Help Me Stop psychotherapist, Debbie Brown, writes about why Black, Asian and Minority Ethnic groups can be resistant to counselling, including for addiction.
In this article, Debbie shares her thoughts on barriers to addiction treatment in BAME communities, and how healthcare professionals can work harder to break them down. To enquire in confidence about alcohol or drug rehab (face-to-face or online), please contact Help Me Stop here.
We know that people from BAME communities report lower levels of satisfaction with mental health services than other groups.
We also know that 1 in 10 Black men will experience a psychotic disorder (as compared to 1 in 30 white men). Yet still, counselling is often viewed as a last resort for Black men, typically when police are already involved.
There are numerous data sets on higher levels of arrests, prosecutions and custodial sentences for Black and Mixed groups. We must continue questioning these glaring inequalities.
In my experience as a counsellor of 13 years, I have also observed that Black women (specifically older Black women) very rarely seek access to counselling. Why is this?
When it comes to alcohol and drugs, I would say the problems begin with the stigma associated with addiction and asking for help. When people do arrive in healthcare services, this stigma is often magnified (consciously or unconsciously) due to lack of diversity and cultural awareness.
Reluctance to ask for help with addiction
Regarding alcohol or drug use, there can be misunderstandings, and sometimes tolerance, within certain cultures. People from BAME communities can be reluctant to come forward and be honest about their addiction for fear of being judged, ostracised or completely written off. This block to seeking help with addiction can cause immense pressure, and typically, this exacerbates the problem.
Cultural taboos often relate to shame and family values. ‘The black sheep’ concept can cause multi-generational trauma within family systems. People affected by addiction, as well as their relatives, can feel guilt, shame, low self-esteem and alienation. The addiction and associated behaviours are often labelled as disrespectful towards family values, religion and community, rather than being understood as a healthcare issue. All of this compounds the mistrust, fear of judgment, and the avoidance of seeking help.
Lack of cultural awareness amongst healthcare professionals
When people do arrive in healthcare services, you’d hope that’s where things start to improve – but this often isn’t the case. As a Black person of Caribbean origin who has worked in health services in England, I have noticed numerous inequalities within mental health care provision for Black, Asian and Minority Ethnic (BAME) communities.
For example, a lack of BAME employees can result in a diversity knowledge gap. Individual patients can feel subjected to cultural or racial bias, discrimination, and not being treated with the same level of respect and care as white peers. Clearly, this impacts negatively upon their experience and outcomes.
There can be language barriers that aren’t addressed properly by professionals in services, intolerance around accents, and misunderstandings of the terminology or body language that people use to express their discomfort. These kinds of differences must be approached proactively, and with great sensitivity and care. If they are overlooked or judged, the client will often disengage.
At the very least, a white middle class counsellor who is working with a Black client from an underprivileged background, must acknowledge and work proactively with this difference, including the notion of ‘white privilege’, otherwise the client can experience the same imbalance in power dynamics within the counselling relationship, further compounding their trauma.
Acknowledging unconscious bias in mental health services
Every person (whether a member of the public, health professional, police officer, judge, member of parliament, prison officer, teacher, or otherwise) is susceptible to unconscious bias, i.e. the norms in their community are different to norms in other communities, often resulting in an unconscious negative judgment or differential treatment of those with different norms.
It’s vital to acknowledge that the psychological and philosophical approach to mental health services in this country is very much based on western culture and norms, which are often very different to other ethnic groups. Professionals must do the work to address this structural bias head on, to centre their service delivery around the individual and their unique life experience.
How we approach difference and diversity at Help Me Stop
At Help Me Stop, we acknowledge the need to reach out to, and serve, those who find it difficult to engage in treatment. We seek continuously to recruit a diverse pool of therapists (staff and bank), to increase the representation and understanding of our clients’ diverse backgrounds and cultural needs. With Dayhabs that serve London and Hampshire, we take care to understand local demographics. And with our Online Rehab, we now have the potential to reach any community, anywhere in the world – as long as there is wifi and computer access. It’s no small feat to be truly representative across cultures, but one which we embrace.
As a relatively new organisation (we launched in 2019), of course we have more work to do as we grow. We are committed to continuous improvement in understanding why individuals struggle to access services to address their addiction. It stands to reason that often a person from a BAME group will only open up by talking to someone who is also from a BAME group, whom they would be able to relate to on a cultural level.
In terms of our service at Help Me Stop, from the initial assessment right through treatment, we start with listening. In group and individual therapy, when people experience being seen and heard without judgment, we can start to break down some of the mental barriers to effective therapy. Creating this non-judgmental environment increases trust, so that our clients feel safer to speak about the issues affecting their health and wellbeing. With trust, it is possible to build a therapeutic relationship where the client feels confident to explore their issues and concerns in depth. In group therapy, we can also model the mutual support that is found in healthy family, work or community settings.
Over time, this approach helps people with unique life experiences to view more objectively, and to accept, areas of their lives that have been shut down, whether that’s internally, in their family, or in their community.
With cultural awareness, we will never be done
Working as a counsellor at Help Me Stop, I have seen first-hand the positive results of our six-week treatment programme for alcohol and drugs. People who had lost hope, including many clients from BAME communities, regain an outlook on life that is immeasurably improved.
But we know we are not done – and we never will be. We recognise the importance to increase cultural competencies, race equality and specialist skills in the provision of BAME-friendly addiction treatment services.
We would like people from BAME groups to think differently about addiction therapy, and for it to be seen as a feasible and accessible treatment option, including as an early intervention. A requisite in achieving this is reducing the stigma around accessing mental health services, including for alcohol and drug treatment. We can do this by continuing to expand our knowledge and skills base, so that our services become even more attractive to BAME clients than they already are. Trust is key, and that’s something we are determined to build across all sections of our society, because addiction does not discriminate.