My name is Rafeea, I am an assistant psychologist and I currently work within the RHSD (Rehabilitation and High Support Directorate) services. I am from a South Asian background and have been an advocate for promoting mental health and wellbeing within BAME communities.
I was recently asked by Muhammad Khan from inmywords.co.uk to contribute to his BAME mental health blog. This was an honour for me as I have been inspired by Muhammed and his story by reading some of his articles. I initially considered the stigma attached to mental health in BAME communities and reflected on my own experiences in the South Asian community. I found that BAME communities find it difficult to open up about their mental health experiences.
“According to research from Mind, the mental health charity, 1 in 4 people from the BAME communities do not share their mental health experiences”.
Most mental health problems go unreported and untreated in these communities, this highlights the stigma surrounding mental health. Mental health problems are treated differently in every culture in the world and the types of problems they face vary from community to community.
The Causes of Stigma
I decided to explore how mental health problems are treated in different cultures, the types of problems they face in their communities and what we can do to help change this. I held discussions within the Pennine Care RHSD services and reflected on the causes, effects and interventions with the staff and service users from BAME backgrounds. The key consensus during the discussions was that communities need to change attitudes towards mental health. There needs to be more information about the various conditions, symptoms, self-care and resources/services. Some of the key themes that arose around the causes of the stigma were environment and upbringing; lack of resources, culture, religion, impact of social network and community involvement.
During the discussions, culture, religion and environment were highlighted as some of the main causes of the stigma surrounding mental health. In most BAME communities there is a lack of awareness and insight into mental health conditions and their symptoms. After discussing this with BAME staff and service users, it became apparent that in most communities, behaviours associated with common issues such as depression, anxiety and addictions were deemed as ‘culturally unacceptable’ and were seen as something easy to ‘fix or cure’. This lack of understanding of mental health problems in BAME communities in turn causes individuals to be reluctant to address their symptoms openly and seek out the help they need.
“Not accepted” “It’s seen as a curse” “lack of resources” “Hard to speak about my mental health” “Feel like an outcast” “Not normal” “Not common” “People are afraid to talk” “Feeling judged” “Expectations from family”
I found that in order to resolve these ‘unacceptable’ behaviours, families turn to influential figures or faith leaders in their community. In BAME communities most of the decisions are based on culture or religion and how the faith/ community leaders perceive the individual’s behaviour. There is an overall reliance on their social network, this is because they are unaware of services that provide professional advice for mental health and wellbeing. In most BAME backgrounds, the community acts as an alternative to professional help. Advice from the community can be quite helpful, but mostly it is not enough to resolve the problem. Occasionally this can be detrimental as in most of the BAME communities, behaviours are believed to stem from a curse, demonic possessions, evil eye or punishment for a sin they or the family has committed. In order to resolve this, some BAME community/ faith leaders advise people to ‘fix or cure’ these behaviours by either ignoring the behaviours and having patience that they will get better on their own, emphasising that they will become better solely through prayer and devotion and using talismans, exorcisms and in some cultures casting the affected person out of the community. The lack of awareness surrounding mental health can come across as negative however; these beliefs have become embedded in the communities over the years as people have not been exposed to alternative approaches.
The sense of community is integral for individuals from BAME backgrounds. We have expressed how that can be unfavorable and a barrier to engagement with health services , however having social networks is also important as it improves wellbeing by making you feel less isolated and gives you a sense of belonging. Family and friends care deeply about the individual and wish that they get better by any means necessary. So how can we use significant factors such as culture, religion and social networks to be more positive and helpful?
It is important that we change attitudes towards mental health issues within BAME communities, to do this we must combat stigma by primarily promoting wellbeing. If we were to begin by introducing mental illnesses within the communities, it would be difficult to have an effective influence against the fixed beliefs held by individuals. By promoting wellbeing, it is a great opportunity to gradually introduce the importance of mental health. Wellbeing groups can include sports groups, social groups, study groups etc. Over time, these can develop to include more sessions around mental health conditions and services available.
There Has Been Some Improvement
There is currently little work being done by local trusts to inform community/ faith leaders on mental health and wellbeing, this needs to be a priority as there is a lot of importance placed on leaders in these communities and it will be an integral gateway into combating stigma towards mental health conditions and publicising mental health services within the BAME communities.
This does not mean that there has not been some improvement around insight into mental health and wellbeing in BAME communities. Discussing the outcomes with staff and service users, I found that there has been some development in addressing health and wellbeing. Service users within the RHSD service from the younger generation have stated that they find it a lot easier to be open and honest about their mental health issues with their immediate families and they are more accepting of this, however there is still progress to be made among the older generation, wider family and social network groups.
To promote awareness around mental health within BAME communities, local council, community development workers and advocates of health and wellbeing need to come forward and hold seminars/ events and drop in sessions tailored towards all age groups (children, young adults and older adults). Such events are currently not being held in mosques, churches and temples and are mainly tailored towards the younger generation. I believe to see a change in the attitudes towards mental health; they need to be held within these religious locations and be available to all age groups.
What are the current services being provided within BAME communities? Here are some of the mental health and wellbeing services I have come across that are tailored towards the BAME communities:
Mental Health and Wellbeing Services
Mental health service: Wai Yin Society: “To raise awareness and challenge discrimination and social exclusion faced by Chinese people with mental health problems. As the Society has grown, they have developed a range of employment, education and community services for men and women and from other ethnic minority groups, including Somali, Pakistani, Bangladeshi, Indian and many European nationalities.Wai Yin has become one of the largest BME Community centres in the UK”:
Salford: BAME champions have been introduced into the community to provide mental health support:
More current service provided for BAME community in Salford during COVID:
BAME Health Outreach Project:
Pakistani resource centre:
BAME health and wellbeing Hub in Leeds:
You can also browse your local council webpage to see what health and wellbeing services they are providing for the BAME community in your area.
“Remember mental health issues do not make people weak.”
I enjoyed having an open discussion with the staff and service users in the RHSD services within Pennine Care NHS Foundation Trust. We were able to reflect on the stigma surrounding mental health in the BAME community, and what needs to change and what local communities are doing to tackle stigma and raise awareness. What can I take away from writing this piece? I am now inspired to look out for more local health and wellbeing groups tailored towards BAME communities and volunteer some of my time to help promote these resources. What will you do to help?
On that note, remember mental health issues do not make people weak.“What mental health needs is more sunlight, more candor, more unashamed conversation about illnesses that affect not only individuals, but their families as well.” – Glenn Close
Thank you for reading,
Rehabilitation and High Support Directorate
Tameside General Hospital