The International Handbook of Black Community Mental Health

Cover of The International Handbook of Black Community Mental Health


Table of contents

(34 chapters)

Part I: Race Relations


This chapter discusses the experiences of black men who encounter the phenomena of a mental health diagnosis, detention and death in a forensic setting in England. Although there are black women with mental health issues who have also died in forensic settings, the occurrence is significantly higher for men who become demonised as ‘Big, Black, Bad and dangerous’. The author discusses the historical over representation of mental ill health amongst black people in the general community and the plethora or reasons attributed to this. The author then discusses the various points of entry into the criminal justice system, where black men with mental health issues are over represented. The author explores some inquiries into the deaths of black men in custody and the recommendations that were subsequently made, which successive governments have failed to act upon. The author argues that the term ‘Institutional Racism’ is insufficient to explain this phenomenon; and offers her own theoretical interpretation which is a combination of systemic racism influenced by post-colonial conceptualisation


The hiring of women of colour faculty is not without unwritten presuppositions. The authors are expected to tolerate racism and to draw from cultural experience in catering to students of colour or when it fulfils institutional needs such as bringing ‘colour’ to all-white committees. Yet, the normative profile of university teachers demands detachment with a focus on high output in terms of students and publications. In the light of this, commitment to social justice seems to be in (certain) disagreements with mainstream interpretations of the academic profession. Women of colour professors are redefining educational leadership. This chapter addresses its effect on emotional wellbeing together with techniques and strategies to strengthen emotional resilience.


African American males experience acute or chronic stress from discriminatory treatment and racial microaggressions, decreasing their biopsychosocial health. Racial microaggressions include but are not limited to merciless and mundane exclusionary messages, being treated as less than fully human, and civil and human rights violations. Racial microaggressions are key to understanding increases in racial battle fatigue (Smith, 2004) resulting from the psychological and physiological stress that racially marginalized individuals/groups experience in response to specific race-related interactions between them and the surrounding dominant environment. Race-related stress taxes and exceeds available resilient coping resources for people of color, while many whites easily build sociocultural and economic environments and resources that shield them from race-based stress and threats to their racial entitlements.

What is at stake, here, is the quest for equilibrium versus disequilibrium in a society that marginalizes human beings into substandard racial groups. Identifying and counteracting the biopsychosocial and behavioral consequences of actual or perceived racism, gendered racism, and racial battle fatigue is a premier challenge of the twenty-first century. The term “racial microaggressions” was introduced in the 1970s to help psychiatrists and psychologists understand the enormity and complications of the subtle but constant racial blows faced by African Americans. Today, racial microaggressions continue to contribute to the negative experiences of African American boys and men in schools, at work, and in society. This chapter will focus on the definition, identification, and long-term effects of racial microaggressions and the resultant racial battle fatigue in anti-black misandric environments.


This chapter intends to provide a reflexive discussion of the experience I loosely refer to as the ‘supervisory relationship breakdown’, which led me to withdraw from a Professional Doctorate in the penultimate year of completion. The event left an indelible impact upon me; a reminder of my blackness, the contrast between that and the ivory tower of academia and the emotional toil I endured as each incident unfolded, ultimately leading to my exit and the shattering of my emotional wellbeing. The term ‘supervisory relationship breakdown’ is a superficial reference to a complex entanglement of what I deemed to be dysconscious racism and attempts situated historically to control people of colour through education. I will explore how I as a black woman in academia believe I am perceived through a dysconscious racial lens, a lens shaped by a perception to maintain white privilege. I posit how a misalignment existed between who I am and who I was perceived to be by my doctoral supervisor. The space between this misalignment became filled with inequity, tension and oppression, culminating in the relationship breakdown. I present an ‘implosion’ of the relationship as a metaphor for the embodied affect having to withdraw from the doctorate had on me; it felt as though my ‘self’ – body, mind and spirit – were broken, in a state of collapse which I did not know how I would recover from. I conclude with support and renewed hope, I returned to academia and found an alternative approach for completing my doctorate.


The role of implicit provider bias in mental health care is an important issue that continues to be of concern in the twenty-first century for the Black/African American community. Access to mental health and quality care remains elusive as members of this social group lack access to mental health screening, diagnosis, and attention due to institutional and cultural barriers. Supporting the position that implicit and explicit provider bias exists in the mental health profession, this chapter will explore how implicit provider bias is an intractable institutional barrier that prevents Black/African Americans from accessing mental health and quality care. A review of the implications related to mental health outcomes with Black/African American clients will also be explored.

