Covid-19 mental illness and race: why are ethnic minorities more at risk?

A global pandemic, summers spent inside and cold winter nights under lockdown – if there is one thing the past year has shown us, it’s that mental health does not discriminate.

Almost everyone – in some way, shape or form – has had to battle their own demons in the wake of Covid-19, with the virus causing chaos and unprecedented change to all of our lives.

While this is true, however, overwhelming evidence still suggests that the virus has had a disproportionate effect on people of colour.

Anyone who saw David Harewood’s BBC One documentary [1] – in which the Birmingham-born actor explored why there seems to be higher death rates from coronavirus amongst the UK’s black and brown communities – will already be familiar with this conversation.

In the wake of this, another conversation has also been brought back to the surface, amid the country’s growing mental health crisis.

Society tells us that black and brown men don’t suffer from depression – rather, they have anger issues. Society tells us that black and brown women don’t have anxiety disorders, but instead, they have attitude problems.

Black and brown Brits who suffer from mental health issues are often seen as problems, threats and as the orchestrators of their own downfalls first – and as human beings in need of help, support and compassion second.

These problems have always existed, but have been exacerbated by Covid-19 – but mental health still doesn’t discriminate, right?

Mental health in black and brown communities: the figures

In a survey of over 14,000 adults aged over 25 carried out last July, mental health charity Mind found that existing inequalities in housing, employment and finance had “a greater impact on the mental health of people from different Black, Asian and Ethnic Minority (BAME) groups than white people, during the coronavirus pandemic”.

The survey found that “employment worries [amid the pandemic] have negatively affected the mental health of 61 per cent of BAME people” – compared with 51 per cent of white people.

52 per cent of ‘BAME’ people surveyed also said that concerns over finances in the wake of Covid-19 had impacted their mental health, compared with 45 per cent of white people. [2]

 

 

It is not a new argument: the 2016 BBC documentary Being Black, Going Crazy? – presented by blogger and radio presenter Keith Dube – reported that black British people were more likely to be diagnosed with mental health problems and to be sectioned than their white counterparts were. [3]

A 2019 report by the Race Equality Foundation also argued that “the evidence on prevalence suggests that black and minority ethnic communities are at comparatively higher risk of mental ill health, and disproportionately impacted by social detriments associated with mental illness”. [4]

Covid-19 is only adding fuel to a fire which has been stoked by a number of different sources – but which ones, and how?

Identity:

Issues around identity surely play a part in the mental health of black and brown people – in a society where the ghosts of colonialism still linger, it is a lot harder for people of colour to feel a sense of belonging.

When Muslims are portrayed as folk devils in the media, when Brexit coincided with a rise in hate crimes and when we have a Prime Minister who has called black children “pickaninnies” and Muslim women “letterboxes”, it is clear to see that racism has become all the more normalised over recent years. [5] [6]

It can sometimes feel like black and brown people are living, working and raising children in a country that still doesn’t really want them. Therefore, it’s hardly surprising that ethnic minorities may sometimes struggle to feel at home here – even in what is, for many of us, the only home we’ve ever had.

But why is our sense of identity so important?

Social psychologists Henri Tajfel and John Turner developed social identity theory some forty to fifty years ago, but it remains as relevant today as it was back then. The theory argues that identity plays a very important role in how we see ourselves, proposing that our identity – and the sense of pride we associate with it – has a huge impact on our self-esteem. [7]

The theory also suggests that human beings often make comparisons between our ‘in-group’ – the social group we identify with – and opposing ‘out-groups’, in a bid to improve our sense of self-worth. This also ties in with Hogg and Abrams’ self-esteem hypothesis, which also argues that there is a correlation between identity and self-esteem. [8]

In a world where labels and definitions are so prevalent, being black and British, being Pakistani and English, or being Scottish and Caribbean may leave you stuck at a crossroads. Maybe your Indian family sees you as not Asian enough, while British society sees you as not British enough – so “who really am I?”, you might ask yourself.

Second and third generation immigrants have been living through a hidden identity crisis for decades, with its impact on mental health often invisible to other people.

Racism:

2020 will not only be remembered as the year a deadly virus disrupted our jobs, goals and travel plans – but also as the year in which a global uprising grew from the ruins of tragedy.

The murder of George Floyd was not an isolated incident. It was not the first, nor the last time a black man would be killed by a white police officer. But it was another reminder that we live in an unequal world, where some are privileged on account of their race, while others are not.

The sociologist Emile Durkheim argued that suicide – and thus, we can infer, mental health too – was complex, often caused by a range of factors.

He argued that there were four ‘types’ of suicide – egoistic, altruistic, anomic and fatalistic. [9]

The fourth and final type, fatalistic, refers to when an individual chooses to end their own life as a result of overregulation in society. In simpler terms, when oppression, tyranny and fascism take hold, people can lose hope.

