The theme for this year’s Black History Month is ‘Time for change: action not words’. Normally a month of celebrating key figures in black history, this year it goes beyond that to recognise the current contributions that black individuals are making to better the lives of their communities.1 In this article, I am following that theme to spotlight some of the individuals and organisations that have picked up the mantle of action by taking black mental health matters into their own hands.
For many years, the need for change to the mental health care and treatment for black people has been widely acknowledged. Pledges have been made to reform, a multitude of five-year plans announced and, within the counselling and psychotherapy world, commitments made to better embrace race, culture and ethnicity.
Despite this, black people continue to be over-represented in acute and secure settings, experience inequalities in the type of mental health support they are offered, and have worse outcomes when engaging with mainstream psychological therapies than their white counterparts.2
In 2020 the murder of George Floyd and the resurgence of Black Lives Matter brought black mental health back into the spotlight, highlighting the long-standing inequalities. NHS trusts and mental health organisations ‘stood in solidarity’, pledging to make the necessary changes.3 In the counselling and psychotherapy world, professional bodies and training institutions followed suit, acknowledging the psychological impact of racism and injustice and the need for change.
For Rameri Moukam, psychotherapist and Clinical Director of Pattigift Therapy (www.pattigifttherapy.org), a long-established African-centred community organisation, it was a watershed moment. She says, ‘It took for the world to be at a standstill for them to see what we have been saying for many years – that there is something very wrong with the way that black people are being treated, and that we were having to live like this, all of the time.’
Professor Patrick Vernon OBE is a long-standing activist and campaigner for black mental health who has spent the past 30 years sitting on various NHS committees and commissioning groups, and working at director and chief executive level for a number of NHS trusts and black community organisations. After George Floyd’s murder, he says, every single mental health charity, NHS trust and professional body released statements promising to work towards becoming anti-racist organisations: ‘They all said “we care about black people and want to make a difference”. But I am sure that, if you did an audit, you would find that not much has changed.’
Two years on, as we consider what changes have been made, NusShen Ankhu, Director of Pattigift, asks a pertinent question: ‘Who is responsible for black people’s mental health?’ For him, the events of 2020 revealed the vulnerable position of black people in UK society and why he feels it’s imperative that, as a community, we need to start taking responsibility and not leave it to mainstream services.
Jay Perkins, founder and Chief Executive Officer of Partisan (www.partisanuk.org), who leads a team of practitioners in developing tailor-made mental health solutions, also believes that the black community can no longer rely on mainstream services, because ‘whiteness prevails’ in these institutions. ‘They are staffed by professionals whose trainings are underpinned by Eurocentric perspectives and theories, that often don’t match the diverse, multicultural communities that they are meant to serve,’ he says. He speaks as a practitioner who has spent most of his career working with children, young people and families who are gang affected and at risk of exploitation and violence.
Culturally appropriate therapy
The call for culturally appropriate therapy is not new – one of the first intercultural therapy models was the inspirational work of the late Jafeer Kareem in 1983,4 and since then, it has gained significant attention in the counselling and psychotherapy professions. More recently, we have seen mainstream services and training institutions attempting to incorporate cultural competencies,5 adaptations,6 responsiveness, sensitivity and humility into their clinical work and theories.
Despite these efforts, the black community still experiences a lack of appropriate support from mainstream services. Vernon recalls a time when people said, ‘Let’s trust the NHS. Let’s try and have all these culturally competent services within NHS organisations.’ He believes the reason why this hasn’t led to change is that the NHS itself is structurally racist. Adding to this, says Perkins, ‘The community has long felt the effects of these discriminations and in order for mainstream services to be fit for purpose, they would need a complete overhaul.’ The implications of this became even more evident in 2020, when black clients started demanding black therapists.
This was one reason why Kunlé Oyedeji set up The Empowerment Group (TEG) (www.theempowermentgroup.co.uk), a registered charity, in the midst of the aftermath of George Floyd’s death and the COVID-19 pandemic and in response to the challenges black people were facing. ‘I couldn’t find or see any service that was delivering culturally appropriate therapy to the black community so I decided to set something up myself.’
From a culturally appropriate perspective, it was important to Oyedeji that he created a service where therapists have an understanding of the clients’ backgrounds, the issues they are bringing and the challenges they’ve experienced with racism. This included an understanding of how some members of the black African and Caribbean community might view mental health, and the attached stigmas and associations. ‘I’d love to see the stigma towards mental illness well addressed and removed, and better understood by the black community,’ he says. ‘I would love to see more conversations about mental health taking place between every generation within the black community, from senior citizens to young children and young adults.’