A brief overview of the Black/African American cultural responses to implicit provider bias will be discussed later in this chapter. There will be an exploration of the ways to help identify, address, and eliminate implicit provider bias using evidence-based personal and community engagement strategies that promote mental health wellness within the Black/African American community. Implications for best practices in Black/African American mental health will also be addressed to eradicate the risk of unethical or medical malpractice with Black/African American clients, reduce the mental health disparity experienced by Blacks/African Americans, and create mental health equity for this population.

Part II: Policy


Since the demise of Delivering Race Equality strategy in 2010 under the last Labour government and with the Coalition (2010–2015), and now the Conservative government at times have adopted a “color blind” approach to race and health. This raises the fundamental question why is race equality off the political agenda and how black mental health issues can be part of a future strategy. The 2015 Care Quality Commission (CQC) annual monitoring report of the Mental Health Act (MHA; which has also incorporated the learning since the inception of the Act in 1985) further highlighted the overrepresentation of African and Caribbean men and women who are sectioned in secure wards or on Community Treatment Order (CTO) in the psychiatric system over the last 30 years. The CQC have revised the code of practice which recognizes issues around race equality as part of wider perspectives and principles of human rights.

In October 2017, the government established an independent review of the 2007 MHA as a way of providing more safeguards for patients and service users. The review, under the leadership of Sir Simon Wessely which is reported in 2018, provided an opportunity for an informed public debate on the historical and contemporary roles of psychiatry and the experiences of mental health in Britain’s African and Caribbean communities. The review did examine community anxieties about the proportionally larger numbers of black ethnic minorities receiving inpatient care and CTOs, or in the criminal justice system. However, after 30 years of Black History Month in the UK, we still need to ask the question: Are those of African descent overrepresented in these systems? If so, is serious mental illness over diagnosed among these groups due to the persistence of stereotypes rooted in the experiences of slavery, or do they in fact experience distinctive patterns of mental health and illness, perhaps due to the wider fallout of historical enslavem


At the heart of health and social care services is the pursuit of safety and dignity. Legislation and organizational policies are the main way in which statutory and independent organizations’ are tasked with enabling adults with mental health services along the road to recovery. Safety is an intrinsic motivator and basic need.

There is increased political recognition that social policy including the Mental Health Act 2007, which is a cornerstone, is in need of reform. A Conservative Manifesto pledge to reform mental health legislation is based upon the need to mitigate discrimination.

The chapter will explore the interrelationship between “poor outcomes” within the black community and safety; consider the opportunities to move from organizational complacency as a result of new policy and legal frameworks; and promote the view that developing a new discourse around safety is an integral part of improving outcomes for service users, particularly those who are poorly served currently.

A literature review plus reference to case studies will form the basis of the chapter ent and modern racism?


This chapter aims to give an overview of key mental health policy and service provision, highlighting the need for specific attention to Black and minority ethnic children and young people. The focus is on mental health provision in the UK provided through the statutory sector and the voluntary and community sector, the issues raised are likely to have resonance across wider geographic locations. The themes examined include: the relevance of terminology regarding race and ethnicity and related impact on the planning and provision of services; the extent to which policy and commissioning of services give due focus and attention to the mental health of Black and minority ethnic children and young people; views young people themselves have contributed on the issue; and a case study illustrating work being undertaken to redress some of the imbalances encountered by young people in accessing appropriate support. The chapter argues that the supply chain to young people receiving support that is relevant and appropriate to their needs is a long and complex one. It is fundamental to take a holistic approach and consider how the components of this chain impact specifically on the mental health of children and young people from Black and minority ethnic communities.

Child and adolescent mental health services (CAMHS) – This term refers to all services that work with children and young people to address their behavioural and emotional wellbeing needs. The services may be provided by the National Health Service (NHS), local authority, school, private sector or charitable organisation and span early intervention support through to specialist treatment.

Care Quality Commission – The independent regulator of health and social care services in England.

Commissioning – The process by which health services are procured and should be based on an up-to-date assessment and understanding of needs of the target population.

Co-production – A process for planning and delivery of health and social care services that involves partnership working and power sharing between those responsible for the planning and provision of services, service users, their family members, carers and other citizens.

National Service Framework – Ten year programmes that, until the health and social care reforms started in 2010, defined standards of care in the NHS including measurable goals within set timeframes.

