The Problem With Mental Health Support For Women Of Colour

Photographed by Flora Maclean.
The mental health crisis in the UK has reached tipping point. Those of you who’ve tried to get help through the NHS recently will be aware that waiting times for therapy are lengthy. Add in the ever increasing stats about how many young people are being affected and it's tough to remain optimistic.
Studies show that people of colour in the UK are disproportionately likely to be affected. Black women, for instance, experience substantially higher rates of mental health issues than white women and black people are four times as likely to be detained under the Mental Health Act. More often than not, racism is a huge contributor. The Royal College of Psychiatrists says that racism and racial discrimination will "have a significant, negative impact on a person’s life chances and mental health." They are particularly concerned about the disproportionate impact on people from "black, Asian and minority ethnic communities."
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Despite this, white British people are twice as likely to seek treatment for mental health issues as people from BAME communities. This is for a great number of reasons, one of which may be cultural stigma. British south Asians who participated in a Time To Change study focusing on Harrow agreed that their mental health diagnosis was something to be "kept private and not openly discussed, even with their immediate family." Similar issues of repression and stigma have been reported in east Asian communities
Regina Zheng and Calah Singleton are best friends who both experienced struggles with mental health and decided that enough was enough. As women of colour, neither found what they needed in traditional messaging or the solutions being offered. And so together they decided to start Mendü, a social enterprise working to expand mental healthcare and change the approach for women of colour. As Regina says, products and services that encourage you to "'feel well' and 'take care of yourself' are not usually made for people who look like us. But we're done settling." Here, Regina and Calah explain what needs to be done and how they're working to change things.
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"We were best friends for years before we started working on Mendü. We’ve both had our struggles with mental health in various aspects of our lives – directly and indirectly. I had lost my mother to suicide following long-term mental health issues and Calah was struggling in graduate school due to mental health problems which were precipitated by being in an environment which did not recognise the challenges of being a woman of colour. After years of super deep conversations (often over wine and cheese) we started wondering: where are the wellness messages that are targeted to women who look like us? Everyone has their own struggles and mental health journeys are all different but we weren’t finding anything that really spoke to the distinct issues we were having to grapple with in our day to day. We wanted something that would speak directly to us. And that didn’t exist…yet. We overcame [our mental health problems] by supporting each other, by having a tribe that had our back. Mendü was born because mainstream mental wellbeing services are not made for people of colour. 
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Mendü is not revolutionary beyond the fact that we address the topics specific to people of colour that other people cannot be bothered to include. These include (but are not limited to) racism, microaggressions and culture. We are particularly focused on racial microaggressions: the everyday slights, insults, putdowns, invalidation and [other experiences] that well intentioned individuals may be unaware of. Evidence suggests that racism and discrimination lead to worse health outcomes for people of colour. Researchers at Columbia University ​have found​ that the experience of racism can result in traumatic stress. This stress is linked to negative mental health outcomes, such as depression, anger, physical reactions, avoidance, intrusion, hypervigilance and low self-esteem.
Older research shows that people of colour living in more affluent and predominantly white neighbourhoods were more likely to develop certain kinds of mental distress compared to their peers. This was a bit of a surprise because it was different from what was observed in the general population. It was then discovered that this was a result of the racism they endured. People of colour living in poorer and more multicultural neighbourhoods endured less racism and were therefore better off in this respect.

In our focus groups, a lot of the women said the very words 'mental health' made the hair on the back of their necks stand up.

