Racism and mental health

Race is a label that groups people together based on similar physical traits, such as skin colour. Racial labels, like Black, were developed to wrongly define some of us as biologically different to others. This was a way of justifying violence and oppression. For example, the British Empire developed the idea of a racial hierarchy, with White people at the top, to justify colonialism and slavery.

But despite these roots, we may now feel that race describes an important part of our identity. We may connect and have a sense of solidarity with people who share our experiences of race and racism.

Race also has a definition in the law. The Equality Act defines race as including our:

• Colour
• Nationality
• Ethnic or national origins

Ethnicity usually refers to a group of people who share a long-standing cultural, national or language identity. Race and ethnicity are different. But they are both included in definitions of racism.

Interpersonal racism is when a person treats you poorly or unfairly because of your race. This might be colleagues, classmates, strangers, service staff, and even family members or friends. It can happen in person or online.

Sometimes it's very obvious, with a clear intention to harm or offend. This is often called overt racism. It can include:

• Being physically attacked or threatened
• Being verbally abused, or called racially offensive names
• Being bullied or excluded

But often racist comments or actions are more subtle, and may not be intended to cause harm. This is often called covert racism or microaggressions.

Covert racism can come from unconscious bias. This is when someone unknowingly accepts racial stereotypes, and this influences their behaviour.

But the lack of bad intention doesn't make experiencing this any easier to cope with.

Covert racism can be much harder to identify and challenge than overt racism. Especially when other people deny it, downplay it or become defensive about it. Or if you have an ongoing relationship with the other person.

You might find you're dealing with this often – even every day. And over time this stress can build up and affect your mental health.

Institutional racism is when an organisation treats us poorly or unfairly because of our race. This can be intentional or unintentional. Many organisations don't realise how their policies and practices disadvantage people.

But it is still racism, and it affects many aspects of our lives.

For example, it shows up in:

• Education. Teachers aren't always supported to discuss diversity or Britain's colonial history in classrooms. Contributions from people from Black, Asian and other marginalised backgrounds aren't equally covered. School exclusion rates are also higher for students from Black Caribbean backgrounds than White students. Read Mind's Not Making The Grade report to find out more.
• Criminal justice. Police are more likely to stop and search Black people than White people. Courts are also more likely to give Black people prison sentences for drug offences than White people.
• Healthcare. There are significantly higher rates of infant and maternal mortality in Black and Asian communities. There are also examples of racism within the mental healthcare system.

A system is something that is made up of lots of different connected parts. So systemic (or structural) racism describes how experiences of racism in many areas of life reinforce and fuel each other over time.

At system level we can see the wider impact of the inequalities and power imbalances, for example those set up by colonialism. We see how these are maintained now in policy, law, economics, culture and wider society. And how this creates White privilege.

How systemic racism can affect individuals

For example – experiencing institutional racism at school as a child might make it more difficult to find work as an adult. Bias in hiring processes can make this even harder.

Then at work, institutional and interpersonal racism can be a barrier to promotion. These barriers can affect your income.

Not having enough money can have a negative effect on your health. This also contributes to people with first-hand experience of racism being under-represented in management jobs. Which makes it less likely that services will meet people's needs.

Health problems can then further affect work and income. Work, study, money, housing and physical health are all connected to our mental health. This creates a vicious circle of disadvantage.

Systemic racism and the pandemic

The coronavirus pandemic has highlighted the impact of systemic racism. Black and Asian people have been more likely to die from coronavirus.

Reasons for this include:

• Employment inequality. Working in frontline jobs makes exposure to coronavirus more likely.
• Income inequality. Having a lower income makes it more difficult to take time off work to isolate.
• Housing inequality. Living in more crowded accommodation makes it more difficult to isolate.

Microaggressions are the most common form of covert, interpersonal racism. They can be very subtle.

They can include things like:

• Implying that you don't belong, such as questions about where you're 'really' from
• Making assumptions about you because of your race, like that English isn't your first language
• Making assumptions about your heritage based on your skin colour
• Making negative statements about people who are the same race as you, while saying 'but you're an exception'

Often microaggressions aren't intended to cause harm or offence. But that doesn't make this kind of racism any less painful to experience. The term 'micro' doesn't mean the impact on you is small.

It is still racism, and its impact can build up over time.

'Racial gaslighting' describes the way that some people or organisations deny or downplay the existence of racism. This discounts and undermines the reality of people's lived experiences of racism.

It might include comments like:

• 'You're being too sensitive' or 'you can't take a joke'
• 'You think everything is racism'
• 'I don't see colour'
• 'I can't be racist because....'

It could also include wider institutional denials of racism. Often despite all the evidence of inequalities between racial groups.

