is Racist

Tia Chahal is a 22 year old British Indian Psychology BSc (Hons) graduate from Doncaster, South Yorkshire, currently working for the NHS in the mental health sector.

This article appeared in Work issue, which came out July 2020

My thoughts as an Indian woman working for the NHS in the Mental Health Sector.

Given the fact that the current pandemic of COVID-19 is disproportionately affecting BPOC (black people of colour) and NBPOC (non-black people of colour), alongside the increased awareness of the #BLACKLIVESMATTER movement - I think it is the perfect time to discuss racial disparities within

the UK healthcare system.

- DISCLAIMER: Before I begin, I just want to emphasise the fact that I am not and do not want to discredit the amazing efforts of NHS staff, especially during the current pandemic. -

As a bit of background in regards to myself, I am a Psychology BSc (Hons) graduate and focused the majority of my university work and thesis on Institutional Racism. Following graduation and much confusion about what I actually want to do with my life (we won’t get into that), I stepped straight into a job within the NHS as a Community Senior Support Worker and a Nursing Assistant on the Mental Health inpatient wards. I’ve worked for the NHS for less than a year now and I can’t lie, it has been such a frustrating and daunting time for me.

I feel as though I was sheltered in this bubble of study throughout my university years, only researching and writing about racial inequality within the healthcare system and now I work for this institution and am very much so witnessing the covert and overt racism I studied, first-hand. I have witnessed unequal treatment towards BPOC and NBPOC service users, ignorant beliefs held by healthcare professionals, microaggressions towards other BPOC and NBPOC staff and myself, limited access to healthcare and (rightly so) poor patient outcome satisfaction of BPOC and NBPOC service users. It’s overwhelming, especially when you feel so powerless to make a change.

Let’s talk about implicit bias.

The healthcare system is riddled with structural racism that is unfortunately perpetuated by healthcare professionals including Psychiatrists, GP’s and Nurses. Most of the time, this is due to their implicit (although, some healthcare professionals are downright explicit) racial bias, which is accompanied by a lack of understanding or ignorance to other cultures.

This sort of bias means that people that report that they are not racist, and that they are committed to fair and non- discriminatory treatment, might nonetheless harbour implicit race biases, and be influenced by these biases in the way they behave. These biases are described as ‘implicit' becausethey are not easy to detect (we cannot easily check whether we have them or are influenced by them), and because they operate automatically, and outside the reach of direct control. This is especially in full effect within mental health care. For example, the racial stereotype that Black men are prone to violence contributes to the misdiagnosis of paranoid schizophrenia. I’m not saying this is the sole reason that there are racial disparities within the healthcare system (this will be an infinite long article if I got into that), but it’s definitely a huge contributor that I have witnessed and don’t feel is talked about enough.

To put this into context, there is an overpopulation of BPOC and NBPOC admitted on to the mental health wards, even though ‘BAME’ people only make up 14.5% of the UK population. The stats show that BPOC are 4x more likely to be sectioned under the Mental Health Act, BPOC and NBPOC are 17x more likely to be diagnosed with a ‘serious’ mental health disorder including schizophrenia, BPOC have the longest stay on the mental health ward once sectioned, BPOC and NBPOC are less likely to be offered therapy and non- medication options in comparison to their white counterparts and so forth.

Something that I have found quite shocking is the fact that there is no training surrounding differing cultures and religions. I mean, the only training that I have participated in is the compulsory ‘diversity’ training where you literally just define what ‘prejudice’ and ‘discrimination’ means...yup, so helpful! I believe this sort of training is so important because something that is considered ‘normal’ in one culture, may be considered ‘abnormal’ in the

next.

For instance, in Hinduism the concept of ‘hearing voices’ is viewed as the voices of spirits, such as the Hindu god Hanuman, so is therefore construed as something that is magical. Whereas psychiatric clinicians in the West, assume that these voices are the meaningless by- products of psychotic illness,‘schizophrenia’ in particular. Therefore ‘unusual’ experiences as such, are constructed as ‘pathological’ causing differing cultures to be medicated for a factor that is in fact celebrated intheir culture.

