Colouring the Mind: Racism and Mental Health – The System

‘Colouring the Mind: Racism and Mental Health’ is a new In Conversation mini-series that will explore how racism affects mental health, with a particular focus on racism in the mental health system and racism in the mental health concept.

In this episode, Malaika Okundi and Jessica O’Logbon focus on racism in the mental health system and discuss what the mental health system is, how people of colour are treated in the mental health system, and where we can go from here.

Discussion points include:

• Definition of the mental health system with a focus on the UK mental health system.
• Formal and informal mental health systems.
• How people of colour are treated differently by the mental health system.
• The biases that exist for people of colour within the mental health system.
• Distrust in the mental health system and how history impacts people’ s perspectives of the system.
• The importance of cultural competency training and lived experience advising.

Please note that what Malaika and Jess share in this series is derived from their work, as well as from research and literature surrounding these topics. Whilst they are not experts on racism or mental health, personal experience does play a role in their discussions.

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Malaika Okundi is an early career researcher working on the Transmission of experiences of Racism, Anxiety and Depression (TRADE) project, the Catalogue of Mental Health Measures and the Landscaping International Longitudinal Datasets (LILD) project. She recently completed a Bachelor of Science degree in Global Health and Social Medicine – Neuroscience at King’s College London. Malaika’s research interests are varied and include interspecies approaches to medicine, biotechnology and its effects on society, data science, longitudinal datasets and the mental health of minority groups. She is enjoying gaining research experience as she decides which of her many ideas to focus on for a PhD.

Jessica O’Logbon is a final year medical student at King’s College London who recently undertook a Master’s in Psychiatry at the University of Cambridge as an intercalated year. Jessica is passionate about raising awareness of health inequalities and methods to tackle them, which is how she became particularly interested in mental health. She was a founding member of the Black & Minority Ethnics in Psychology and Psychiatry (BiPP) Network and ran events to discuss men’s mental health, barriers to service use in BME communities and the effect of racism on mental health – the complex relationship between intersectionality and mental health is often overlooked.

Transcript

[00:00:01.400] Jessica O’Logbon: Hello, and welcome to the Colouring the Mind: Racism and Mental Health podcast series for the Association for Child and Adolescent Mental Health, or ACAMH for short. This is a new three-part mini-series that will explore how racism affects mental health, with a particular focus on racism in the mental health system and racism in the mental health concept.

This is the second episode focused on racism in the mental health system. I’m Jessica O’Logbon, a final year medical student at King’s College London. I’m interested in child and adolescent mental health and women’s health, particularly the health inequalities in these fields, and I’ve worked with a number of organisations that focus on black and minority ethnic people and their mental health. Over to you, Malaika.

[00:00:53.080] Malaika Okundi: I’m Malaika Okundi, a Research Assistant at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London. I work on projects focused on mental health, racism and longitudinal datasets. These include the TRADE project, which looks at racism, anxiety and depressions in families intergenerationally, the Catalogue of Mental Health Measures and the Landscaping International Longitudinal Datasets project. I am interested in these topics, because as a black woman living in London, they intersect with my day-to-day experience.

[00:01:23.030] Jessica O’Logbon: Amazing, and in our episode today we’ll be talking about what the mental health system is, how people of colour are often treated within the system and where we can go from here. But before we get started, we do have a little disclaimer. Malaika and I are not experts on racism or mental health and all of what we share with you is derived from our work, research and literature surrounding these topics. Of course, as two black women, personal experience plays a role, as well.

[00:01:48.320] Malaika Okundi: If you’re a fan of our In Conversation series, please subscribe on your preferred streaming platform, let us know how we did, with a rating or review, and do share with your friends and colleagues.  So, Jess, what is the mental health system?

[00:02:03.829] Jessica O’Logbon: To me, a mental health system involves the services that are available to catch people who are struggling with their mental health. This doesn’t just encompass healthcare services, but it could also include law enforcement and education, like schools and universities. It can also differ by country, and those who access the UK mental health system, for example, may have touchpoints with the NHS, their school or university, or even the Police.