As a pastor, the inclusion of religion and spirituality was also essential for Oyedeji. ‘A lot of members of the community are rooted in spirituality, so when you talk about mental health and you talk about spirituality and religion, sometimes there can be a clash. Culturally appropriate therapy allows for the understanding of these kinds of things that the client is bringing into the therapy space,’ he says.
Oyedeji describes TEG as a black-led specialist therapy service for the black community. An organisational member of BACP, TEG provides a heavily subsidised therapy service to adults of black African and Caribbean heritage. Collaborating with a number of partners and funders, TEG prides itself on linking clients with black therapists faster than NHS and mainstream services can.
Two years since the launch, Oyedeji says, ‘We continue to empower the black community to take hold and charge of their mental wellbeing.’
Partisan was also founded in 2020 by Perkins, an experienced psychotherapist and former youth worker, out of disillusionment with long waiting lists and services staffed by professionals with limited understanding of cultural context, located in areas where young people felt unsafe and with inflexible appointment times. ‘They were not meeting the needs of the most marginalised, stigmatised and excluded communities,’ he says.
On a personal level, Perkins felt a need to get back to the ‘frontline’: ‘The further along I went in my career, the further I was distancing myself from the young people I had sought to help in the first place.’ Based on the values of community psychology, the work of Partisan is centred around young people, community and collaboration. Perkins and his team aim to create specialist mental health solutions to meet the complex, specific and localised needs of young black people in the community.
At the heart of Partisan’s work is co-production, based on the principle that the communities they support have valuable knowledge and expertise. Much of the learning takes place through co-working and thinking together. By working collaboratively, the team can scope and assess the mental health and emotional wellbeing needs of that particular community and then design, develop and co-produce therapeutic and trauma-informed support. ‘We stand alongside communities in thinking about systems change at all levels, to ensure that what we’ve developed and embedded is sustainable,’ says Perkins.
Part of the offering at Pattigift Therapy are traditional African-centred healing circles, created to provide support to the black community after George Floyd’s murder and during the pandemic. ‘There was a lot of anxiety and introspection in regard to everything that was happening on both sides of the Atlantic,’ says Pattigift’s co-founder and Director Ankhu. The US Association of Black Psychologists, of which Pattigift’s directors are members, thought it was important to provide healing spaces during that time of uncertainty and racial trauma, so Ankhu and Moukam took the lead to create them in the UK. Ankhu describes them as safe spaces where the community could come together to ‘discuss and share’ and ‘breathe and grieve’.
Two-and-a-half years on, the healing circles are still in demand. ‘They continue to be safe spaces for community members to join and talk about whatever is going on for them,’ says Ankhu. Based for the past 20 years in Birmingham, Pattigift now has plans to offer the healing circles nationwide.
Pattigift is also in an exciting phase of working towards the launch of an accredited African-centred psychotherapy model. Moukam says: ‘We are going back to core African-centred psychological concepts of what it means to be human, framing the therapy around that – rather than around Eurocentric constructs of human development.’
The model will also bring in ancient traditional ways of knowing, Ankhu says, centring around five African characteristics – I am divine, I am perfectible, I am teachable, I am free will and I am social responsibility: ‘We are taking from the past and modernising it for the contemporary and current times that we find ourselves in.’ The courses will comprise a Level 3 ‘therapeutic underpinning of black psychology’ introductory course, a Level 4 accredited course in African-centred psychotherapy, and a Level 5 course for qualified and experienced therapists to learn to integrate black African-centred learning with their previous Eurocentric training. The Level 3 course will begin in January 2023.
Joy has found us
Another exciting new initiative comes from Ubele (‘the future’ in Swahili), an African diaspora-led organisation. Founded in 2014, Ubele is described as community rooted and collaborative in character, working to support the growth of individuals and community-based groups and organisations. In 2020, it launched Bayo (www.bayo.ubele.org), an online digital directory collating and spotlighting black-led initiatives, community groups and mental health services, in collaboration with Mind, Young Minds and Best Beginnings.
Dr Yansie Rolston, Ubele’s Associate Director of Health and Wellbeing, says the aim is to ‘elevate services “for the black community by the black community”, already out there doing the work. This is the first of its kind’.
