Why mental health services are failing people of colour in the UK

Counselling psychologist Dr Richard Majors talks candidly about racism towards Black mental health professionals and the impact racism has on mental health services for the Black community, particularly Black Males. Keen to make progress on these issues, Dr Majors speaks about the status of mental health and a new emotion technology he is developing that could be life-changing for Black boys and young Black men.

You recently edited The International Handbook of Black Community Mental Health that brings together perspectives on Black mental health from researchers, therapists and students. What did you discover about the state of Black mental health and mental health treatment for people of colour? 

It’s still very much in crisis for people of colour, and particularly men of colour. When you compare Whites to Blacks, there are still great disparities in NHS services and access. Not only are the services inappropriate and lacking for people of colour, but there is also an issue with staffing.

Black men often do not trust mental health services or the White authority figures that provide those services. That’s because most Blacks, particularly Black males, feel that any need for therapy will in most cases be the direct result of racism and White hegemonic systems. So, they feel how can they then open up and trust the same White people/therapist to solve their problems? Most Black men simply say they cannot trust White therapists or open up not only because of this, but also because of unfavourable experiences shared with them over and over and passed down from fathers, brothers, uncles, or friends of theirs. Hence, Blacks have a feeling of cultural mistrust of Whites in general and of course White therapists and I feel there is good reason for them to think and feel this way. Black males are disproportionately more likely to be misdiagnosed and hospitalised inappropriately and mislabelled than others. Blacks have a deep and profound mistrust for Whites/White therapists. It is no wonder that Blacks and particularly Black males feel that White therapists would be the last people they would trust or open up to.

One of the themes in the book is the emotional wellbeing of Black men and boys. You and your co-authors explain that Black males have tended to feel uncomfortable accessing traditional therapies, which means they face unique challenges when it comes to maintaining good mental health. What are the reasons for this?

Therapeutic services are ad-hoc for Black men because of their political status in society as second class citizens...yes second citizens in this 21st century when compared to others. This political view of Black males, whether consciously or unconsciously, is driven by implicit bias and stereotypes. Thus, many White therapists are not comfortable sitting across from a Black male in therapy. When White therapists are uncomfortable with Black males in therapy, along with their implicit bias, this gets played out in therapy though microaggressions – both verbally and non-verbally. Theses micro aggressions communicate to Black males that you are not wanted or liked. These perceptions are caused by ignorance, and the lack of both gender and cultural competence training. White therapeutic staff have little if any at all cultural and gender specific competence training either in universities or in the mental health settings they work in, so most White therapists do not understand Black males’ values, belief systems and customs, and that is why there are so many stereotypes, and explicit and implicit biases against Black males in therapy. Because of ad-hoc and inadequate mental health services, high numbers of Black men die in police custody tragically and inhumanly with untreated mental health issues.

Have you personally witnessed racism within the mental health services?

When I was working in the NHS it was common for me to be subjected to racism, not only verbally in the way people talked to me or talked down to me but in non-verbal ways e.g. micro-aggression too for example in how they stared at me, rolled their eyes, cut me off and just plain ignored or dismissed me when compared to White colleagues or therapists on the team. Black people stopped complaining because anytime you did senior management did absolutely nothing. When many of my White colleagues saw not only how I was being treated but other people of colour being treated in the same ways they would come up to us and tell us what they saw and mentioned how embarrassed they were. Racism for me in the NHS was not just limited to this. Often, I would be the last person to get my clinical notes typed up, if I got my notes typed up at all, while White colleagues had a lot more both secretarial and staffing support. Even things like where my seating compared to Whites would often communicate to me and other people of colour how much we were valued by my staff and the Mental Trust I was working in.

There are lots of overt and covert racism and microaggressions that are communicated to a person of colour day in and day out that is so stressful in the NHS that communicate you are less important, and you are second class. My colleagues constantly complained of differential treatment, but no one ever did anything as I mentioned earlier in the interview.

I would argue that so called ‘old school’ racism is still prevalent, but to make headway in combatting racism, we need to make progress on institutional racism. I refer to institutional racism as cloud or virtual racism because we often do not really know who is behind the racist act because more often than not the individual who commits the racist act is part of the system by definition, so very rarely is there any accountability. I think it’s more appropriate to focus on racial microaggressions because you can identify the offender and therefore expect some kind of accountability and opportunity to challenge and educate the individual.

Along with racism and a lack of cultural competence in mental health services, you argue that therapeutic process itself is a barrier for people of colour. Could you tell us more about this?

Most therapy for people of colour is boring and ineffective. This is where cultural competency comes in. People of colour want to be engaged in the therapeutic process more, they want the therapist to be more pro-active - not just listen and regurgitate words back to them but provide some common-sense advice and insight that will change their lives. Many Black people who come to therapy are in crisis and need urgent information and psychoeducation that will help them now not later. Many people of colour are catching hell in terms of the unfit environments they live in, lack of money, lack of opportunities, and unemployment among other problems. In terms of the therapeutic process, they often see therapy as a waste of time because of a lack of urgency and relevant information or signposting that can help them. Blacks see White therapy as more about process and procedure than substance and genuineness. People of colour often complaint that psychoeducation, advice and signposting is not relevant to them or culturally specific. People of colour and particularly Black males are very aware of stereotypes, bias and historical maltreatment towards them by White authority figures and therapists and are uncomfortable and despise going to a White therapist or authority figure and let them judge and label them and make decisions clinically that could impact them for decades to come. No wonder many Black people do not trust White therapists or authority figures and feel they are not trying to help them but rather out to get them and hurt them. They constantly talk about bad experiences of friends going to therapy where the White therapist could not understand what they were saying, seemed to fear them, seemed uptight, kept looking at them strangely, staring at them like something was wrong with them, and whose advice did not make sense or was relevant to them . People of colour often see the therapeutic process as a humiliating experience, not as a place you go to seek help or support.

