Black History Month
by See Change Ambassador, Blessing Dada
The theme for this year’s Mental Health Week is “Mental Health in an Unequal World.” Thoughts that first come to mind when you read I read these:
While the terms equity and equality may sound similar, the implementation of one versus the other can lead to dramatically different outcomes for marginalised people.
Equality means each individual or group of people is given the same resources or opportunities. Equity recognises that each person/community/society has different circumstances and allocates the exact resources and opportunities needed to reach an equal outcome. Equity is a solution for addressing imbalanced social systems. Justice can take equity one step further by fixing the systems in a way that leads to long-term, sustainable, equitable access for generations to come. If we treat these people equally, we would give everyone the same box to stand on, so only the tallest person could reach the fruit. If we treat them equitably, we would give them as many boxes as they need to reach the fruit. These are what came into my head for this year’s theme.
As an ethnic minority mental health advocate, here’s why the subject of inequality in relation to mental health is important to me:
I think the increasing diversity of the nation brings opportunities and challenges for health care providers, health care systems, and policy makers to create and deliver culturally competent services. Cultural competence is defined as the ability of providers and organisations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients. This is why the subject of inequality in relation to mental health is so important to me. A culturally competent health care system can help improve health outcomes and quality of care and can contribute to the elimination of racial and ethnic health disparities. Examples of strategies to move the health care system towards these goals include providing relevant (and mandatory) training on cultural competence and cross-cultural issues to health professionals and creating policies that reduce administrative and linguistic barriers to patient care.
Personal experiences in disparities in access to mental health services:
I definitely have. Among many others who can relate. People with chronic conditions (like myself) require more health services, therefore increasing their interaction with the health care system. If the providers, organisations, and systems are not working together to provide culturally competent care, patients are at higher risk of having negative health consequences, receiving poor quality care, or being dissatisfied with their care. The black community and other ethnic minorities report less partnership and lower levels of satisfaction with care, which was my experience. I had to be my own advocate since a child, in physical and mental illnesses to be taken seriously, take longer to get the basics help and have even had to change doctor due to his bias (with a lot of fight) due to my intersectional identities of being a woman and being black. This delay and stress has had a huge knock-on effect in many areas of my life and medical racism needs to be a topic of seriousness and consequences.
My experience as a Black woman finding a mental health professional that can affectively provide culturally appropriate care:
As a Black woman, most of the common barriers were the importance of family privacy and the cultural conflict of being a first generation Black Irish in an African household (child to immigrant parents), lack of knowledge regarding available treatments, denial of mental health problems, and concerns about stigma, medications, and treatment. Acknowledging the need for mental health services, having a supportive environment, and positive past treatment experiences are identified as treatment facilitators. Community outreach, adequate follow-up, and coordination of services also are important messages delivered by us. Not that it is too late for me (better for things to happen and develop now than never), but early intervention would have saved so much hassle. I have never had a Black or POC as a therapist. Someone who I can relate with. Black Therapists Ireland was set up this time last year, a directory of Black therapists in Ireland, by Ejiro Ogbevoen. The Irish Council for Psychotherapy has about 4,000 therapists, and right now I think have less than 15 people. I didn’t know there were Black therapists in Dublin until I crossed connections with them and was very happy to see some progress. At the moment, mental health services doesn’t reflect much according with the government’s mental-health policy document, A Vision for Change. There are many significant institutional barriers, to diversifying therapists in the country from a generally hostile labour market to high rent costs for offices and etc. for Black people in Ireland, to the particular obstacles for those who are migrants. An example would be a non-European counsellors – if their status is such that they need a permit to work – can’t work as therapists in Ireland. Change needs to come.
Thoughts in relation to the general experiences of inequality someone living with mental health difficulties in Ireland:
Social inequalities are all around us: People are multifaceted and focusing on one aspect of group identity or experience at the expense of another can sometimes mean we miss a more detailed and diverse understanding of how things like life experiences, disability, sexual orientation, gender, and gender identity, and racial or ethnic identity interact to affect people’s mental health. Yet discussion on the causes of mental health problems often focusses on individual factors
Rarely does public discourse acknowledge that the circumstances in which we are born, raised and live profoundly affect our chances of having good mental health. Racial and ethnic minorities are also more likely to have lower levels of literacy, often due to cultural and language barriers and differing educational opportunities. Low literacy may affect patients’ ability to read and understand instructions on prescription or medicine bottles, health educational materials, insurance forms and even system barriers, such as not receiving appropriate information about services or receiving inadequate, dehumanising services. Tackling social inequalities seeks to shine a light on the social inequalities that put too many people at a disadvantage in achieving mental health and wellbeing. We all have mental health and we all can experience mental health problems, whatever our background or walk of life. But the risks of mental ill-health are not equally distributed. We do not all have an equal opportunity to flourish and that: needs to change. Now!
Additional thoughts:
For centuries, mental ill-health has been overlooked, misunderstood, stigmatised and, for a long time, inappropriately treated. Much of this is now changing (loads still need to be done), although misunderstanding and stigma are not yet things of the past. As a society, we have some way to go before the extent of mental health problems and their damage to our individual and collective wellbeing is fully recognised and comprehensively responded. Cultural competence is not an isolated aspect of medical care, but an important component of overall excellence in health care delivery. In general, to fully develop our understanding, more work is needed that takes this mandatory intersectional approach.
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