 

A black man walking the streets of the UK – when remembering that Mark Duggan, Jimmy Mubenga and Sarah Reed are just a few who have died at the hands of the authorities here – will perhaps be reminded of the barriers he faces.

A Muslim woman being told to “go back” to her “own country” on a London bus – a situation evidenced by a 2015 viral video – is also reminded of how her path is a lot harder to walk than others are. [10]

Research suggests that experiencing racism can be “very stressful and have a negative effect on overall health and mental health”, while a “growing body of research” is also implying that “those exposed to racism may be more likely to experience mental health problems such as psychosis and depression”, according to the Mental Health Foundation. [11]

Stigma:

Cultural stigma can also play a role when it comes to the mental well-being of people of colour.

In some cultures, mental illness is a taboo subject which is rarely dealt with appropriately, let alone even spoken about.

In a report entitled Mental Health Stigma in the Muslim Community, published in the Journal of Muslim Mental Health in 2012 by Ayse Ciftci, Nev Jones and Patrick W. Corrigan, it is argued that illness – whether mental or physical – is sometimes seen by some minority groups as something which is in the hands of god, as opposed to something which human beings can discuss, ease and deal with themselves.

Citing Johnson et al. (1999), the report says: “South Asian Muslim women queried about the cause of breast cancer strongly affirmed god’s role in determining both who gets sick and who is healed”, while adding that “mental illness may also be perceived as a test or punishment from god”, as referenced in Abu-Ras, Gheith & Cournos, (2008) and Rassoll (2000). [12] [13] [14]

Norms and beliefs are culturally relative – there are some practices or viewpoints that are the norm in British culture, but are alien in Chinese society, for example. As such, the way mental health is perceived and understood by some minority cultures in the UK can create a barrier for sufferers. How can you seek help for your mental health issues, when your immediate family, friends, or social group just don’t get it?

Environmental factors:

Barriers are not only in place on one side of the fence, however. A lack of adequate mental health services – and the way mentally ill minorities are sometimes perceived by services – has long been a problem for black and brown communities.

The Mind mental health charity reported that there is often a disparity in how people are treated for mental health problems, and that treatment can differ depending on your ethnicity.

The charity said: “If one examines routes to treatment, you will see that black people are 40 per cent more likely to access treatment through a police or criminal justice route, less likely to receive psychological therapies, more likely to be compulsorily admitted for treatment, more likely to be on a medium or high secure ward and be more likely to be subject to seclusion or restraint (56.2 per 100,000 population for Black Caribbean as against 16.2 per 100,000 population for white)”.

It added: “We must stress that there is a hugely complex picture here, but it seems undeniable that black people get to the sharper end of treatment, in the more uncomfortable ways.” [15]

This again suggests that the services which are meant to be here to protect us often have a ‘fear’ associated with black people who are suffering from mental illness. This is perhaps another example of institutions dehumanising black people – whether consciously or subconsciously – and seeing them as more akin to dangerous animals than to human beings.

Some mental health services may also come across as culturally insensitive to some ethnic minority groups. For example, a white British counsellor may not have the cultural awareness to fully understand the struggles of a mentally ill British-Bengali person – their problems may be influenced by cultural factors which are out of the counsellor’s range of perception.

When it was reported that Covid-19 was disproportionately affecting ethnic minority groups, some mistakenly assumed that was down to genetics. However, societal factors were the main force at play, and the same can be said for mental illness.

Black and brown people are not born genetically pre-disposed to mental illness – environmental factors create the disparity.

In the English Indices of Deprivation 2019, it was found that “people from the Pakistani ethnic group were over three times as likely as white British people to live in the most overall deprived 10 per cent of neighbourhoods”, with 31.1 per cent of British-Pakistanis living in such areas.

Furthermore, 15.2 per cent of black British people were found to be living in the most deprived 10 per cent of neighbourhoods.

The figure for white British people stood at just nine per cent. [16]

If you are poor, you are more likely to experience mental health problems. The Mental Health Foundation argues – citing Palmer et. al (2003) and O’Shea, E. and Kennelly, B. (2008) – that, “across the UK, both men and women in the poorest fifth of the population were twice as likely to be at risk of developing mental health problems as those on average incomes.” [17] [18] [19]

Higher poverty rates amongst black and brown communities in the UK, coupled with a general lack of support for mental health issues in poorer areas, is therefore another factor in why some ethnic minority groups are more susceptible to mental illness.

So, what next?

There is a growing sense of mistrust between British public bodies and ethnic minority groups, amid many of the conversations we have had over the last year. However, the Government, the police and the education system need to ensure that black and brown people are not left out of the conversation on mental health.

There must be early intervention and support available for everyone, regardless of their race – but more support must be implemented in the places where there currently appears to be less of it.

