Mental health services: 'What is it about your outreach that makes it hard to reach our Black communities?
Isaac Ouro-Gnao sits on our Young Black Men’s steering group supporting the delivery of our Young Black Men’s programme. He is a freelance journalist, dance artist and poet. Talking to other steering group members, he explores the long-held myth of ‘hard to reach’ when it comes to Black people accessing mental health support and services.
The term 'hard to reach' is quite stigmatising and diminishing. If we’re hard to reach, it suggests we're the problem. It’s because of something we do, where or who we are. It’s as if the responsibility is completely on us to address and eliminate it as an issue. Not the services struggling to engage us.
The term 'hard to reach' is quite stigmatising and diminishing. If we’re hard to reach, it suggests we're the problem
I'm not interested in trying to replace this term with phrases like ‘seldom heard’, 'hard to engage', or 'reachable distance'. Though they may have their merits, no language will perfectly represent our communities' concerns. In my opinion, they shift the goalpost towards focusing on the words themselves and distract us from engaging with the real issues.
'What is it about your outreach work that makes it hard to reach us?' I want to turn the spotlight onto mental health organisations and services with this question. I don’t think it’s asked enough, and I don’t think it’s answered well enough.
Hari Sewell, founding director of HS Consultancy, and consultant to our Young Black Men’s steering group, has been asking that same question since his work began in the 90s. “I don’t subscribe to the term. I don’t use it. It’s not a term that I recognise as having any value,” he says. “Services find it hard to reach (communities) and they need to then ask, what is it about their communication systems or networks that makes it hard to reach them?”
This question moves us away from lazy reasons like ‘we don’t know what they want,’ or ‘they are not interested in participating,’ and moves us towards thinking about biases and the underlying racism of the term. Let’s not forget it is often (though not only) Black communities that are seen as the most hard to reach. Covid-19 is also disproportionately affecting our communities, on top of us still being at high risk of being diagnosed, sectioned, and detained under the Mental Health Act. Services should think about how they reflect these inequalities and systemic racism in their own structures. Especially about how their outreach work could make things worse if they remain blind to these issues.
“Services are turning up with a load of baggage and they are unaware of the baggage they’re casting of 'we’re here just helping'", Hari adds. "For all you know that community (has) known about somebody who’s been sectioned and put in handcuffs (and) services can’t even reflect on that. They think they're completely benevolent, so they just turn up and are like ‘we’re here to support you and this community'”.
“For all you know that community’s known about somebody who’s been sectioned and put in handcuffs, (and) services can’t even reflect on that. They think they're completely benevolent, so they just turn up and are like ‘we’re here to support you and this community'”.
But they still hold power when working with Black communities. The power to section, to harm indirectly from held biases, or directly through the mismanagement of Black people’s traumas and experiences. This rigid position of power will always bring similar results of obliviousness from services and mistrust from users.
I spoke to members of Young Black Men’s steering group about why they think this issue remains. Nyall Simms, a PhD student and sports consultant, who thinks the issue of engagement and lack of trust is to do with “empty promises”. He says that we develop a hardened layer from experiencing racism on a day to day basis, and it can cause services “to feel that they cannot get through to the Black man. Therefore, labelling them hard to reach”.
In Daniel Thompson's case, a Young Person's Practitioner mentoring and supporting young people with their mental health, thinks that "in some instances, we are hard to engage (due) to past experiences that we have had as well as hearing the stories from others through many forms". Adding to that with his experience as a service user is Kai Wheeler, a singer by passion and trade. He says it's hard to be trusting "especially when you feel the person you are talking to has a lack of understanding". This hits harder when the things we need to talk about are linked to racism.
Hari thinks our and other well documented negative experiences, will continue to happen unless mental health services look at themselves to unpick their biases and power structures. “You’ve got to say: ‘I’m aware that you’re going to have views about who I am, being an officer of the state',” he says. “'Or you might have views about what we might have done to friends or family in terms of mental health… I don’t want to assume that you might actually feel very positive (but) I know you might have your own views about what we might represent, and we can kind of talk about that'. That opens up a dialogue.”
I acknowledge that progress is being made. I welcome what Mind have changed in their approach to become an anti-racist organisation. With its own research highlighting the worsening mental health of BAME communities during the pandemic, and its campaign tackling racial disparities in the use of the Mental Health Act.
But hurdles remain, for Mind and other mental health services. Reviewing biased structures behind closed doors will lead to tripping up on blind spots. It's not enough to reach out to leaders of our communities only to maintain a puppet spokesperson power dynamic. There's a growing body of research showing that those exposed to racism may be more likely to experience mental health problems. When it comes to racism, lived experiences are as important as professional ones. This can't be dismissed. Services should learn and make changes from it to rebuild trust.
When it comes to racism, lived experiences are as important as professional ones. This can't be dismissed. Services should learn and make changes from it to rebuild trust.
We aren't 'hard to reach'. Examining and dismantling biases, rigid power dynamics, and the systemic racism within organisation structures will show that to be true. And mental health services must be up to that task.
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