There is a room in Lambeth, inside a small charity that has stood on the same street for years. The young man has known it most of his life. He knows the people who work there, and they know him. Today is the first time he steps inside to talk about what he has been carrying alone. He sits with an older man he has always looked up to. He is not a clinician, but someone the young man trusts, who shares his culture and his community. For the first time, he lets the thoughts out.
What he does not know is that the charity’s funding was cut in half this year. Volunteers are holding the door open now, and it may not be there much longer. Years of trust, built one conversation at a time, can be undone by a single decision.
I grew up in South London, where the isolation, substance misuse and institutionalisation that untreated mental illness brings were so common they came to feel normal. Those struggles run across Pakistani communities like mine, and I came to understand them alongside Black communities too, learning from experiences that have shaped how I view and feel about the issues. When I started in public health research, I began to see them these struggles through a new lens. That started with becoming a community researcher at the height of the COVID-19 pandemic. I joined what would become Centric Community Research, a Black-led organisation, since closed, that built the capacity and capability of communities to get involved in research, with the local knowledge to know why places like that room in Lambeth matter.
One of my first projects was Medical Scepticism, where I was one of a team of community researchers who interviewed 120 people from racialised communities across South London, whose experiences of discrimination and mistreatment had hardened into a deep distrust of healthcare services. Two years on, I heard the same themes in more detail when I led research into Black mental health and trauma in Lambeth and Southwark. One person described the landscape as “us versus them”, and said plainly, “that’s why we don’t bother going.” They mirror sentiments I heard growing up, and they are deepening. This divide is not abstract: Black people in England are still detained under the Mental Health Act at around four times the rate of white people. Yet the need for help does not disappear. People look for it in the places they already trust.
Those are the community and voluntary organisations that have spent years building relationships in communities the health service reaches last. As the Centre’s Pursuing racial justice in mental health report puts it, the voluntary sector holds established links to the communities most in need but least likely to get support. That reach is infrastructure, and it does not behave like the rest of the system. A clinic can reopen. A contract can be re-let. Trust is rebuilt slowly, person by person, and when the organisations that hold it close their doors, it leaves with them. You cannot buy it back when you need it.
The new cross-government mental health strategy is a real step forward, and a long time coming. It depends on exactly the trust those organisations hold. Everything it builds towards points to the community: care closer to home, prevention, neighbourhood teams. The Neighbourhood Health Framework names the voluntary sector as central. Yet the funding points the other way. Mental health’s share of NHS spending is falling for the first time since 2016/17, even as the cash total reaches a record. As action research charity IVAR has documented, the funding small community organisations can reach is so unequal that the infrastructure the strategy relies on is being eroded, while it asks these organisations to do more.
It does not have to be this way. In south east London, the Integrated Care System and Impact on Urban Health are piloting community-led approaches to reduce Black mental health inequalities, including £1.5 million in multi-year grants to community organisations, informed by insights from my work at Centric. It is a step in the right direction, shifting what, who and how we fund.
If the strategy is to make a meaningful difference, it has to treat community organisations as what they are: social infrastructure for preventative care. That means multi-year, ring-fenced funding, and treating them as trusted partners in how mental health care is designed and delivered. A strategy that depends on community trust has to invest in it long term. It takes years to build, but just a moment to lose. The future of the nation’s mental health will depend on what we choose.
The young man in that room does not know any of this. He just knows whether the door is open, or closed. If it stays closed, so do the thoughts and emotions he needs to let out. Where that will lead him, we do not know.
Muhammed Rauf is the founder of Elysium London, an inclusive research and advisory consultancy working to close the gap between policy and practice. His white paper, The Inclusive Research Collaborative, draws on five years of practice across South London to make the evidence-based case for new infrastructure to sustain inclusive research.