Charities and support groups must also step up and ensure that they treat mentally ill people of colour the same way they treat mentally ill white people – and see them as victims who need support, and not as threats who need to be feared or controlled.

Black and brown faith and community groups must also learn to avoid judging people in their communities and to let go of the hyper-masculine view of mental illness which they are often guilty of holding. Black and brown people must know that it is okay to experience mental health problems, that there are ways out and that their community is here to uplift them, and not to hold them down.

In a society where people of colour are already disenfranchised, honest conversations and unity can go a long way.

Yusef Alam is a 23-year-old journalist and writer from Leeds. He is a sociology graduate and has a particular interest in race, racism and identity. He is British-Pakistani and often cites his own personal experiences as inspiration for his work, hoping to break a few stereotypes in the process.

 

 

References / links:

[1] ‘Why is Covid Killing People of Colour?’, BBC One (2021) – https://www.bbc.co.uk/programmes/m000sv1d

[2] ‘Existing inequalities have made mental health of BAME groups worse during pandemic, says Mind’, Mind (2020) – https://www.mind.org.uk/news-campaigns/news/existing-inequalities-have-made-mental-health-of-bame-groups-worse-during-pandemic-says-mind/

[3] ‘Being Black, Going Crazy?’, BBC Three (2016) – https://www.bbc.co.uk/mediacentre/proginfo/2016/39/being-black-going-crazy

[4] Bignall, T., Jeraj, S., Helsby, E. and Butt, J., (2019) ‘Racial disparities in mental health: Literature and evidence review’, Racial Equality Foundation, VCSE Health and Wellbeing Alliance - https://raceequalityfoundation.org.uk/wp-content/uploads/2020/03/mental-health-report-v5-2.pdf

[5] Bowcott, O. and Jones, S (2008) ‘Johnson’s Piccanninnies Apology’, The Guardian – https://www.theguardian.com/politics/2008/jan/23/london.race

[6] ‘Boris Johnson faces criticism over burka 'letter box' jibe’, BBC News (2018) – https://www.bbc.co.uk/news/uk-politics-45083275

[7] McLeod, Dr. S (2019), ‘Social Identity Theory’, Simply Psychology – https://www.simplypsychology.org/social-identity-theory.html

[8] Rubin, M and Hewstone, M (1998). Social Identity Theory's Self-Esteem Hypothesis: A Review and Some Suggestions for Clarification - https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.863.6885&rep=rep1&type=pdf

[9] Holligan, C, McLean, R, (2019) A Durkheimian Theorization of Scottish Suicide Rates, 2011–2017, Social Sciences - https://onlinelibrary.wiley.com/doi/abs/10.1111/issj.12111

[10] Elgot, J (2015), Woman arrested over racist abuse on London bus, The Guardian – https://www.theguardian.com/uk-news/2015/oct/17/woman-arrested-over-racist-abuse-on-london-bus

[11] ‘Black, Asian and Minority Ethnic (BAME) Communities’, Mental Health Foundation – https://www.mentalhealth.org.uk/a-to-z/b/black-asian-and-minority-ethnic-bame-communities

[12] Ciftci, A., Jones, N. and Corrigan, P., (2012). Mental Health Stigma in the Muslim Community. Journal of Muslim Mental Health, 7(1). – http://felton.org/wp-content/uploads/2016/10/Ciftci-Jones-2013.pdf

[13] Abu-Ras, W., Gheith, A., & Cournos, F. (2008). The imam’s role in mental health promotion: A study at 22 mosques in New York City’s Muslim Community. Journal of Muslim Mental Health, 3, 155-176. http://dx.doi.org/10.1080/15564900802487576

[14] Rassool, G. H. (2000). The crescent and Islam: Healing, nursing, and the spiritual dimension: Some considerations towards an understanding of the Islamic perspectives on caring. Journal of Advanced Nursing, 32, 1476-1484.

[15] ‘Discrimination in Mental Health Services’, Mind – https://www.mind.org.uk/news-campaigns/legal-news/legal-newsletter-june-2019/discrimination-in-mental-health-services/

[16] English indices of deprivation 2019. Gov.uk – https://www.gov.uk/government/statistics/english-indices-of-deprivation-2019

[17] Elliott, I. (2016) Poverty and Mental Health: A review to inform the Joseph Rowntree Foundation’s Anti-Poverty Strategy. London: Mental Health Foundation – https://www.mentalhealth.org.uk/sites/default/files/Poverty%20and%20Mental%20Health.pdf

[18] Palmer, S., Tubbs, I. and Whybrow, W. (2003). Health coaching to facilitate the promotion of healthy behaviour and achievement of health-related goals. International Journal of Health Promotion and Education

[19] O’Shea, E. and Kennelly, B. (2008) The Economics of Mental Health Care in Ireland. Dublin: Mental Health Commission. p. 16