Population Needs Assessments – The collection and study of relevant data to understand and estimate current and future needs of a population in order to inform the planning of services that meet identified needs.

Voluntary and Community Sector – Also referred to as the Third Sector and encompassing a diverse range of organisations, services and groups that are seen as distinct from the public (also referred to as statutory) and private sectors.

Youth Information, Advice and Counselling Services (YIACS) – Most YIACS have charitable status and provide services to young people on a range of issues, a key feature associated with YIACS is the provision of holistic, young person centred support provided under one roof.

Part III: Interventions


Research suggests that African-Caribbeans are less likely than their white British counterparts to ask for mental health support (Cooper et al., 2013). This is despite research identifying that minority groups as a whole, when compared to the white majority, report higher levels of psychological distress and a marked lack of social support (Erens, Primatesta, & Prior, 2001). Those who do request support are less likely to receive antidepressants (British Fourth National Survey of Ethnic Minorities, 1994; Cooper et al., 2010) even when controlling for mental health symptom severity, with African-Caribbeans less likely to make use of medication for depression even when prescribed (Bhui, Christie, & Bhugra, 1995; Cooper et al., 2013). Studies reporting on reasons for black people being less likely to attend for mental health consultation with their GP suggest a variety of explanations why this may be, focussing both on the suspicion of what services may offer (Karlsen, Mazroo, McKenzie, Bhui, & Weich, 2005) and the concern of black clients that they may experience a racialised service with stigma (Marwaha & Livingstone, 2002). Different understandings and models of mental illness may also exist (Marwaha & Livingstone, 2002). Different perspectives and models of mental health may deter black people from making use of antidepressants even when prescribed. Despite a random control trial showing that African-Caribbean people significantly benefit from targeted therapy services (Afuwape et al., 2010), the government, despite a report by the Department of Health in 2003 admitting there was no national strategy or policy specifically targeting mental health of black people or their care and treatment has not yet built on evidence-based success. One important aspect recognised by the Department of Health (2003), was that of the need to develop a mental health workforce capable of providing efficacious mental health services to a multicultural population. Although there were good strategic objectives little appeared to exist in how to meet this important objective, particularly in the context of research showing that such service provision could show real benefit. The Department of Health Guidelines (2003) focussed on the need to change what it termed as ‘conventional practice’, but was not specific in what this might be, or even how this could improve services to ethnic minorities. There was discussion of cultural competencies without defining what these were or referencing publications where these would be identified. There was a rather vague suggestion that recent work had begun to occur, but no indication that this had been evaluated and shown to have value (Royal College of Psychiatrists, 2001). Neither British Association for Counselling and Psychotherapy nor British Psychological Society makes mention of the need for cultural competencies in organisational service delivery to ethnic minority clients. This chapter will describe, explore and debate the need for individual and organisational cultural competencies in delivering counselling and psychotherapy services to African-Caribbean people to improve service delivery and efficacious outcomes.


Black males often are raised in poverty, exposed to violence and toxic environments that create different levels of trauma that can cause social emotional problems which lead to mental health problems. These problems along with a lack of adequate relationships with teachers can affect their schooling and attainment. No wonder, black males often suffer disproportionately from poor achievement, high suspension, exclusions, and drop-out rates. Young people who struggle in school often lack the social and emotional skills (or “soft skills”) needed to succeed academically, deal with anger, make sound choices, and handle challenging situations constructively, ethically, and manage behaviors that prevent them from being suspended/excluded from school. It does not help that teachers who are often afraid of them, and do not know how to relate to them and lack emotional literacy (EL) themselves. Unfortunately, because of these challenges schools will often place black males in special education classes.

There is a cognitive/non-cognitive divide in education. Most of the school curriculum/pedagogy focus on cognitive aspects of education/learning (e.g., memory-based education) when compared to non-cognitive aspects of learning (social and emotional skills/learning). If our young people are to realize their full potential in our schools, it is crucial we begin educating the “whole child” and increase social and emotional provisions in our schools. It is the cognitive and non-cognitive aspects of learning combined that make young people successful. We need a new educational paradigm/mind shift. After all, educating the whole child makes good sense of course, all learning has an emotional base.

