A black-centred approach to mental health services

We take a close look at some of the community organisations delivering culturally-informed mental health services

SUPPORT: Recent years have seen a number of initiatives launched to better meet the needs of black people (photo: Getty Images)

LITTLE SEEMS to have changed for black people in the mental health system since the tragic death of David ‘Rocky’ Bennett in October 1998.

Rocky, a 38-year-old black man, was a detained patient in the Norvic secure psychiatric clinic in Norwich. He died after being restrained by up to five nurses.

In February 2004 the Independent Inquiry set up to examine the care he received branded the NHS, and especially its mental health services, institutionally racist.

It said that black and minority ethnic people in the mental health system were ‘not getting the service they are entitled to. Putting it bluntly, this is a disgrace.’

David ‘Rocky’ Bennett, 38, from Peterborough, whose death at a psychiatric clinic in Norwich sparked a public inquiry

Nearly two decades later serious concerns remain. Campaigners have highlighted how the Mental Health Act has led to disproportionate numbers of black people detained against their will.

Recent data from NHS England found that black people are more than four times more likely to be detained under the Act, and more than 10 times more likely to be subject to a community treatment order.

Studies also show that while black people, and black men in particular,  are far more likely than people of other ethnic backgrounds to be diagnosed with severe mental health problems, their engagement with services is still very low. 

But there is hope. The last decade has seen the launch of several initiatives aimed at providing black people facing ill-health with help they need.

Here, we take a look at three such projects.

IRIE Mind, Hackney

The impact of growing up with an abusive father had a devastating effect on east London mum-of four Anthea (name changed) while growing up in Birmingham in the 1980s.

The violence she, her mother and five siblings experienced led to them leaving their home in the city and coming to London in the early 90s.

Even though she had escaped the abuse inflicted by her father, what she had been through took a severe toll on her mental health.

Nichola Lauder, Director of IRIE Mind

“I’m a very sensitive soul, very emotional so I bottle things up unlike my two sisters” she tells The Voice.

Further tough times were to follow. Years after moving to London, her brother took his own life. Her mother died a few years later.

Anthea also dealt with the pressures of being a single parent of four children. After the birth of her daughter she experienced severe postnatal depression.

In 2009, after suffering a breakdown, she was admitted to a psychiatric hospital and diagnosed with paranoid schizophrenia.

The lifeline she needed came when she was put in touch with Irie Minds.

The project, run by the City, Hackney and Waltham Forest branch of the charity Mind, aims to provide community-based solutions to people of African and Caribbean heritage who are experiencing mental ill-health.

The service is led and staffed by black mental health specialists in a bid to reflect the cultural background of its service users who often shy away from mainstream services.

And the individual and group therapy it offers, as well as a range of other activities, are informed by key aspects of African Caribbean culture. The goal of this approach is to not only prevent users experiencing a mental health crisis but give them a sense of purpose and hope.

“Coming to IRIE Mind has helped ground me,” she says. “I still have my struggles but I’m getting there. If it wasn’t for places like this I wouldn’t have been well. I probably would have had a relapse and gone back into hospital. And I don’t want to be back in the system.”

Anthea credits IRIE Mind with helping her overcome some of the cultural stigmas that often prevent many black people from seeking help.

“Our parents and elders came from the Windrush Generation, they are proud people” she says. “When I had my breakdown they couldn’t believe it. One of them even suggested getting a priest to exorcise evil spirits in the house. 

“They just don’t understand the issue of mental health because they had it so hard when they came here, especially the racism they had to face. When we younger family members like me have our breakdowns they look at us in disgust and say ‘pull yourself together’.

“It’s very hard to get black people to seek help for mental health because we’re just not culturally inclined to do that. We’re more likely to bottle things up but when you do that things get worse.”

Explaining the project’s approach to working with clients Nichola Lauder, Director of IRIE Mind says: “It’s really about love for the people coming through the door. How do we create that? It starts with recruitment. We look for staff who work with their hearts. For us, it’s about creating relationships from the moment people walk through the door. We slip back all the formalities. As they come in there are pictures and resources to do with black culture and history which helps create a sense of familiarity.”

Lauder continues: “We start by asking them what they are looking for, not asking what’s wrong with them.  It’s about starting from a place of positivity, of strength. I think mainstream services are more formal in how they work. There’s a perception that informal means unprofessional but that’s not true. Culturally, it’s a different approach.”

