Hard to Reach Communities or Hard to Reach Services?

By Maninder Sangar

adult dark depressed face


Statistics suggest that there is an underutilisation of mental health services by Black, Asian and minority ethnic (BAME) people. As a consequence, people from minority ethnic groups are commonly constructed as being ‘hard to reach’ when it comes to accessing mental health services. This is despite the assertion that BAME groups have ‘higher rates’ of mental illness.

It is interesting to consider why this is. Is it because these groups inherently have more ‘risk factors’ for mental health problems? For me, this suggestion is deeply problematic as it is based upon the assumption that there are biological differences between people from different ‘races’. It is an essentialist, racist notion which presumes that some ethnic groups are more susceptible due to defective genes or a defective culture.

Constructions of mental health problems differ amongst communities and individuals as how we understand mental health is socially constructed. If we believe that the concept of mental distress is socially and culturally dependent then religion, culture, gender, and socio-economic factors cannot be ignored when considering help-seeking for mental health problems.

A further explanation may be that individuals from some communities are not seeking help and reach crisis point. This may happen in some communities where there can be a lack of awareness or knowledge, as well as stigma and shame attached to experiencing poor mental health.

An alternative explanation may be the level of cultural competence of mental health services in the UK. The ’identification’ and ‘diagnosis’ of problems is promoted in current practice through the medicalisation of mental distress. Hence alternative discourses around mental health may be dismissed placing particular groups at a disadvantage. This is linked with the ethnocentric nature of medical and psychological research within the domain of mental health. This is problematic for a number of reasons; firstly it ignores the social, economic, cultural backgrounds of individuals and considers groups to be homogenous. Secondly, the view of ‘normal’ functioning is based upon western notions of well-being constructed by those with the authority to decide what is ‘normal’.

So, in practice, people who view mental distress as a chemical imbalance may seek medical assistance, while people from particular cultures may construct problems with ‘mental health’ as arising from a supernatural cause or as an indication of a spiritual imbalance . With these varying constructions of mental health come a range of potential strategies to resolve distress incorporating spiritual and religious practices.

Thus discourses of mental health have implications for the ways in which particular communities are constructed and therefore the ways in which they are supported. It is vital that these discourses are deconstructed to enable multiple, complex and nuanced constructions to surface and for negative stereotypes to be challenged. Only then will we understand the mental health experiences of black and ethnic minority groups and provide more culturally fair services.

Maninder graduated from the initial training course in educational psychology at the University of Birmingham in 2018 and now works in a local authority.

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