While there has been a proliferation of social and emotional learning programs in schools in recent years, social and emotional learning programs that focus on black males and cultural competence are limited. Therefore, we propose a new framework for social and emotional development/learning model for black males that focus on cultural competence. Our EL/cultural competence model is called teacher empathy, which focuses on relationship black males have with their teachers and therefore focuses on both the pupil/student EL and the teachers. The aim/goal of our model/curriculum is to: improve academic performance, motivate and help both black males and teachers, regulate and manage their behaviors more effectively, and reduce suspensions, exclusions, and drop-outs.


This chapter explores the importance of early autism spectrum disorder (ASD) assessment and diagnosis to facilitate early treatment. This chapter will have a particular focus on ASD assessment and diagnosis within a Black and Minority Ethnic (BME) context. We propose using a Cultural Competence framework to process, analyze, assessment, and diagnosis results/findings. BME assessments/diagnoses can be delayed by up to 18 months longer when compared to Whites.

ASD Assessment aims to assess certain developmental traits in individuals to identify ASD which is a developmental disability. Autism is a spectrum condition which can manifest differently in each diagnosed individual. There are core features necessary for an ASD diagnosis to be made. These include among other traits: poor eye contact, abnormality in body language: for example, gestures, difficulties with social communication and social interaction, often they exhibit repetitive patterns of behavior, have obsessional interests, rigid thinking patterns, and have an aversion to certain sounds and textures and an unusual interest in sensory satisfaction.


The Vocational Rehabilitation (VR) Service System was created in 1973 in the United States as a way to help people with disabilities access necessary supports and services to return to work and live independently. The program receives federal funds and operates in all 50 states and territories. The program is designed to allow consumers to develop a rehabilitation plan in collaboration with a VR counselor and receive necessary services and supports in order to meet their rehabilitation goals. Unfortunately, there are serious issues with access to services and rehabilitation success for minority individuals in the program, particularly African Americans. The chapter will first provide a brief overview of the Rehabilitation Act and its purpose, then we will introduce some of the research that has been conducted to evaluate the program over the years, with particular emphasis on the outcomes for African Americans, and then will focus on a series of studies that have been conducted by the authors in the state of Illinois. The chapter will conclude with some suggestions about ways in which the system could be improved and ways to empower African Americans in pursue of their rehabilitation and independent living goals, including peer-support and supported employment.


If we are to help diminish some of the negative schooling experiences and behaviour often manifested in Black boys, such as frequent displays of anger, defiance to authority, low self-esteem, and their deployment of coping strategies, which further contributes to their disengagement or expulsion from school, we have to ensure that their health and emotional well-being in schools is optimised. Black boys in the UK comprise the largest proportion of young people who have been excluded from secondary schools, and they are often among one of the lowest groups of underachievers in the UK. It is against these bleak backgrounds of underachievement and disengagement from the mainstream education system that this present study posits the argument for increased targeted intervention, not only to improve academic performance but also to improve the emotional well-being in Black boys. Drawing upon case studies of targeted intervention strategies employed in schools and the community over a period of nearly two decades, by the education charity called Excell3, this chapter argues that greater levels of targeted interventions can result in higher levels of social aspiration, educational attainment, self-esteem and emotional well-being among Black boys.

Part IV: Theory and Practice


The increased and varying presence of spirituality within mental health services has assisted practitioners to consider how individual beliefs might shape behaviors, relationships, and communication patterns. Constraints arise when assumptions about the meaning and nature of the spiritual beliefs is associated with an organized religion such as Christianity, which can hinder open inclusion within clinical and supervisory practice. When there is a dominant discourse about how Christianity (and other religions) has inherent and current instances of historical abuse at the foreground, policy-makers have used this as reason to be cautious about open inclusion in practice. This chapter seeks to open a more integrated conversational space between spirituality, reflexivity, and black mental health.

Given there is a great deal of scope for transforming mental health services for Black service users there remains a plethora of possibility for joining systemic reflexivity with spirituality (Cook, Powell, & Sims, 2010). There is less discourse around the applicability of spirituality expressed within leadership and supervisory practice; however, it can play a significant role for leaders, managers, and supervisors who practice from positions of spiritual awareness, orientation, and competence. There is particular relevance for Black African-Caribbean practitioners that consider they have a history of strength-based spiritual approaches and support systems inherent within their cultural identity (Boyd-Franklin, 1989). Consideration needs to be given as to how the associated concepts of collaboration, community cohesion, and support systems might assist professionals within leadership and organizational development roles as part of addressing Black mental health service provision.