Black Health Initiative, Leeds

The Black Health Initiative (BHI), a charity in Leeds  which runs a wide range of health and community initiatives alongside its work on mental health, emphasises what it calls cultural intimacy as a way of helping to create a space where people can open up.

FAMILIARITY: Many of BHI’s counsellors are of African or Caribbean heritage, to create ‘cultural intimacy’ (photo: Getty)

BHI CEO Heather Nelson says: “Many of our counsellors are from African or Caribbean heritage. Our service users say that when they come to a black counsellor, they don’t have to explain mannerisms.

“So, for example, if a black person kisses their teeth, we wouldn’t be asking for an interpretation of that because culturally are aware of what that means”.

Heather Nelson, CEO of Black Health Initiative

BHI individual, group and talking therapy sessions closely follow guidelines set down by the British Association for Counselling and Psychotherapists. However cultural aspects are added.  

“At group discussions,  we’ll always have Caribbean food.  We’ll have music such as  reggae or r ‘n’ b.  It sounds really simple but when people are in crisis music and food can be very soothing. They can be symbols of something familiar, a connection to happier times, which can be important to a person’s recovery.”

Nelson continues: “A big part of the group discussions is asking people what they do to cope when they’re feeling unwell. Some are honest and say they’ll smoke a spliff.

“Others might tell the group how they play squash. I’ve heard the discussions where someone will come and say ‘what you doing with squash? It’s a white man’s sport.’ But before you know it peer support and sharing of ideas to support recovery is happening right in front of them.”

Improving Black Minds, Haringey

The shame that 34-year-old Jehourney Coulson, from Enfield, felt at being a male victim of domestic violence made it difficult to speak up about the abuse he faced from his ex-partner.

It was especially tough given his Caribbean heritage.

AWARENESS: Improving Black Minds has focused on training people in Haringey as mental health first aiders to help tackle stigma (photo: Getty Images).

“There were times when I felt like I wanted to commit suicide” he tells The Voice. “I grew up in Jamaica. Over there, if you called the police on your partner after an argument it made you seem weak as a man.”

However the continued abuse left Coulson with severe depression. He finally found the courage to talk to his GP about what was going on who then referred him to the Improving Black Minds Project run by Mind in Haringey.

Nadiyah Davis, Counselling Service Manager at Mind in Haringey

The project, launched in September 2021, offers access to one to one counselling and therapeutic group support to people it describes as being from ‘racialised communities’. 

According to figures from Mind Haringey has the 6th highest prevalence of serious mental illness (SMI) in London. and men from Black and minority ethnic groups have the highest prevalence of serious mental illness. It’s estimated that 85% of Improving Black Minds users will report increased mental health and wellbeing after using the service.

Coulson was given 13 counselling sessions through the project which eventually led him to getting the support he needed.

“It helped that the sessions were confidential,” he says. “I didn’t know the counsellor so that made it easier for me to open up. Each week after the sessions I felt a lot better. I still have my ups and downs, but it’s much better than before.

Lynette Charles, CEO of Mind in Haringey

Coulson says he also benefited from the fact that his counsellor was from the same cultural background as he was.

“When I was speaking about certain things he could relate to me more because he understood the culture and my background. Finding someone to talk to, whether a relative, friend or counsellor is crucial. There are people who have taken their own lives who would be alive today if they had someone to talk to.”

Like Coulson, many first time Improving Black Minds users are hesitant, something which Nadiyah Davis, Counselling Service Manager at Mind in Haringey, acknowledges.

“There are a lot of people who present to our service who aren’t even sure about what counselling or one to one therapy is all about” she says. “They might feel as though the counsellor is going to tell them what to do and how to change things in their life. But that’s not what counselling is about.

“Whoever comes to the project will meet with a counsellor who is also from a racialized community. That’s really important in terms of the service user feeling comfortable and hopefully beginning that journey of opening up.”

Lynette Charles, CEO of Mind in Haringey, says that when the project was launched, a unique approach was adopted to the challenge of spreading awareness.

“We decided to train people from black and minority ethnic backgrounds as mental health first aiders” she recalls. “During the two-day training sessions people sat in a room with others from their own community and that enabled them to speak more openly about some of the stigma that prevented them from reaching mental health services.

“They then walked out of those sessions with the skills and confidence to help their family members and others in the community. So far we’ve trained over 200 people from the black community as mental health first aiders. Since then we’ve also partnered with grassroots organisations such as Somali community groups, mosques and refugee groups and given them money to deliver their own mental well being programmes.”

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