Institutional and systemic racism are hard to see from looking at isolated incidents. And microaggressions are often unintentional. Some people may not understand that this is all racism.

But having your experiences denied or downplayed by others is harmful. It can make racism even more difficult to challenge. And it can make it harder to cope with.

Colourism

Colourism is when someone treats you differently based on how light or dark your skin shade is. It's sometimes also known as shadism.

We are all exposed to subtle messages in society and the media about lighter skin being preferable. This can make some of us feel like our skin shade is too dark, or like our hair or features don't meet society's 'ideal'.

Those of us who are Mixed race may find we experience colourism in conflicting ways. We may be treated as 'too dark' in some situations and 'too light' in others. This can lead to feeling doubly excluded.

Casteism

Casteism means prejudice or discrimination on the basis of caste. We may experience casteism within South Asian communities if we are born into a caste that is traditionally considered 'lower'.

Caste is different from race. But researchers sometimes consider casteism as part of race discrimination. This is because it can have similar effects on our lives. It can also often overlap with colourism.

Islamophobia

Islamophobia means prejudice and discrimination against Muslims, and people assumed to be Muslim. It disadvantages people because of their perceived race, culture and religion. This is a form of racism.

Islamophobia also often overlaps with other forms of racism - for example based on skin colour.

Antisemitism

Antisemitism means prejudice and discrimination against people from the Jewish community. It disadvantages people because of their ethnicity, culture and religion.

Antisemitism is different to other forms of racism, such as racism based on skin colour. But it is still a form of racism, and it can have similar effects on our lives.

A privilege is any perk or advantage which is granted to one person or group of people, but denied to others.

So 'White privilege' refers to the day-to-day advantages that come from being White (or assumed by others to be White) and thus not facing racism.

Some people feel that this term is not clear enough, because it only links privilege to skin colour. But this kind of privilege can also apply to other racialised traits – like names and accents. It can also exclude people who are seen as White in some spaces, yet who do face all forms of racism. Like people from the Jewish community, and Gypsy, Roma and Traveller communities.

At Mind we use this term to convey that people who do not face racism hold privilege.

White people may experience prejudice, discrimination, stigma and disadvantage for many other reasons. But not facing an extra layer of disadvantage on the basis of one's race is still a privilege.

Anti-racism is taking action to challenge racism and promote equality. It is more than not being racist – it is about working against racism.

Allyship (being an ally) is when someone takes action to support a marginalised group.

To be an ally, a White person should:

• Recognise their own privilege
• Educate themselves about racism
• Use their privilege to amplify marginalised voices
• Work with marginalised groups to challenge racism
• Speak up and actively challenge racism when they see or hear it

Decolonisation can mean many different things.

It can mean the historical end of colonial rule. But it can also mean challenging the cultural dominance of Western ideas over others. It can mean breaking down the lasting impact colonialism has had on society.

In mental health services, this can mean working to:

• Recognise the dominance of Western ideas about mental health, including diagnosis and treatment
• Highlight a variety of cultural ideas about mental health
• Increase diversity in the mental health workforce

The main routes to access therapy in the UK are:

• Your GP. For advice on preparing for a GP appointment, see our Find the Words guide.
• Self-referral. In some areas you can refer yourself to services directly. If you live in England you could use the psychological therapy service finder on the NHS website. Your GP might also give you details of self-referral services.
• Private therapists. Private therapy is an option some people choose to explore. For example, the Black, African and Asian Therapy Network’s online directory lists therapists you could contact. There are details of more therapy directories on our how to find a therapist page. But unfortunately private therapy isn't realistic for everyone because it can be expensive.
• Charities and local services. Some local services offer free or low-cost support. Hub of Hope lets you search for local services near you. You can also filter results using their 'BAME Support' tag. Mind's Infoline could also help you find appropriate local services.

Be aware that any therapy you're offered through the NHS will depend on:

• Your particular needs, and your diagnosis (if you have one)
• What's available near you

You might not be offered a choice, and waiting lists can be long.

If you're not able to see a therapist right away try our self-care tips while you're waiting.

There are many reasons why you might want to ask for certain people in your treatment – or avoid them.

For example:

• You may feel unsure about opening up to a GP from your community, who knows your family. Or who you've had bad experiences with in the past.
• If you've been abused, you may feel unsafe seeing anyone who is the same race or gender as your abuser.
• Or you might feel that only someone from a similar background to you will be able to help you.

You are allowed to ask NHS services for what you want. It's a good idea to tell them your needs as early as possible, when first booking your appointment.

If it's possible for the service to accommodate you, they should. But unfortunately it may not always be possible. In this case some of the organisations on our useful contacts page may be able to help you.

