By Lorraine Khan
The Centre’s recently published evaluation of the Up My Street projects in Birmingham highlights once again longstanding inequalities in the mental health system affecting young African Caribbean men. Some 15 years to the month after we published Breaking the Circles of Fear, exploring the experiences of African Caribbean men of mental health services in the UK, our new report Against the Odds focuses on the experiences of boys and young men.
We now know from research that at age 11, African Caribbean boys are not more likely to present with a diagnosable mental health condition compared with their white peers (see Children of the new century). Yet by the time they become adults they are many times more likely to be identified with severe diagnosable mental health conditions, and more likely to end up in costly and restrictive mental health crisis settings. These young men are also over-represented in other areas of the system: they are more likely to be excluded from school and to be in contact with the criminal justice system. And in some of these areas, young African Caribbean men’s over-representation has worsened in recent years.
So what’s driving this persistent pattern of poor mental health and broader inequalities, and what do we need to do to shift the dial on these longstanding inequalities? We know that black boys and young men face a greater chance of exposure to key risks such as prolonged poverty – with a greater number of families either living on or under the poverty line. And we know that prolonged exposure to poverty can be particularly harmful to children’s mental health.
But there is also evidence that daily inequalities and routine experiences of racism and discrimination (such as race based bullying, being followed around a shop because you are believed to be shoplifting, having to think twice about calling the police when others are in difficulty because of fear of ending up in the back of a police car, being exposed to media representations and messages that you’re not good enough, struggling to access opportunities to move forward in life) have a weathering effect on wellbeing, leading to cumulative stress.
Over time, this ‘drip-drip’ effect of exposure to stress can be toxic to young men’s stress response systems – with research suggesting it leads to later distressing and costly spikes in mental and physical health problems. The young men who participated in our evaluation consistently told us that they are flooded, over time, with negative images of themselves which incrementally undermine self-belief. Where they lack positive male role models in their lives, negative representations of black masculinity affect what they think they can be or achieve.
We asked young men what needs to change to address these risks. They said that they needed male role models who were open about mental health and who modelled resilience and achievement against the odds. They told us that schools also missed important opportunities to promote mental health and embed resilience boosting activity supporting young black men – giving positive messages about black young men’s identity, potential for achievement, heritage, and wellbeing. And they said they had been particularly affected by the contraction of youth services and the lack of sustainable funding for community-based initiatives, which for some were the only contexts in which they might be exposed to a wider range of male role models.
Finally, they stressed the detrimental effect of economic survival pressures on their mental health and of the importance, therefore, of solutions providing concrete opportunities for personal and vocational growth to help them secure equal access to real educational or employment opportunities.
We have learnt that shining a spotlight on race inequalities in mental health has not, in the past, been enough to bring about real change in people’s lives. Many of the problems our report highlights and some of these solutions are not new and have been recommended before following large scale reviews. But sustained action has been lacking and the dial has remained firmly stuck or got worse.
Sustainable change requires Government to take a strong leadership role to tackle both mental health inequalities and the attritional impact of racism. It means ensuring that there is adequate focus on young black men’s mental health and avoiding a colour-blind approach in the forthcoming green paper which seeks to transform mental health in schools.
It requires robust leadership from Government to create priorities across a range of departments which can drive improvements in the longstanding mental health inequalities and cumulative risk factors (for example inequities in employment, school performance and housing) that inflict wear and tear on young black men’s wellbeing over time. For example we need to see the Department for Education embed good quality mental health promotion into the curriculum of all schools, and there should also be explicit reference in the Ofsted inspectorate framework of the importance of supporting all children’s mental health, with particular reference to the need to promote black boys’ and young men’s resilience.
In order to ensure coordinated local action to shift the dial, the Government should drive a national concordat for change. This should require local areas to produce an agreement and a prioritised action plan that draws together a range of partners (schools, justice, police and crime commissioners, health, job centres, parenting, early years) who work with local communities to co-produce solutions to shift the dial in addressing longstanding inequalities.
This concordat might mean local areas commissioning African Caribbean mentoring organisations to engage with young black men who are identified as vulnerable at the point of arrest, linking up with the national Liaison and Diversion services. It may also mean creating and accrediting, through partnerships with Further Education Colleges, a wave of mentors and male role models who can develop skills to support improved aspiration and employment prospects. Or it may involve the commissioning of mentoring projects such as Up My Street to support young African Caribbean and men at risk of school exclusion to get back on track.
For too long, race inequality in mental health has been accepted as a fact of life in the UK. It is now time to take up the challenge set by the Prime Minister to tackle ‘burning injustices’ in mental health and prioritise action to shift the dial and ensure future generations of young black men have a fairer chance in life and a better prospect of good mental health through their lives.