Clinicians conducting full psychiatric evaluations of a race or culture differing to their own, doesn’t personally sit right with me.

To support this, a 2020 study conducted by Kuldip Kaur Kang and Nicola Moran found that - Inpatient staff reported lacking the confidence and knowledge to identify and meet BAME inpatients’ religious and cultural needs, especially inpatients from smaller ethnic groups and newly emerging communities. They also found that there was no specific assessment used to identify religious and cultural needs and not all inpatient staff received training on meeting these needs. Concerns were raised about difficulties for staff in differentiating whether unusual beliefs and practices were expressions of religiosity or delusions. In conclusion to their study, staff identified the potential role of inpatients’ family members in identifying and meeting needs, explaining religious and cultural beliefs and practices, and psychoeducation to encourage treatment or

medication adherence as vital. All of the institutions around us are designed to benefit our white counterparts.

In addition, BPOC and NBPOC – we go through a lot, more than we even recognise most times. Racism affects our lived realities in so many aspects - whether this be being racially profiled, police brutality, directly being called racist terms, experiencing microaggressions on the daily, social media forcing trauma porn onto us, marginalisation in white populated spaces...I could go on and on. And on top of all that, literally all of the institutions around us are designed to benefit our white counterparts. Therefore making the lives of BPOC and NBPOC increasingly more difficult as we have to work twice as hard to achieve, be heard or be taken seriously compared to white people. But the point is, all of the above are extremely distressing experiences/realities that undoubtedly take a toll on our mental health yet are completely disregarded and unrecognised by healthcare professionals.

When was the last time you went to visit a GP in relation to your mental health, and they took the time out to discuss or recognise or even try to understand the effect of racism on yourwellbeing? I can most probably guess that it has never happened. I have never witnessed any practitioner do this - instead, most healthcare professionals adopt an individualised or victim- blaming approach and overlook the importance of social context, interpersonal relations, or economic condition as a sourceof unhappiness.

In direct relation,‘BAME individuals make up only 9.6 per cent of qualified clinical psychologists in the UK’. Personally, I have not even seen one BPOC or NBPOC psychologist the whole time I have been working for the NHS, how crazy is that? Especially in the North, there are increasingly less BAME practitioners which I believe is also part of the problem. BPOC and NBPOC hold epistemic knowledge so can therefore understand and relate to the damaging effects of racism as it is a factor they experience also – so they are more inclined to account for social context and give the appropriate support to

the service user.

Where I work, I have noticed that there has been little to no adaptations to make our servicemore accessible to NBPOC whom speak another language. I don’t really see no effort from my colleagues to combat this either, it's kind of like, “Oh well they can’t speak English, so what can we do?”. This includes little things – for example we send out letters to remind service users of upcoming appointments, but some patients are unable to read the letters sent to them in the post as it is written in English so will unfortunately miss it. Is it so hard to translate the letter for them? Being Indian, and having an Indian grandparent who can’t read English, I empathise with this struggle – so I will make the suggestion to you know, maybe make letters more accessible. I have also done a lot of translation work for other services such as, making flashcards that are both in English and the language spoken by the patient, whereby they can express their emotion to the nurses. Which takes me back to why we need more BPOC and NBPOC practitioners in the field of mental healthcare.

This is just a few examples; trust me I have seen a lot of questionable practices. Although, being young, freshly graduated thus lack of work experience, own confidence issues, internalised oppression- I find it difficult to speak up most of the times and be like ‘hey this isn’t right?’, or ‘you shouldn’t say that?’. Besides the psychiatrist, I am the only NBPOC within my team, so I am completely out shadowed by all white professionals and often feel

marginalised.

In a short summary, The Mental Health Act, The Mental Capacity Act, the DSM-5, the policies and training guidance of the NHS for example, were all written by a panel of white people -to ultimately benefit them and the white majority. BPOC and NBPOC are being marginalised and inadequately treated and placed in white healthcare institutions that are systemically racist as a means to uphold unjust social structures. The sooner that people realise this, the sooner we

can advocate for change.

Follow Tia Chahal:

Twitter: @TIAcXxx Instagram: @tiachahal

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