Although women are obtaining and maintaining leadership positions in health, education, and social care services, women from Black, Asian and Minority Ethnic backgrounds remain a minority and on the margins. In particular, services working therapeutically with marginalised and oppressed communities often fail to represent the population they serve. In this chapter, the authors will outline the development of an innovative therapeutic service for disenfranchised young people with Black women as leaders. The authors will outline and reflect on how they developed a leadership style drawing on Afrocentric practice, social justice, emancipatory practice and community psychology as they attempted to bring about systems change. The authors will draw on ideas of ‘marginality’ (Collins, 1986) to make visible their experience of ‘be-coming’ leaders, and the challenges that they experienced on several different levels: personal, professional, institutional, political and cultural. It will also examine how race, gender and class intersect in Black women’s leadership experiences, and how they tackle stereotyping in the making of Black female leaders. The chapter will examine how Black female leaders make creative use of their marginal positions to influence and reflect a radical standpoint on self, children, young people, families and community.


This chapter briefly summaries research over the past four decades (and prior) associated with black men and mental health in the UK. The chapter also examines some responses to the research. This is because we unfortunately remain in a situation where black men in Britain are 17 times more likely than white counterparts to be diagnosed with a psychotic illness. Research into the mental health needs of black men has been conducted repeatedly in the UK, with each new generation hopeful for change. By briefly exploring some policies that have emerged to address this inequality, this chapter highlights the barriers to change.


The main theme of this chapter is raising awareness and improving insights and planning abilities in relation to problems faced by people of colour, as individuals and in institutions. In promoting these skills, there is a need to recognize the role played by personal perceptions and emotions in the way in which we construe problems. Here, the author presents a personal construct psychology (Kelly, 1955, Ravenette, 1997) derived approach, which offers a way through the conceptual confusion clouding our thinking about aspects of our lives that concern us, and often leaves us lacking the energy and ability to loosen our thinking and move in the direction of rewarding new attitudes and behaviours.


Border crossing between systemic and racial identity theories can contribute to systemic research on Black therapists work with White families.

Questionnaires were used to gather data from 29 Black, Asian and Mixed Heritage therapists in order to test the significance of variables associated with transgenerational advice, socialisation experience, professional training and therapists’ perception of successful outcomes (n=29). The study concluded that White clients were associated with the contact and disintegration statuses at the beginning of therapy, and that Black therapists were associated with being at least two racial identity statuses in advance of their White clients. In addition, results showed that there was a significant association with eye contact and White clients across all racial identity statuses in therapy, and that the therapist’s age was significantly associated with therapeutic experiences, length of therapeutic practice and the belief in working with unintentional racism in therapy. The outcome of this study will have policy implications in terms of clinical practice and supervision.


The practice of transracial adoption often triggers strong emotions, effecting views on its ethical validity, both from individuals who are pro transracial adoption and those who strongly resist transracial adoption. This chapter will consider transracial adoption of children of African-Caribbean origin and its psychological impact along a continuum of psychological wellbeing, psychological adjustment and aspects of mental health. The chapter will draw on literature from the USA and, where available, from the UK.

One of the earliest publications on transracial adoption by Grow and Shapiro (1974) explored the psychological adjustment of African-American children placed within white American families. This study along with later studies (Silverman & Feigelman, 1981) concluded that the children were adjusting well in placement. Further early research appeared to suggest that transracial placements have little negative impact on issues of self-esteem, racial or self-identity or intellectual development (Curtis, 1996; Hayes, 1993; Hollingsworth, 1997, 1998; McRoy, 1994; Simon, Altstein & Melli, 1994; Vrogeh, 1997).

The undermining impact on mental health for transracial adoptees appears to be an argument related to the disconnect between the child’s developing racial identity and lack of preparation for racism and the cultural and ethnic group social devaluation likely to be experienced in a white racist society. The impact of loss of ethnic identity is said to be a key issue in the research on transracial adoption. Ethnic identity is the connection or recognition that one is a member of a specific ethnic or racial group and coming to adopt those associated characteristics into the group associated cultural and historical connections into oneself identity (Rotheram & Phinney, 1987). The establishment of a secure and accurate racial identity is said to be a protective factor in psychological adjustment. This chapter will explore issues and narratives related to this argument.


An overview of the impact of dementia that focuses on underdeveloped countries across the globe, and migrant and minority ethnic communities within the developed world. Increased longevity increases the risk of dementia and brings new challenges in terms of cultural perspectives and cultural obligations in the care of elders. The chapter examines these challenges in detail and their consequences in planning for support and care.