In the private sector you may have more choice in who you work with. But this isn't an option for many people because of the cost.

Culturally competent therapy is when your therapist:

• Understands the differences between race, ethnicity and culture
• Understands your cultural practices and values – but doesn't make assumptions
• Understands how racism can affect mental health
• Respects any cultural differences between you
• Sensitively reflects your culture and experiences in your treatment

For example, this might include them showing awareness of:

• How racism, colourism and casteism affect people of colour
• Common experiences that marginalised people go through in the UK – like the pressure to 'fit in'
• Common family dynamics and values in collectivist cultures (as opposed to individualist cultures)
• Key tenets of different faiths, and how beliefs may relate to emotional health - for example, for those us from Muslim backgrounds, the Islamic concept of jinn may be a factor in how we understand our experiences
• Expectations and pressure around who we should turn to for support, like elders and spiritual leaders
• The dates and traditions of important festivals

Cultural competence does not depend on your therapist's own race, culture or specialism.

And any type of therapy can be delivered in a culturally competent or culturally sensitive way.

But for services to improve, it's really important that:

• Therapists seek to educate themselves on how racism affects mental health
• Therapists get proper training to support clients from diverse backgrounds
• Mental health services hire and promote professionals from diverse backgrounds

Often when you're offered therapy, you might not be sure who your therapist will be. It can take time to develop trust and confidence in them.

Here are some questions to consider, to help you decide if you feel comfortable with them:

• Have they had any experience of supporting people with the effects of racism? You can ask them directly. A responsible therapist will answer your questions honestly and openly.
• Do they seem open to learning about racism, and your culture, without making assumptions? For example, do they acknowledge what they don't know?
• Do they take your experiences of racism seriously? For example, by being respectful and not downplaying or denying them.
• Do they seem aware of their own privileges or biases?
• Do they recognise how your experiences of racism may intersect with other parts of your identity? For example your gender, religion or sexuality.
• Do you feel able to be honest about your experiences of racism with them? For example, do they help you feel at ease?

Our page on how to find a therapist has a list of more things to ask when arranging an appointment with a therapist.

Unfortunately, not all therapists are confident talking about racism during therapy. This can happen even if they have had some cultural competence training.

This may make it harder to develop a good relationship with them. In some cases you may end up feeling more upset, stressed or isolated.

If your therapist's approach isn't suiting you, it might help to:

• Tell your therapist about any problems you're having with them. They might be keen to reflect, learn and do better.
• Show them our information about how racism can affect mental health. It's your therapist's own responsibility to educate themselves about racism. But they may welcome new information.
• Give it some time. It can take time to build trust. And some sessions may be more challenging than others.
• Stop seeing them, or ask to be referred to another therapist. This might feel like the right option if they're often making you feel unheard, or unsafe.

Our page on getting the most from therapy has more tips.

If you have a serious concern about any treatment you've received, you can make a complaint.

Speaking to someone who understands racism can be helpful. It may be that having someone listen to you and show they care can help in itself.

You may want to speak to someone you know. Or you might feel more comfortable speaking to someone you don't know.

• Our tips on talking to a friend or family member might help.
• Our useful contacts page has some ideas for organisations you could approach.

Try and take time to praise yourself and think about what you're proud of. For example, you could think about your character traits, skills or things you’ve done.

See our pages on self-esteem for more tips

You could spend time thinking about what makes you happy and what you value in life. For example, you could think about any activities you enjoy or people you like spending time with.

This may help you get to know yourself and challenge racist assumptions about who you are – and who you aren't.

You may also find it helpful to connect with people who share your racial identity, to enjoy and celebrate your culture.

Relaxation can help when you're feeling stressed, anxious or overwhelmed.

See our pages on relaxation for tips

Mindfulness is a technique you can learn. It involves making a special effort to notice what's happening in the present moment – without judging anything. It aims to help you feel calmer, manage your thoughts, and be kinder towards yourself.

It has roots in Buddhism and meditation, but you don't have to be spiritual, or have any particular beliefs, to try it.

See our pages on mindfulness for more information 

Getting creative can help you express thoughts and feelings that are weighing on your mind. You could use dancing, making music, painting, poetry, writing or any other creative activity.

See our page on arts and creative therapies

I think even if you're just putting it down on paper, you're having more of that self-awareness, you're having that little conversation and reflection with yourself. That might just make it a bit less heavy in your head. – Kai, member of our young Black men programme

Experiencing racism can affect our body as well as our mind. Physical health and mental health are connected, so looking after one can boost both.

Being active doesn't have to mean doing sports or going to the gym a lot – although that works well for some people. But there are plenty of things you could try on any budget – and at any level of fitness or ability.

