Article first appeared on Intent Health's website.
Several years ago, my International Relations degree included a year abroad at the National University of Singapore. I was on a rooftop bar overlooking the iconic Marina Bay and its stunning accompanying views. Amongst the shining lights and the distant thud of music, a group of friends and I were enjoying some exquisite yet overpriced cocktails. Basking in the delight of my surroundings, I had never encountered such a kind, funny, and inspirational group of people from such varied places. From Australia, to Germany, to Britain, China and Brazil; I hadn't seen four continents represented so nonchalantly. Juxtaposed with my surroundings I felt like the luckiest man alive. However, as the euphoria dissipated a haunting dread overcame me, a feeling so overwhelming that eye-contact became impossible. The bliss of my surroundings became inconsequential as I retreated into the depths of my subconscious, consumed by fear, sadness and insecurity.
For me, talking about mental health is like describing a colour that doesn’t exist. The variety of symptoms makes it incredibly difficult to diagnose, understand and ultimately treat. Although it’s not all things to all people, the malignant, debilitating nature of mental illness continues to cripple countless individuals worldwide.
By all accounts I have led a charmed existence filled with privilege and opportunities. However, growing up South-Asian in an all-white English town, the only choice was to assimilate. I excelled at this, joining a variety of sports and music clubs with an ingrained necessity to be liked, accepted and tolerable. The result was a dissolution of my heritage at the expense of fitting in; an all too familiar tale for people of colour. The fact I am called Adam was in-part about finding a western sounding Asian name to reduce discrimination.
Stuck between a rock and a hard place you can feel culturally homeless, like an incomplete jigsaw puzzle. For me, the dysphoria of being half Indian, half Bengali, wholly British yet unilingual brought me to this juncture. For most of my life I have felt Asian amongst Brits and British amongst Asians, never truly fitting anywhere. I caveat this with the progress we have made around racial discrimination. Multicultural Britain has enabled me to lead a rich, vital and fulfilling life whilst being brown which is not something I take lightly. I am proud to be British and it’s from a place of patriotism I believe we can do better.
In 2021 there is a broad consensus mental health is an issue, but how does ethnicity fit into all this? After all, a recent report claimed institutional racism is a myth so things can’t be that bad right? With a subsequent BMJ article criticising these findings there is clearly a debate to be had.
A look at the facts
● Studies show Black, Asian and other ethnic minorities reported a 14% deterioration in their mental health from April 2017 to April 2020; for whites it was 6.5%
● The numbers are even more harrowing when you look deeper. A study from Mind shows that for every white person with schizophrenia, there are nearly three Asian and five Black people
● Covid-19 has exacerbated these issues. The death rate amongst people of colour in English hospitals has been 2.5 times higher than their white counterparts.
With these distressing figures now commonplace, it’s no wonder more people of colour are overcome by the spectre of mental illness. Whether it’s anxiety around contracting a virus to which they are more susceptible, or the higher risk of death after a Covid-19 diagnosis, or the trauma of seeing friends and loved ones fall ill and never recover; communities of colour have been subjected to disproportionate levels of psychological stress. Add debates like those around Black Lives Matter and the tragic Atlanta shootings into the mix and it’s understandable why people feel overwhelmed. At Intent Health our team is 60% minority ethnic and these conversations have become increasingly more frequent amongst colleagues.
My intention is not to demean the plight of white men and women, but to highlight the grim, visceral reality people of colour face. The uncertainty of a global pandemic combined with a relentless 24 hour news cycle, exposes us to a constant stream of fatiguing content that fuels mental ill-health. In an age of social media and instant information, we are in a constant state of hyper-vigilance surrounding both our own and other people’s trauma. It’s exhausting!
The limits of conventional rhetoric
People of colour often encounter a conservative stoicism when trying to flag mental health difficulties. Older family members were often denied or unaware of psychological support. This can lead to mental health struggles being deligtimised within many communities. Looking slightly deeper, it’s clear why. In a world where refrains like "no dogs, no blacks, no Irish” were commonplace, many people had other priorities. This is a generation shaped by the rhetoric of Enoch Powell’s Rivers of Blood Speech. Growing up I heard countless anecdotes from friends and family of people being spat at, kicked in the street and having feces put through their letter boxes for simply having too much melanin. The fact this version of Britain has all-but disappeared is the progress I mentioned earlier.
The conditions my grandparents and many others faced are inconceivable by modern British standards. To travel halfway across the world to start a new life must be difficult at the best of times. Especially when fleeing war, persecution or political turmoil (I can only assume on both counts). To then build such a vibrant, rich and fulfilling life in the face of such sustained and relentless hostility takes monumental amounts of resilience and courage. As a third generation immigrant I have grown up in a country significantly kinder, more compassionate and prosperous the one my grandparents found. I will always appreciate the sacrifices this pioneering generation made; leaving friends, family and familiarity behind to build a better future for themselves and their families.
However, when survival is the extent of your community's ambition, mental health will never be taken seriously.
A look to the future: compassion and the power of lived experience
My short time in healthcare communications has shown me the industry is far from immune to issues of race and mental health. Statements like ‘it’s okay not to be okay’ are key focal points for industry activity. Although well-meaning platitudes are sufficient for some, they are unable to meaningfully impact the conversation when race is added into the mix. So where do we go from here? That simple yet daunting question is a difficult square to circle. In a world where Black men are the most likely to be sectioned under the mental health act but the least likely to be offered counselling, the status quo cannot continue.
At Intent Health I have seen the power communications can have when lived experience is considered and diversity celebrated. Messaging based on relevant personal stories are able to amplify the voices of the traditionally voiceless to help facilitate positive change. One project we are working on is around improving care in Sickle Cell Disease. The insights provided by team members with lived experience not only impressed the client but greatly enriched the quality of our work. Life doesn’t take place in a vacuum and communications that ignore the value of lived experience are destined to fail.
I’m confident that through authentic storytelling we can continue to engage with marginalised communities in a way that can provide positive change. Progress is never linear nor easy; but I think the pursuit of a kinder more compassionate world is a worthwhile pursuit. As we take the scenic route towards a better future I’ll do my best to enjoy the view.