[00:02:28.849] Malaika Okundi: Yeah, I mean, I would agree. When I think of the mental health system, I think of the institutions and places where people go to access help or care for their mental health. So, these could include, like, [inaudible – 02:43] institutions, like hospitals and so on and so forth, or it could be a Therapist, a Psychologist, a Psychiatrist, who usually operate out of these institutions. Like you mentioned also, schools and universities, so these could be Guidance Counsellors and people of that nature.

[00:02:58.140] Jessica O’Logbon: Yeah, and I think being a medic, I’ve definitely seen more of the NHS focused side.

[00:03:05.300] Malaika Okundi: Hmmm.

[00:03:06.709] Jessica O’Logbon: You know, you may access your GP as a first point of call and if things need to be escalated, or you need to be referred, that might come to the secondary system, where you’re seen in a hospital or admitted as an inpatient. But more often than not, a lot of mental health issues are dealt in primary care, in the community, in schools and, in special cases, people are brought in by the Police or found by the Police. So, I think it’s quite interesting to consider those key aspects of our society, as well, ‘cause they do make up the system and they can have an impact on how people of colour are treated within the system as a whole.

[00:03:47.290] Malaika Okundi: Yeah, I think within the term “mental health system,” it sounds quite organised, in that sounds like one thing, the mental health system, but in practice, different systems intersecting with each other. Obviously, there are fit for purpose mental health institutions that only deal with mental health, but like you mentioned, a lot of mental health is dealt with at the primary care level, so with your GP, who is not, I would say technically, a mental health professional. But lots of people, that’s their first point of access, when you’re feeling in the same way when you have a cough or you have – you feel some – unwell in some way, you go to your GP. When you’re feeling mentally unwell or your mental health is not doing well, you go to your GP, as well.

So, I feel like GPs and the primary care system sees majority of the mental health concerns of people, but it’s only when things get worse or escalate to a certain level that, then, you, kind of, go through the different levels of care. And it’s interesting to think of the medical system. In my mind, it’s often quite a separate thing, when I think of the medical system and the mental health system, but in reality, they intersect on a daily level.

[00:05:00.070] Jessica O’Logbon: We’re definitely being taught to consider mental health in all of our practice and everything that we do. Although medicine is still very traditionally split up into specialties, you know, there’s become more emphasis than ever to consider mental health when a patient shows up for the first time. I also was thinking, as you were speaking, about more of an informal system going on, as well, because as you mentioned, the system sounds really organised, but in reality, it’s struggling, and there’s more of an informal system going on where people are accessing help online. They are accessing therapy, they are, you know, connecting with people on social media, and going to support groups, and it’s a really interesting other system that’s going on.

[00:05:51.510] Malaika Okundi: That’s actually – yeah, that’s a really cool point. I mean, in 2023, we are in the modern world, I guess, and there are a whole heap of online services that you can access, too, for your mental health. I mean, there are chatrooms, there are support groups, there are services that – where you can speak to your Therapist completely online. You can find a Therapist, pay for your therapy, receive treatment, without ever meeting the person, and I think lots of these services became much more widespread and much more mainstream in the pandemic, when we were all at home and we were all social distancing. But it’s interesting – again, it’s so cool that you brought it up, because when I was talking about the mental health system, and even though I was mentioning that there were a bunch of different services, that didn’t even cross my mind, but once you said it, it was like, of course, of course. There’s the physical world that’s part of the mental health system, but the online world really is part of the mental health system. I mean, also, the mental health problem, definitely the mental health system.

[00:06:52.970] Jessica O’Logbon: Yes, and we’re going to be speaking, in the next few minutes, about how people of colour are treated differently by the system, but I think – so, I’ve recently published a systematic review and meta-analysis on digital health and its use specifically in young people in substance use. But there were quite a few studies that spoke about the use of digital health in things like depression, and some of the things young people quite liked about digital health interventions for their mental health was a little bit of anonymity, that convenience, that 24/7 access. And it – and sometimes people just needed an immediate response, or an immediate reassurance, or an immediate de-escalation, which is often not able to be provided by a GP because they’re set hours, or even an out of hours service, you might still be waiting or you might have to go and physically access that service.

