Counsellors open their doors to anyone who knocks; but who actually knocks? Inclusion is about equalising access and opportunity and eradicating discrimination and intolerance. So simple, yet so hard to achieve. It just isn’t enough to expound equality without serious scrutiny of the barriers that might prevent that knock on the door and attempting to remove them.
Mental health cannot be divorced from societal context. The mental health of people of colour is inextricably bound up with political dimensions including those of racism, culture, and social and educational status.
We might ask why, for example, black Americans are 2.4 times more likely to be diagnosed with schizophrenia than their white counterparts. Many factors contribute to the diagnosis of schizophrenia but we should not ignore the findings o a 2021 study published by the American Journal of Psychiatry which stated that “Black Americans are marginalised and experience more trauma than white Americans because of systemic and interpersonal racism, including police brutality, which may contribute to the higher observed rates of schizophrenia.” So, there are structural factors that affect inclusion. It was no surprise, for example, that when COVID took the country by storm we learned that “the raised risk of death involving COVID-19 for people of Black ethnic background of all ages together was 2.0 times greater for males and 1.4 times greater for females compared with those of White ethnic background” .
From the publicity created by the Black Lives Matter movement, to the uncomfortable examination of how white privilege plays out in everyday life among professionals from many walks of life, inclusion is rightfully on our radar. Black and minority ethnic (BAME) communities are less likely to access mental health support in primary care and people from African Caribbean groups are three times more likely to be diagnosed and admitted to hospital for schizophrenia than for any other group. The stigma associated with mental illness and the cultural expectations among BAME communities for individuals to ‘be strong’ also serve as barriers to accessing mental health services.
Then there is the question of what happens when a person of colour actually walks through the door. Even when the barriers to access have been overcome, there may be others that are not immediately apparent. Let us imagine, for example, a young black man accessing counselling for the first time. It would be critically important to examine preconceptions on the part of both therapist and client. The careful mapping of common ground is crucial; understanding where the boundaries lie and a willingness to explore the territory beyond is likely to illuminate the client’s sense of place within the community, his role and degree of autonomy, and how all are influenced by cultural norms that may be very different from those expected or aspired to within the broader, largely white, European culture.
The world is now responding to the casualties of the war in Ukraine. A generation of young Ukrainians will have a particular experience of childhood trauma whose ramifications will continue to be felt for years to come. Their ability to access help, along with the abilities of refugees and asylum seekers from Afghanistan, Syria, and other zones of conflict, is in part down to our responsibility to keep ourselves informed and up to date with the changing needs of a fast-changing world.