British Asians with mental illnesses are being failed: we all must do more to overcome stigma and redress inequalities
Mental illness is a growing challenge. One in four of us in the UK will suffer with a diagnosable mental illness. Like any community in Britain, Asians are not immune from mental health difficulties, but sadly individuals of South Asian origin suffering with mental illness are often invisible – not just in terms of failing to receive help, treatment or support from mainstream services, but even within our own communities.
The data available on British Asian communities is inconsistent and there are huge research gaps. Monitoring of mental health issues affecting British Asians remains poor. The vast national, regional, cultural, religious, linguistic and political differences between different Asian communities are often overlooked and homogenised in studies, under the catch-all term ‘Asian.’ As a result, many studies of mental health in South Asian communities are contradictory and inconclusive. Therefore more careful research and better monitoring of ethnic mental health issues are necessary.
In my experience there is no shortage of British Asians dealing with poor mental health. Rather than being overdiagnosed, ethnic South Asians with mental health difficulties are ignored and underdiagnosed. For example, young South Asian women have high rates of suicide – in 2008, the BBC reported that twice as many Asian women killed themselves compared to the rest of the population.
But herein lies the puzzle. Some earlier studies showed low rates of depression amongst young South Asian women and girls, compared to the rest of the population. How to explain this paradox?
Poverty and discrimination are more commonly experienced by BAME groups than the rest of the population, in particular individuals of Pakistani or Bangladeshi origin. High rates of unemployment, low socioeconomic status, and insecure and overcrowded housing heightens their vulnerability to poor mental health. For young South Asian women, the vulnerability can be even worse due to the double-whammy of being part of a disadvantaged group, while facing discrimination based on both their gender and ethnicity.
Certainly, a lack of awareness on mental health problems within some Asian communities plays a role. But over the years whilst working with Asian groups, I have repeatedly encountered a sense of marginalisation. Studies show that many BAME service users and their carers are dissatisfied with mainstream mental health services which they often perceive as misunderstanding them. They are also less likely to be offered a talking therapy as opposed to drug based therapy alone.
The myth that the genesis of a British Asian girl’s problems is located primarily within her culture and faith must be jettisoned. In reality, Asian girls often find it frustrating to hear professionals tell them that if they ‘left their culture behind, and lived their lives freely (as we do in the West)’ then they would be fine, with no thought for the confusing impact this advice could have on their identity and self-esteem. Of course, in the many cases where young girls are forced to do things they do not wish to, such as stay at home rather than go to university, these experiences adversely impact their mental health. But practitioners should treat each case on an individual basis, supporting the patient’s wishes, and wherever appropriate working with the family to overcome their issues.
But this requires policymakers and service providers to understand the cultural and social circumstances of Asian communities, and their reluctance to seek help. Many services struggle to meet the needs of their local Asian communities despite their high density.
In 2008, Antony Sheehan, chief executive of Leicestershire NHS Trust, said that government attempts to improve mental health services for the South Asian community had simply not worked: “We really should acknowledge the impact of institutional racism in mental health and wider health and social care services, in the same way it is recognised in the criminal justice system. The real issue is just how we’ve chosen not to connect with these communities.”
This is not to downplay the potentially negative impact of culture. Rather than visiting the GP, Asians suffering with emotional or psychological distress may rather visit the temple, mosque or gurudwara, seeking a spiritual or community-based solutions to their distress. Added to this is the stigma that surrounds mental health issues within our Asian communities.
One project worker based in Leicester, Harjit Sandhu, says that stigma is deadly. It can stop Asian people from going to see their GP for fear of being talked about. In one case parents stopped their 18 year old daughter with bipolar disorder from receiving specialist treatment because they felt “she had no mental illness” and labelling her with one would prevent her from getting married. Stigma can lead to self harm (which South Asian girls have the highest rates of compared to other minorities), isolation, and in worst cases suicide.
Mental health problems in British Asian communities are a challenge we must deal with collectively – both in terms of mainstream services and attitudes inside communities. If we allow our feelings of shame and denial to stop ourselves or those around us from seeking help, we risk failing young Asian people and creating a situation in which in twenty years time, Asians will be nearly 18 times more likely to end up hospitalised for a mental health disorder.
Mental health services need to ensure that the recommendations made by the Department of Health in its 2005 action plan ‘Delivering Race Equality’ are actually delivered. It’s widely recognised failure underscores the need for a deeper official inquiry into the state of our mental health services. Ultimately, better services require a different approach: engaging with communities effectively, in a way that is culturally and faith sensitive; providing better information to both communities and health professionals; better monitoring of ethnicity; and finally more research to understand the complex mutifacted factors affecting the mental health of Asians within the UK.
I wrote this piece in April for the Asians UK magazine.