There have been massive strides in recent years as to how mental health is viewed within society. People from across the social spectrum appear to be far more willing to publicly discuss their mental ill health, something previously considered best kept ‘behind closed doors’. However, despite such societal developments, the subject of mental health remains a taboo within many communities in the UK.
The BAME communities are rich in their diversity and, according to the 2011 Census, make up 14% of the population or one in every 7 people in the country. Although there is growing data on aspects of their physical health, research studies that explore the mental health of BAME groups are still few and far between. In the absence of such research, it is quite easy for the specific needs of BAME communities to be overlooked and, in some circumstances, for the idea of mental poor health within that community to be simply dismissed as a fallacy.
The British Sikh Report 2018 has focussed on mental health amongst Sikhs, and its findings included that twice as many women (10%) have been diagnosed with mental health conditions compared to men (5%), whilst about 1 in 10 Sikhs feel that their mental health impacts on their daily activities and lifestyle. When asked about the main causes of stress, work figured highly in the responses (35% said it was a major cause of stress and 39% described it as a minor cause), followed very closely by family responsibilities (with 27% describing it as a major cause of stress and 42% saying it was a minor cause).
For many within BAME communities, their first encounter with any form of mental health resources is when they find themselves being sectioned under the Mental Health Act 1983.
This is due to a lack of engagement with mainstream healthcare services in the UK resulting from notions of stigma and shame, and its taboo nature.
In most South Asian communities, mental health is viewed through the lens of culture and religion instead of science and evidence-based treatments. It is considered something to be ashamed of, a sign of weakness, and an issue never to be spoken about in public. This is due to the notions of honour (izzat) and shame (sharam), concepts which have great influence within all of those communities, including amongst Sikhs, and prevents BAME communities from engaging with mainstream health care services on this issue.
Causes of mental ill health vary from community to community, and it is important to acknowledge that they may have their root causes in religious or cultural expectations. For example, for South Asian women the pressure to conform to expectations and the existence of socially determined gender norms such as restrictions on liberty, along with the notions of izzat and sharam, can put them at a much higher risk of suffering mental ill health. The pressure of balancing work commitments with family responsibilities, as well as the expectations of getting married young and having children, can have a detrimental impact on women’s mental health.
Healthcare professionals and policy makers require cultural competency if they are to improve the uptake of mental health services amongst BAME individuals. The current ‘one size fits all’ approach taken by the vast majority of service providers fails to sufficiently address the specific needs of BAME communities, and that absence of understanding makes it more difficult to ensure that there is appropriate engagement from BAME men and women as service users.
It is vital to have frank discussions and for sustainable partnerships to be fostered and developed to ensure that the treatments and resources for mental ill health meet the needs of all communities in contemporary British society.