And I found that really interesting, and I wonder, especially for people of colour, that that anonymity aspect, and this is something I’m really interested in, the therapeutic alliance between a Psychiatrist or a mental health professional or a Therapist and a patient can be difficult when you don’t feel represented, or when you don’t feel…

[00:08:12.990] Malaika Okundi: Absolutely.

[00:08:13.990] Jessica O’Logbon: …you can truly say everything you want and be truly understood. And there’s lots of data on this, as well, but I’d wonder if that could be replicated online or if it’s the same thing. So, that’s something I’d be looking at in the future, for sure.

[00:08:30.280] Malaika Okundi: We spoke a lot in the last episode about what race is and we hit upon the definition that, you know, it’s a very visual thing. You see people and you categorise them into different races, and the idea of being able to interact with the mental health system online without that sort of visual interference, so that somebody cannot stereotype you by what you look like, I imagine it can give quite a sense of comfort. Because suddenly, you are what you’re feeling, not what you look like, and if you don’t see my face and you don’t know what I look like, you can only take my words at face value. And it allows you to be more than the stereotypes, your skin colour or your hair texture may provoke, if that makes sense.

And I think it really segues greatly into the next question of, how are people of colour treated differently by the system? And the reason why people of colour would be treated differently in the mental health system is because they are people of colour. They look visually different. They are categorised in different races. We are non-white and being able to circumvent that through online modes of intervention and therapy and psychological help is a really interesting way that the world has moved forward in the modern sense. We think – the internet is a weird, wild and wonderful place. There are great parts, there are not so great parts, but I think that’s something that really is interesting and should be studied to see if not having the visual stimuli of somebody’s skin colour does reduce the biases that are often present in the mental health system.

[00:10:16.250] Jessica O’Logbon: And, sort of, going on from that, what biases tend to happen for people of colour in the mental health system, maybe both from personal experience, what you’ve researched or things you’ve seen?

[00:10:29.450] Malaika Okundi: I think it’s clear, or I hope it’s clear, that the mental health system doesn’t exist in a vacuum. We’ve just talked about all the different institutions and people and players that are involved. So, the mental health system is not immune to racism and systemic racism that affects our society. So, stereotypes about people of colour and different races do affect the quality of care that those people receive within the system.

One interesting statistic that I saw from the MIND organisation, is that statistically, black people are sectioned under the Mental Health Act to a far greater extent than their white counterparts. This speaks to, sort of, the institutional racism at play, when race-based beliefs become policies and practices in institutions and organisations, and in this case, quite a disjointed system.

So, the stereotype that black people are angrier or more aggressive, or more dangerous than their white counterparts, then, is translated in the system and into practices that result in black men being restrained more than their white counterparts, black people being sectioned more than their white counterparts. What it means is that the expression of anger in a person of colour is not looked at the same way as the expression of anger in a white person. The expression of fear of distress of a mental health crisis is not looked at the same way.

And that isn’t to say that people within this system are particularly racist, more than society at large, but it is to say that the lens is quite focused because there are relationships of power within the mental health system. The ability to be sectioned, the ability to give or withhold treatment, dependent on what a Psychiatrist, Psychologist or other professional decides that you have and what diagnosis they’re willing to give you. When that relationship of power meets societal stereotypes, it does often result in sub-par standards of care for people of colour.

[00:12:41.139] Jessica O’Logbon: I mean, you touched on so many things there and I think the overriding thought of mine is that racism does permeate every corner of society.

[00:12:51.720] Malaika Okundi: Yeah.