Regina
Recently, the conversation has shifted a bit. While blatant racism is perhaps becoming less common, people of colour often experience microaggressions on a daily basis. Microaggressions are usually more subtle remarks that send powerful messages around power dynamics, values and inequality but which seem small and insignificant if it were only a one-off experience. Over time however, research shows that it has significant impact. As a result, it is often described as 'death by a thousand cuts'.
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A couple of examples might include a teacher saying to a second-generation Asian student: 'Your English is so good!' There is an underlying message here that may read along the lines of: 'People of colour do not speak English well, they are perhaps less qualified. You are a perpetual alien in your own country. You are not a true European.' Or a man says to a woman of colour: 'Wow, you’re so beautiful for a dark skinned girl!' There is an underlying message here that implies: 'It is unusual for a woman with dark skin to be attractive.' Research​ on microaggressions provides evidence that it leads to elevated levels of depression and trauma among minorities. In a sample of 405 students at an undergraduate university, depressive symptoms were the link in ​the relationship​ between racial microaggressions and thoughts of suicide.
There’s a lot of stigma in BAME communities around mental health and illness. In our focus groups, a lot of the women said the very words 'mental health' made the hair on the back of their necks stand up. Sometimes it’s not even an issue of not feeling comfortable or safe seeking help, it’s an issue of not even allowing oneself to entertain the notion of having mental health issues. Until recently, the language around being depressed or having anxiety wasn’t even mainstream; it’s hard to know exactly what is happening with your mind if you don’t have the language to articulate it, and [even more so] if no one around you is talking about it.
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Obstacles preventing women of colour from getting mental health treatment, [as well as] the aforementioned lack of understanding or community stigma, include the fact that a lot of the medical establishment is very white. If you’re feeling unwell, it’s sometimes a struggle to even get out of bed, much less go to the GP and and wait to get referred so you can tell a stranger (probably a white person) your entire life… You don’t feel like that person is completely understanding what you’re going through on a cultural level. It could even make your situation worse.
There’s also the issue of time. And money. You have to have some free time during the week to get an appointment through the NHS and a lot of people don’t have that time. And if you don’t have that time, you’re going to have to shell out 60-80 quid or more and that’s not really feasible for a lot of people (whatever their ethnicity) in London and elsewhere.
Lastly, as far as preventative measures such as self-care is concerned, there are few options that address the causes of stress that are specific to us. Sure, we can feel distress from things like heartbreak, heavy workloads and grief, just like everyone else. But on top of that, we also experience an intricate web of difficult experiences related to race and culture that builds over time. So we end up in a bit of a situation where the preventative measures are not for us and neither are the main solutions.
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It’s important that people realise that these obstacles may differ between different communities; there’s so much diversity within 'diversity'. We don’t feel comfortable giving specific examples within our communities and generalising is a dangerous game but [many of] these obstacles have a lot to do with family interaction, religion of all kinds and expectations from the family at large. If you’re living at home and your parents don’t want you to see a mental health specialist, you don’t have a lot of options.

Right now, we often settle as women of colour. We accept and anticipate feeling less 'well' in any given space.

Regina
[As for Mendü], we were recently selected to take part in the Red Bull Amaphiko Academy which offers workshops and lectures for inspiration, business support and growth. It was a game changer. Right now, we have monthly events and an early draft of what our online tools will look like. Short term, we want to amp up the number of events that we have and refine our online tools. Long term, we want our tools to be available to every woman of colour, and we want to have a community that understands her and can support her on that journey. We want to be a part of helping her create spaces that communicate in more culturally aware ways by helping her educate her peers. And if it turns out that a space can simply not be changed, we want to help her find another place, such as a school or a workplace where she can feel well.
Right now, we often settle as women of colour. We accept and anticipate feeling less 'well' in any given space. We expect [to face] microaggressions, which has been proven to take a mental and emotional toll over time. When that coworker makes small racially charged comments which get our hearts racing, we let it go because it’s important to get along with others in the workplace and we depend on that job. And we’ve heard worse stories, so at least it’s not THAT bad. When HR tells us that we have to use hair straighteners to move up the corporate ladder, we accept it despite how toxic it is and how emotionally difficult it is to hear that our natural hair is not good enough. When it’s suggested that we don’t belong in a meeting, that might get our heart racing and make us uncomfortable in that space, but we often just settle for that feeling.
Our goal is to empower our users to change their environments in impactful ways. In our journey, users should be able to decompress from difficult situations as opposed to just settle for feeling less good. They should be able to analyse what is happening and strategise how to move forward as opposed to settling for feeling unsure about what to do. They should be able to have frameworks that help them communicate what is difficult in their environments in impactful ways, rather than just living with the uncomfortable emotions. Our vision is that women of colour should have the tools and community to make changes in their environments in meaningful ways, to create culturally aware spaces so that they feel equally well in any given space." 
Regina Zheng was a successful applicant of the UK’s first Red Bull Amaphiko Academy. Red Bull Amaphiko supports social entrepreneurs who are making a difference in their community. For more information visit their website.
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