As the number of black-led community initiatives grows, it’s vital to bring them all together in one platform, says Rolston, as lack of information about what help is out there and how to access it can be a barrier to finding appropriate support. As well as mental health services, the directory spotlights a range of social prescribing organisations – a reflection of Ubele’s awareness that mental health is intertwined with social environment and the experience of structural inequalities. Another key feature is a list of organisations that work specifically with young black people.
Ubele’s long-term aim is to consciously address the issues of racial trauma and the intergenerational impact. ‘The Bayo initiative is about exploring and navigating routes to healing these traumas and supporting organisations in reducing communal harm,’ says Rolston. ‘But Bayo means “joy has found us” in Yoruba, and it’s also a digital space for the black community to find joy, strength, community and support.’
Dr Yansie Rolston
Alongside community action, larger, research-based initiatives are also important to inform future developments, says Patrick Vernon, who is currently leading a study at University College London (UCL) into the mental health impact of the Windrush scandal and associated hostile immigration policies (www.ucl.ac.uk/global-health/ties-bind).7 The first study of its kind, Vernon is working with Dr Rochelle Burgess, Associate Professor at UCL Global Institute of Health, and BACP member and psychotherapist Dawn Estefan, to interview a number of affected families over a six-month period, exploring their mental health challenges.
Vernon believes that the Windrush scandal, which came to light in 2018 after the Government publicly apologised to hundreds of victims who had been wrongly targeted by immigration enforcement as a result of their hostile environment policies,8 represents and reflects the state of black mental health in Britain. ‘Four years on, the NHS and Government have not made enough effort to formally acknowledge the scale of trauma and mental health difficulties that the victims have experienced,’ he says, despite many victims being barred from working, refused access to government services and losing welfare benefits. In some cases, they were even forcibly removed from their families and homes, detained in detention centres and deported.
The research study will look at the intergenerational mental health consequences of the Windrush scandal by working directly with affected families. ‘We are trying to capture some of the stories and experiences so that we can influence policy and black therapists can be funded to provide free counselling and psychotherapy to the Windrush victims and their families,’ says Vernon. ‘The ultimate aim is for every single victim to get the mental health support that they need.’
For real long-term change to happen, however, Vernon would also like to see more black leaders shaping and influencing the mental health and care agendas. ‘We need more black chief executives, directors and leaders running mental health trusts and psychological services. I believe that, if you have black people in those positions, things might be a lot better. More and more black people are open about their mental health compared with 20-plus years ago, which is a positive thing. But we still have a long way to go.'
Services also have a long way to go in rebuilding the trust with our community, says Perkins, but he has hopes that Partisan ‘will not need to exist in the future, that we will put ourselves out of business by making a reality our vision of a more connected, just and equal world, where mental health and wellbeing support is accessible for everyone’.
Ankhu acknowledges the limitations of taking black mental health matters into their own hands: ‘We can’t save the world and we can’t save the black world.’ But what we can do, he says, ‘is to work towards creating a road that black people can travel on, that will be of some help and assistance, paving the way for generations to come and for the younger generation to walk down and extend’.
Moukam adds: ‘When we have a sense of ourselves and our purpose, when black people truly understand who we are, it is a truly wonderful thing. It is then that we can feel healed and loved. It is then that we can feel safe to be our full selves. And when we are our full selves, we can breathe.’
Next in this issue
1. Ross C. Our theme for Black History Month 2022 is time for change: action not words. [Online.] B:M2022; 6 June 2022. bit.ly/3R3xEU2
2. Dyer J. Advancing mental health equalities strategy. NHS England Advancing Mental Health Equalities Taskforce; September 2020 [online]. bit.ly/3CGNeR8
3. Stevens S. Personal message from Sir Simon Stevens on Black Lives Matter and health inequalities. NHS England; 9 June 2020 [online]. bit.ly/3AW11Sr
4. Kareem J, Littlewood R. Intercultural therapy: themes interpretations and practice. Oxford: Blackwell Scientific Publications; 1992.
5. Banks N. Cultural competencies in delivering counselling and psychotherapy services to a black multicultural population: time for change and action. In Majors R, Carberry K and Ransaw TS (eds). The international handbook of black community mental health. Bingley: Emerald Publishing Limited; 2020.
6. Beck A et al. IAPT Black, asian and minority ethnic service user positive practice guide. BABCP; 2019. [Online.] bit.ly/3wGWrVM
7. Windrush scandal victims to speak up about mental health and trauma. UCL News; 20 April 2022 [online]. bit.ly/3R24Bjs
8. Javid S. Home Secretary apologises to members of Windrush generation. Gov.uk; 10 June 2019. [Online.] bit.ly/3RkZ6MI