[00:12:52.880] Jessica O’Logbon: We spoke about how the racialised experience translates to poor mental health, but then, you’ve got to experience that again when you access the mental health support. It’s a really dangerous cycle that a lot of papers have reported on, as well, that, you know, black people don’t access the mental health system as much, and if we take time to investigate those barriers, how much of that is because they lack awareness of their condition or, you know, just don’t know about the services? Or is it really about, “Am I going to get the help I need? Am I going to be sectioned? Am I going to be forced to stay in hospital? Is this going to end up being a criminal record for me?” you know.

[00:13:41.380] Malaika Okundi: Absolutely.

[00:13:42.380] Jessica O’Logbon: And that is a big concern when worrying about being admitted or seen by a health professional. And distrust, I would say, in the healthcare system when it comes to people of colour is not completely unjustified, because they do see family members and the way they’re treated, they hear things. We – it’s not – for example, mental health is one part, then there’s black maternal mortality. Then, there’s BAME people and COVID. It’s like, hmmm, there is a pattern here and I – the media contributes to that distrust, and if you don’t access help, you don’t get help, and that’s just the really difficult part of it, I think.

[00:14:27.050] Malaika Okundi: Yeah, and I mean, you mentioned the distrust is not unjustified. I think we can’t ignore the histories. There are really grim histories at play within these institutions, and when we think of just psychiatry as a practice, Western psychiatry, there is a colonial history of institutions. And the way other concepts of mental health from other countries are dismissed and seen – people are seen as crazy for things that are really core beliefs in their cultures and their languages and so on and so forth, and that don’t translate very well to the Western concept of mental health.

We also mentioned how the mental health system is spread across many institutions, one of which is our Police system, the justice system, and that historically, has been in conflict with people of colour. Historically, the Police have targeted young black men more so than any other demographic. And so, feeling unsafe is not unwarranted, because the history is there.

I mean, when we look even in the last ten years, even in the last few weeks, of things that have happened in London and how the feeling of unsafety does permeate these institutions. And it’s difficult – when I said earlier that I think of it as a mental health system, it’s only when you really think about okay, what is the mental health system? Who are the players? There’s the Police, there’s the hospitals, and so on and so forth. Once you begin to put names to faces, the different ways to access the system, you realise why there is an instinctive fear, why there is a distrust, why there is a fear of being sectioned, of being restrained, of being seen as dangerous and angry when you’re really hurt and afraid. And there has been a classic misinterpretation of emotion with people of colour.

I mean, one example that comes to mind, historical example, is there was a mental health disorder was coined to describe slaves who ran away from their slave masters, as if that’s not an absolutely normal experience, but then, it was considered disorder. And psychiatry has had a history of othering and abnormalizing and disordering really normal states of being, and so, I think it’s clear that a vicious cycle of needing help, being afraid to get help, not seeking help and then getting worse, is perpetuated by the history of the system.

It’s not perpetuated by a lack of knowledge. It’s not perpetuated by a lack of education. It’s perpetuated by distrust and by stigma, and I feel like it goes both ways. The black community, I suppose I can say, stigmatises the mental health system because we see what has happened historically, and it’s hard to forget when there’s been historical injustice. But in the same vein, the mental health system stigmatises black people and sees them as angry, as aggressive, as all sorts of other awful adjectives, when really, we’re just people.

[00:17:44.130] Jessica O’Logbon: And going on from what you said, I think you brought up something in me, that the stigma within the community, for example, the words we use to describe someone with mental health, it’s linked with that distrust, okay, “They’re,” you know, “they’re mad, they’re crazy, now they’re going to be put into the hospital, restrained and taken away.” And if that’s the mentality, I wouldn’t want to go to hospital either.

And just moving on into our next segment of the podcast about what can be done about this, I think about my own medical education and the cultural competency teaching that I’ve had and the difficulty and the uniqueness of psychiatry. You were talking about the DSM-5, we have the ICD-10 and I just do not think disorders can be boxed and there can be strict criteria that are met.

I was part of a debate during my time doing my master’s at Cambridge, where we discussed a transdiagnostic approach, typically more of a spectrum approach, but then, that’s really difficult for Clinicians. And then, the – on the other side of that, do we just do away with labels entirely and talk to the person in front of us, have a chat about things and go from there? But then, how do we direct treatment?