In your book you move beyond theory to focus on solutions, introducing emotional literacy and technologies that can not only improve emotional wellbeing but help to choose emotions. How can these technologies support the mental health of the Black community?

In Chapter 10 (Social and Education Emotional and Emotional Wellness: A Cultural Competence Model for Black Boys and Teachers) of our book, The International Handbook of Black Community Mental Health, we introduce emotional literacy, gender and cultural competence into the Black community. We are really excited about emotional literacy, because emotional development and emotional literacy is something very little is known about in the Black community. With regard to emotional literacy, we are talking about how people understand, recognise, process, manage and regulate not only their emotions but those of others. It’s about the power of being able to know what to say, when to say and how to say it. Emotional Literacy helps you to choose emotions...That’s right we now have technology that helps us chose emotions. In fact, we are currently developing an emotion app to help both teachers and young Black boys to choose their emotions. We are so excited about the potential of this new technology.

In my chapter, we discuss the technology we are creating, along with existing technology such as mood meters and heart monitors, that can be used both in and out of the educational setting to help individuals choose their emotions. I also discuss a tool I’ve developed called The Emotional Literacy/ Interactive Tool which we are making into an app. This tool is in some ways more complex than the previous two I’ve just mentioned because it asks a series of questions for the teacher to consider to help them understand the pupil/student’s emotions/behaviours, rather than just punish the student. Not only is the Black child’s emotional literacy important, but also the teacher’s emotional literacy. The fact is, the child is not going to change unless the teachers changes. Thus, the importance of Teacher emotional literacy too. Our research has found that for far too long we have been able to improve the emotional literacy of the Black boy, but the teacher’s emotional literacy has not changed.

We found that a lot of school exclusions are spontaneous - a knee jerk response by teachers. And oftentimes, the teacher will personalise behaviours of young people far too much that have nothing to do with them. But the emotional literacy reflective tool /app we are developing helps the teacher to pause when an incident happens, reflect, de-personalise, and analyse more. The idea is that the teacher uses the app and goes through a series of questions that help them focus on their own emotional literacy, not only that of the child. The app will ask a lot of questions that help teachers understand their state of mind and what might have contributed to how they acted towards the child during a particular time/crisis. By reflecting they are better able to learn more about themselves so in the future they react more appropriately and then make an informed and just decision toward that child that may contribute to a life-changing situation.

Let’s turn our attention to your mentors Professor Joseph White and Dr Reginald Jones, who laid the foundation for Black psychology. Could you tell us about their work and the difference they have made to Black mental health?

I was very fortunate to have both Joseph and Reginald as my mentors, confidants, coaches and friends. Before Joseph White (the Father of Black Psychology) passed he wrote a Foreword for our book. Joseph White was the founder of Black psychology and Reginald Jones, who is probably less known but was one of the greatest Black psychologists of the 20^th century, was the architect of Black psychology. Reginald Jones wanted to make Black psychology a viable science and discipline. He recruited eminent psychologists and scholars of psychology to the field, along with those tracking data in the area of child psychology, clinical psychology, developmental psychology adolescent psychology, mental health, adult psychology and special education among other psychological areas. He published numerous books on all these areas of scientific inquiry and scientific disciplines with not only eminent Black psychologists but prominent psychologists who were collecting data. He was able to then take the ball from Joseph White and make Black psychology a legitimate scientific discipline. He was also a prolific editor and one the first Black publishers.

In 1968, Joseph White wrote the influential paper, ‘Towards a Black Psychology’, and that paper ushered in what we know today as Black psychology, which is the foundation of Black mental health. This paper countered the eugenics movement that perpetuated the notion that all races were inferior from the 1900s right up until the 1960s. When many other Afrocentric scholars like Joseph White began to challenge the eugenicists, Eurocentric values, and many of the therapies and pseudo theories that were around, they instead advocated Afrocentric values of Black people that they were not a deficit people and they/society should  celebrate, embrace and acknowledge their values, cultures, beliefs and customs.

Building on the work of your mentors, and other esteemed scholars and therapists, how do you think Black men and boys can be better served by mental health services? What do you think is the way forward?

There are two ways forward, one is structural and the other is those individuals who bring change on by their leadership.

Structural change and hope lie in such groups like the Black Lives Matter movement and other grassroots organisations.

Dr Majors is a chartered psychologist and a Fellow of the British Psychological Society (BPS). He is also the founder of the Journal of African American Studies (formerly the Journal of African American Men, the first referred journal in the United Stated for African American Men). His book Cool Pose is considered a classic in the field of race relations. He is also an honorary professor and former Clinical Fellow and Post Doctorate at Harvard Medical School.