See our pages on food and mood, physical activity and sleep problems for some ideas.

You may also find that spending time in nature helps improve your physical health and your mood.

Seeing news stories or social media content about racism might sometimes make you feel anxious or overwhelmed.

In this case, you could think about switching off or limiting what you look at for a while.

If a particular person on your social media is upsetting you, think about blocking them to give yourself space.

Remember: racist abuse or bullying online could be a hate crime. If you see racist abuse happen online:

• If the site or app is moderated, you could report the user to the site.
• You can report hate crimes to the police using the True Vision website.
• If you don't want to go to the police, you might be able to report it through Stop Hate UK.

... if I'm feeling unwell or something worries/upsets me, I turn off the laptop for the day. – Mind supporter

You may find that examining your experiences is helpful at some times, but not at others.

It can be good to spend a while sitting with your experiences. But it's also ok to try and take a break from thinking about them when this feels useful.

Try to treat yourself the way you would treat a friend. And give yourself space when you need it.

When compared to White British people, people from minoritised backgrounds are:

• More likely to experience a common mental health problem like anxiety or depression
• Less likely to receive mental health support for these problems

This might be because the mental health system fails to build our trust. If we expect to face inequality and racism in these services, we might choose not to approach them early on.
 
It can also be difficult to find culturally competent support.

This might be because:

• Services don't reflect a variety of cultural understandings of emotional and spiritual wellbeing.
• Most healthcare services in the UK take Euro-centric views on mental health, and often aren't designed to meet the needs of culturally diverse populations.
• Services don't recognise the impact of racism and systemic inequalities on mental health.
• Services don't support people with racial trauma.
• services don't hire a diverse professional workforce.

There is no biological evidence that Black people are more or less prone to certain mental health problems than other people.

Yet we still see inequality in who gets diagnosed with certain conditions.

For example, doctors are far more likely to diagnose Black people with schizophrenia than White people.

The possible reasons for this disparity may include:

• Differences in stressful life events which make mental health problems more likely - including experiences of racism and racial trauma.
• Differences in access to support early on, before problems become more severe.
• Unconscious bias and lack of cultural competence among doctors. Some doctors may interpret similar symptoms differently in Black patients and White patients. They may make assumptions based on racial stereotypes. This may lead them to diagnose some conditions more or less often in Black people. For example, there's also some evidence that White doctors may be less confident diagnosing depression in Black people.

For example, healthcare professionals are:

• Over 4 times more likely to section Black people than White people. Being sectioned under the Mental Health Act means that you can be kept in hospital against your will.
• Over 4 times more likely to restrain Black people in mental health hospital services (this includes learning disability and autism services).
• Over 10 times more likely to subject Black people to a Community Treatment Order (CTO). Under a CTO you must follow some rules after leaving hospital, or you will have to go back in.

There are many reasons for this, but one factor is racism.

There is a racist stereotype of Black men as being dangerous, or 'needing to be controlled'. This may bias the decisions professionals make about their Black patients.

Find out about Mind’s work to challenge the discriminatory use of the Mental Health Act.

Inequalities in access, diagnosis and treatment all contribute to worse mental health outcomes.

For example, compared to White British counterparts:

• People from a Black Caribbean background who have had psychosis are more likely to find their symptoms come back again, and sooner.
• People from a Bangladeshi background are less likely to feel better after trying talking therapy for anxiety or depression.

The service may not realise they aren't being inclusive. They may be able to reflect, learn and do better. If speaking to them informally doesn't get outcome you need, you can take things further.

It is illegal for UK healthcare providers to discriminate based on your race. If you think you've been discriminated against, you can make a complaint.

But we know that complaining might not always feel like a safe or effective option. If you're unsure, call Mind's Legal Line. We can help provide information about the laws related to mental health.

Advocacy means getting support from another person to help you express yourself, and stand up for your rights. Someone who helps you in this way is called your advocate.

See our pages on advocacy for details of advocacy organisations that may be able to help you.

Take a look at our useful contacts page to see if there are any other services who could support you.

For example, some local Minds offer tailored support for people from diverse backgrounds.

The Black, African and Asian Therapy Network lists some free and subsidised services that might be able to help.

You may find it rewarding to find ways to campaign against racism. It can feel helpful to have your say on how to make things better, and be heard.

Our useful contacts page lists campaigning organisations you could approach. You could also campaign with Mind for a fairer system.

If nothing is working, you may feel like you are becoming too stressed or exhausted to challenge injustice.

In this case, you might choose to focus on self-care and peer support for a while. That's ok. It doesn't mean you are accepting racism or poor care.

But you are the expert on what's best for your wellbeing right now. You can always try again when you're ready.