So, it’s really difficult because although psychiatry is very much laced within a patient’s feelings and experiences, sometimes the manifestation of that is an illness and it can be unsafe to that person and others. So, action has to be taken and some kind of treatment has to be given, and it can be difficult when that person in front of you is treated differently, subconsciously, unconsciously, which is the really insidious part about it, because of their skin colour.

I mean, the BMJ has an amazing editorial on “Institutional Racism in Mental Health Care,” and black African and black Caribbean and white and black Caribbean mixed groups are three or more times higher than average to be admitted to hospital for a mental health condition. But the really shocking bit was that they were up to 39% more likely to be admitted involuntarily. And of those in hospital, those who saw themselves as black Caribbean had the longest stay, and that’s really, really something to think about. And not all of those statistics are necessarily good things.

Having a long psychiatric inpatient stay, especially if it’s a long unnecessary stay, may mean that patient never comes back again.

[00:20:25.150] Malaika Okundi: Yeah, and when you mention cultural competency, that is a really interesting term. I think we’ve discussed at length that a person is not just their skin colour.

[00:20:35.640] Jessica O’Logbon: Hmmm.

[00:20:36.640] Malaika Okundi: And I think part of the problem – part of the solution, in a way, is cultural competency. The system is not as culturally competent as it could be. I think when we think of mental health disorders as these things in neat little boxes, it’s difficult to take into account the person’s culture, their values, their personal experiences, their belief systems, in relation to that disorder.

If a person is not just a disease – like, if I had, I don’t know, the flu, I am not suddenly just the flu. I am still a bunch of other cells that interact with flu when it’s in my body. I am an immune system, I am – etc., etc. The same applies for mental health disorders. I think we have to not treat it – mental health disorders in its own silo and we have to think about it holistically to be able to be culturally competent. Because even the way people conceptualise mental health and good mental health, change is dependent on culture.

When I was doing the landscaping activity on one of our projects, something that became very apparent is that in a lot of studies, longitudinal studies in Europe and America, the concept of mental health was very individual. So, person accesses mental health services and if they are not doing well mentally, then perhaps their government has failed them. The system has failed them. Something has happened in them, personally.

But in a lot of studies in Asia and Africa, what we saw was a much more community-based concept of mental healthcare, where if one person is having mental health difficulties, the solution was not individual, the solution was community-based. The solution was training their whole family, their whole village, their whole town, and so on and so forth, in how to better deal with mental health disorders. It wasn’t – you weren’t going it alone, in a sense.

And when I think about myself and my own culture, when I think of my mental health, it is very much intertwined with the health and wellbeing of my family. We – kind of like, we all win together, and we all lose together, for lack of a better term. So, when I’m going through mental health difficulties, I have my family members alongside who help me with the solutions, who rally around me. And when we don’t think about mental health in that kind of concept, it becomes difficult for me, at least, access and think of my mental health as a very individual thing that is not dependent at all on anyone else, or anything else. I’m very much affected by circumstances, the context in which I live and work, as well as the mental health and wellbeing of the people around me. And I think sometimes, the mental health system doesn’t quite account for that.

And having looked at – when we were doing our landscaping activity, we saw over 3,000 longitudinal studies from across the world. And the theme of community care was really prevalent in African and Asian communities, and I think it would translate to African and Asian communities even here in the UK. And so, I think more work needs to be done to move away from this paradigm that Western psychiatry is the be all and end all. Begin to accept other ways of thinking and other modes of being. I think – when I think of global mental health, which is, sort of, this movement that is trying to address the idea that Western psychiatry is not the only answer, that’s what I see.

I see taking people’s culture, taking the way people live, taking the words they use. Not everybody uses anxiety. Not everybody uses depression. Not everybody is able to describe their mental health in those terms. There are other words in other languages that don’t translate, and just because they don’t translate, doesn’t mean they can’t be treated.

