Professor Kamaldeep Bhui, Director of The Synergi Collaborative Centre, explores racism and mental illness, and explains why these realities need to "sit alongside any evidence base generated from research or policy reviews, to remind us of the mission and what is at stake". Photo credit: Oliver Barrett

Synergi Collaborative Centre Stroke

Can we talk about racism?

The launch of the Synergi Collaborative Centre at Rivington Place on Wednesday 22 November 2017 featured artists who weaved experiences of mental illness, ethnic inequalities and disadvantage into their creative expressions.

All of the performances were powerful, moving, disquieting and yet familiar in that racism and mental health has been a topic of heated debate and discussion for decades.

Ethnic inequalities in the incidence of severe mental illnesses, and adverse pathways to care and recovery, are often explained away as inexorable consequences of social disadvantage. Multiple social disadvantages, and the clustering of poverty, unstable housing, troubled family and community lives – due to loss, separation, violence or substance misuse – might drive the development of mental illnesses.

These factors also undermine protective influences that lessen the chances of poor mental health, and also guard against adversity and its consequences. For example, social support, friendships, belonging to a loving and caring community in which you can trust and feel safe, knowing that disagreements will be resolved by thoughtful engagement and not harm friendships, and the ability and confidence to oppose oppression, bullying and harassment, and discrimination and humiliation. And the intergenerational transmission of hopes and worries is well established. All these interplays were captured by the performances at the launch event.

A recurrent explanation for persistent disadvantage through the generations is that racism influences life chances and opportunities, undermines confidence and esteem and can cause deep distress, demoralisation and, ultimately, depression and mental illnesses.

Extreme racism associated with violence and harassment of course is a powerful traumatic event that attacks the very heart and existence of ethnic minorities, and vilifies them for the social ills in society. These seem especially troubling at times of austerity, when there are limited budgets committed to prevention and care, and widening inequalities. The UK government has acknowledged that we do not have a fair society, but are the causes courageously named or tackled? Is racism a relevant factor?

One might argue that multiple social disadvantages exist in rural and urban communities, and in all ethnic groups, not just minorities; that those who are from ethnic minorities have to contend with the additional hazards of racism and discrimination. Personal responses can help with coping and sustain confidence in pursuit of the best life chances, or fend off the micro-aggressions and daily hassles, the repeated experiences of exclusion and disappointments which erodes resilience and beliefs in a fair society.

This is an enormous agenda, but talking about racism is essential as not doing so denies what to many is a daily experience, and further reinforces the sense of injustice. Racism seems to exist in all areas of society, in institutions, and there continues to be regular media reports of brutal racist slurs and attacks.

Yet talking about racism is not easy, given the historical and latent legacies and identities that are reactivated: ones of conflict, hatred, violence and even homicide. Personal vulnerabilities and survival threats are then experienced by all, with some seeking to shut down the discourse while others become overwhelmed and unable to think, link or articulate painful experiences.

The organisations in which we work, and our common sense notions of how to relate, talk and belong to a group, are disrupted by these processes. As a result, these processes and racism talk is feared.

Public and private institutions, and our relationships, reflect our society. That is not a given but is open to change and needs constant effort in the form of progressive social policy and personal courage to stand up for what is right and fair. It would be extraordinary to suggest that mental health systems where somehow immune to these influences, given the marked power dynamics and imbalance that is inevitable when social disadvantage is part of the lived experience of people experiencing and surviving mental illnesses.

Not only is social disadvantage increasingly recognised as a cause of mental illness but also a consequence, and both take their toll on physical health. The stigma associated with mental health systems perhaps reflects the public perception and imagination around the power dynamics and the potential harms to health and wellbeing.

People working in the mental health system are some of the most remarkable compassionate and humane people. They have made a commitment to work with distress and illnesses that are complex and not always responsive to simple treatments, be these medication or therapy or socially-based. Yet something is not working and we must understand why that is.

We must listen to the lived experiences, stories and narratives of people experiencing multiple social disadvantage and people facing mental illnesses. We must embrace, hear and feel the pain and suffering to understand. Only then can we help process this for ourselves and for people experiencing racism.

These experiences need to sit alongside any evidence base generated from research or policy reviews, to remind us of the mission and what is at stake, should we not succeed. Managing these internal, hidden and primitive conflicts should be central to tackling ethnic inequalities. And the leaders, activists, both powerful and powerless, share this dilemma of engaging with a demanding, painful and exhausting narrative in which they are entangled, and by which they are changed. A narrative that can invoke insular protections and avoidances. We have to keep thinking clearly, safely and logically to intellectually seek a dispassionate algorithmic solution.

The Synergi Collaborative Centre will encourage, invite, host and share conversations about new approaches to science, and health inequalities, to better understand approaches to effectively tackle ethnic inequalities in mental health.

We will look into society, health and social systems, and interpersonal and group relations, places, towns, parks and schools; anywhere that affords us opportunities to break the cycles of fear, avoidance, persistence and repetition.

Racism will be part of the conversation, alongside a host of other related and important experiences which are often dismissed as social determinants. We will evolve new ways of talking about racism, its vicissitudes, its impact and its relevance to mental health.