Mental health, intersectionality and the need for more diverse representation

The weekend before last, I went to a DIY Cultures talk in Rich Mix called “Radical Mental Health: Fanon, Laing, Decolonising, Demedicalising”. The speakers discussed the work of the intellectual and revolutionary Frantz Fanon, alongside that of the progressive 20th century psychiatrist R. D. Laing, in the context of mental health.

I was particularly moved by the final speaker, Guilaine Kinouani, who told the story of a service user who was instutionalised, effectively as a result of his psychiatrist refusing to understand that mental health can be constructed in alternative ways in different cultures. Guilaine was keen to emphasise the importance of integrating indigenous cultural understandings of mental health into Western psychiatric practice. Indeed, she supported this by referring to the World Health Organization (WHO) studies which suggested that mental health outcomes (specifically, among those experiencing symptoms related to ‘schizophrenia’ and/or psychosis) are better in the Global South than the Global North. So, her argument went, by introducing alternative ways of thinking into Western psychiatry, outcomes might improve for those experiencing mental health issues. This could especially be the case for those from a black and minority ethnic (BME) background, who are over-represented in psychiatric hospitals.

A story…

This got me thinking about a similar story that a junior doctor friend of mine told me about his time on a psychiatric ward in East London. The in-patients on the ward were largely black men from the surrounding borough. One of the men often referred to himself as ‘king’ of the ward. My friend, who is also a black man, was aware that other men on the ward were scared of the ‘king’ – he recognised that perhaps this man had some kind of street credibility and reputation outside of the ward. Unfortunately, the older white male psychiatrist recognised the ‘king’ as experiencing ‘delusions of grandeur’, which led to him being detained for longer. Ultimately, this was a misdiagnosis and it would not have led to any significant improvement in the man’s mental health.

For me, this highlights the importance of intersectional understandings in our approach to mental health (which was also discussed at the DIY Cultures event). My friend does have a level of privilege, however he grew up in a neglected area of South London alongside family and friends with a lower socio-economic status (SES). On the other hand, the psychiatrist was a middle-class man from Dulwich.

What next?

So, this is not just about understanding how mental health symptoms might be experienced differently by black men, but also understanding the wider systemic issues that black men with a lower SES might experience and how these issues might manifest themselves on a psychiatric ward (or lead to more black men with a lower SES being referred to psychiatric wards in the first place).

Are we any closer then to a system that is better equipped to assist diverse groups? In psychology, at least, it would appear not. Although they do not record SES, the latest figures for trainee clinical psychologist applicants show that 13% of applicants were from a BME background and that 7% of BME applicants were ultimately successful. Considering that over 11% of the UK population are from a BME background, we may have a while to wait yet…

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