Perhaps the treatment is different, but how I describe my mental health in the ways that I know how, is equally as important as correction diagnosed with a PHQ-9 standard measure. And we need to try and understand. I mean, I think on some levels, we need to do away with the whole standardised and non-standardised measures of mental health, but until then, we need to start standardising other ways of conceiving mental health.

[00:24:59.980] Jessica O’Logbon: And what you spoke about just then are the principles of cultural competence, so that diversity of perspective and being able to consider that when you’re talking to somebody. Being sensitive to, aware of and, you know, happy to adapt to cultural differences, that is all part of being culturally competent and seeing a culturally competent Teacher, Police Officer, mental health professional, Therapist, whoever it is, can really transform your experience.

I love what you said about use a patient’s own words, ‘cause I really don’t think we do that enough, and it’s something that actually hammering into us in medical school recently. “Do they use the word, you know, ‘depressed’? Did they use the word ‘seizure’? Did they use the word ‘unhappy’? Were they crying? What did they describe? And write that down word-for-word, repeat it back to them, ask them questions.” And I think a really important part of cultural competence that I think a lot of people aren’t comfortable with is being inquisitive. You can ask questions. You can find out more.

I think more resources do need to be available in terms of learning about, for exam – and also, an encouragement of learning about cultures, from religion to racial differences. I mean, look at what food they eat, if you want, and as a Doctor, that could be really helpful, for example, in a diabetic.

[00:26:23.740] Malaika Okundi: Yeah.

[00:26:24.740] Jessica O’Logbon: Where people eat…

[00:26:25.740] Malaika Okundi: Yes, absolutely.

[00:26:26.740] Jessica O’Logbon: …different food. I mean, it has amazing effects for everyone, and I think that I wish there was more encouragement to ask those questions, and if you’re not comfortable to ask them to a patient, because they’re also not there to educate you if they don’t feel like it, go and look things up, and that’s absolutely fine.

[00:26:43.390] Malaika Okundi: So interesting hearing about it from the Doctor perspective. Obviously, I’m in research and so, when we think about bringing in patient perspectives, we think about lived experience experts being part of our studies. And so, bringing in their perspectives from the beginning of a research study to the end and making sure that the research is culturally competent and that we’re really amplifying the voices of the people that we’re studying. I think it’s so interesting to hear from your perspective that in training, they are telling you to use the patient’s words, and that’s really encouraging for me to hear, ‘cause obviously, I’m not a Doctor and so, I don’t know what goes on in training to be a Doctor. But it’s really encouraging to hear that that’s an important part of what they’re hammering home, that you need to use a patient’s own words.

And the example you gave about diet is so – it’s so useful, because when you think about any sort of dietary issue, usually, the diets that you are prescribed to follow are not – they do not translate across cultures. It adds to the resistance to treatment. It adds to the unlikeness of the person searching the treatment and getting better. Because not only are you ill, you’re already feeling awful and now you have to do something that is so out of your comfort zone. You now have to go and stock all new staples in your cupboard, in your kitchen. It’s expensive, etc. It just makes everything harder. And if we think of mental health in the same terms, when you speak to me in a language that I don’t identify with, I’ll have to store new terms in my brain.

And now, not that learning new terms for what we experience is technically a bad thing. If I’m already ill, I’m already feeling awful, we look towards this comfort. I want to feel better, and I want to be comfortable, so I want to use the terms that I understand, that I’m used to.

And also, a large part of mental health and physical health is communicating what’s going on with other people.

If you give me words I don’t understand, how I am supposed to tell my mum what’s going on? How am I supposed to communicate it to, then, my Pharmacist that I’m taking my prescription to you and that we’re discussing side effects and things like that? How am I supposed to communicate outside of that session with that mental health professional, to the rest of the world, what’s going on with me? When I’m talking to my Line Manager, when I’m talking to anybody else and trying to explain what’s happening and what accommodations I need, if the language is not my own, can’t communicate fully.

It’s almost like if a native English speaker is suddenly forced to speak and understand what’s going on with them in Spanish. It’s difficult. It’s just the grammar’s different, the tensing is different, the words are different, and even if you can muddle your way through, you can’t quite communicate fluently. And I don’t think anybody should be forced to have to muddle their way through their own mental health difficulties. I think we should all be able and should have – it shouldn’t be a luxury to be able to communicate how you think and what you feel fluently, but it is, because the language is not conceived for us, by us. And that’s the real issue here, is that the mental health system is not created for people of colour, by people of colour.

Now, I’m not saying that it hasn’t improved over the years and honestly, if we think about the mental health system and all of the different institutions we mentioned, they’ve all been institutions, the medical system, the Police system, they’ve been around for centuries at this point. So, they are quite ingrained in history and there’s always that saying that “It’s hard to teach a old dog new tricks,” I think?

[00:30:33.330] Jessica O’Logbon: Hmmm hmm.

[00:30:34.580] Malaika Okundi: And so, these are old dogs with a history. They’ve been trained for certain things, and they are trying to adapt to this new way of being in a society that is attempting to be less racist. But it’s difficult because we remember what they were like before and they are, kind of, beholden to systems that have “worked,” worked for centuries.  And so, the thing that we need is something in between and this is where Lived Experience Advisors come in.

This is where – and I think lived experience advising in medical training, or Police training, or in the training systems within these institutions, will be really interesting in that they could also provide perspective. There needs to be something built for us, by us, can be a go between, and that’s where fantastic organisations, like Black Thrive come in, that can work to translate what can sometimes be complex medical or psychological jargon into terms that are fit for cultural purpose.

[00:31:38.649] Jessica O’Logbon: During my education, I’m happy to say that I had Lived Experience Advisors come in and tell us their story, and one of which was a black woman. So, I was really happy about that, and I think little things that you can do, especially speaking to anybody who might be thinking of studying medicine or studying medicine here, or in any mental health practitioner role, is to just question and consider another perspective.

If a patient doesn’t speak English and a whole consultation is being conducted in English, question that. Ask for it to be done with a Translator. If you notice a patient isn’t bringing their diabetes blood glucose down, ask them what they eat, what they were told to eat and why they haven’t been doing that. And trust me, you will get some pretty understandable answers, and make it your mission to do something about that.

You don’t have to come up with a personalised food plan for them, but there are actually amazing grassroots organisations doing great things. You can try diabetic friendly proper meals if you just took the time to Google that. We’ve got black skin conditions, we’ve got a whole manual on that, and I’m quite trendy and a medical student who did that. And when it comes to that therapeutic alliance, you cannot have it if you don’t make it your mission to try and understand the person sitting in front of you. Whether you’re the same race or not, that’s what you’re there to do, and I think you just brought up so many amazing points.

So, as we wrap up, Malaika, do you have any final thoughts?

[00:33:14.140] Malaika Okundi: I think, on a slightly positive note, despite the immense challenges for people of colour within the mental health system, it is possible to receive an excellent standard of care. And there are charities and organisations working hard to make sure people of colour do receive culturally competent care. Some examples that spring to mind are Black Mind Matters UK or Black Thrive. And if you’re on the other side of the mental health system, where you want to become, or already are, a psychiatric professional or a Psychologist, or a Doctor, the BiPP Network is another great resource for you to see representation of black and minority ethnic people within psychiatric, psychology and medical spaces.

[00:34:03.370] Jessica O’Logbon: Thank you for joining Malaika and I as we explored racism in the mental health system. Do please subscribe to our series of podcasts, entitled “Colouring the Mind: Racism and Mental Health,” and look out for other episodes, including “Exploring Racism in the Mental Concept” and “Examining the Effects of Racism on Mental Health.”

For more details on myself, Jess O’Logbon, and on Malaika Okundi, please visit the ACAMH website, www.acamh.org, and Twitter @ACAMH. And don’t forget to follow us on your preferred streaming platform, let us know if you enjoy the podcast, with a rating or review, and do share with friends and colleagues.