Mental health is an underdeveloped service to the population generally and to African-Caribbean in particular. There is a need for more sensitive diagnosing, treatment and care. African-Caribbean people are asking for a more culturally competent mental healthcare system.

This chapter aims to address the following issues: how African-Caribbean people reflect on mental health and mental ill health. Their reflections are drawn from interviews done with African-Caribbean people who are involved with Hagar, a mental health charity in Lewisham, London. Mental health and mental illnesses will be examined, followed by the Psychiatrists’ use of the diagnostic tools that do a disservice to Black people. The Trans-Atlantic slave trade and its contribution to the mental ill health of Black people will be addressed, thus providing a historical underpinning for much of Black people’s struggle with mental ill health. Racism and its contribution to mental health issues will be presented. The views of the Black Psychiatrist Franz Fanon will be argued as a way of understanding oppression, alienation and mental ill health in Black people, and going on to open up ways of providing treatment and care. Finally suggestions will be made about how to provide a culturally competent mental health service to African Heritage peoples.


Several decades of mental health research in the UK repeatedly report that people of African-Caribbean origin are more likely than other ethnic minorities, including the White majority, to be diagnosed with schizophrenia and related psychoses. Race-based inequalities in mental healthcare persist despite numerous initiatives such as the UK’s ‘Delivering Race Equality’ policy, which sought to reduce the fear of mainstream services and promote more timely access to care. Community-level engagement with members of African-Caribbean communities highlighted the need to develop culturally relevant psychosocial treatments. Family Intervention (FI) is a ‘talking treatment’ with a strong evidence-base for clinical-effectiveness in the management of psychoses. Benefits of FI include improved self-care, problem-solving and coping for both service users and carers, reducing the risk of relapse and re-hospitalisation. Working collaboratively with African-Caribbeans as ‘experts-by-experience’ enabled co-production, implementation and evaluation of Culturally adapted Family Intervention (CaFI). Our findings suggests that a community frequently labelled ‘hard-to-reach’ can be highly motivated to engage in solutions-focussed research to improve engagement, experiences and outcomes in mental health. This underscores the UK’s Mental Health Task Force’s message that ‘new ways of working’ are required to reduce the inequalities faced by African-Caribbeans and other marginalised groups in accessing mental healthcare. Although conducted in the UK (a high-income multi-cultural country), co-production of more culturally appropriate psychosocial interventions may have wider implications in the global health context. Interventions like CaFI could, for example, contribute to reducing the 75% ‘mental health gap’ between High and Low-and-Middle-Income counties reported by the World Health Organization.


This chapter will consider the media and white western society’s use of various ‘othering’ terms at the personal, social and political levels to misconstrue and inaccurately describe Islam and events and actions involving Muslim people. A psychological analysis of the personal and social impact on the misuse of ‘othering’ terminology will be undertaken to explore how British African-Caribbean converts to Islam, as a group, may find themselves antagonised and alienated by descriptions made about Islamic groups and behaviours misapplied and associated to Islamic religious and cultural practices. The chapter will consider how this antagonism may lead to alienation which, in turn may result in behaviours perceived to come about as a result of radicalisation. The chapter will consider whether British African-Caribbean converts to Islam are responding in a way which is the result of a process of ‘radicalisation’ or more reacting to antagonism and alienation affecting poor mental health due to negative media and dominant social group portrayal of black people. A critique of the media portrayal in depicting Muslims and Islam as ‘the other’ rather than depicting terrorist activity and terrorist groups as anti-Islamic, separate and distinct from Islam will be considered. Missed opportunities for critical review of inaccurate and racist terminology and its potential impact on British African-Caribbean converts to Islam will be explored.

Strategies for decreasing antagonism, alienation and violence through the review of terminology and social reclaiming will be suggested. The process of ethnic identity development and an evolving British Muslim identity will also be considered and how understanding and knowledge of this minority ethnic group identity process can be used to reduce the process of antagonism, alienation and violence. Psychological theories of minority group ethnic identity development will be explored and applied to the development of an alienated psychology of British African-Caribbean converts to Islam. Minority group identity theories relevance for individual and group intervention with alienated British African-Caribbean converts to Islam will be discussed in terms of the building and maintenance of a positive sense of self and affirmation to one’s religious group membership. Affirmation of ethnicity membership is proposed as a more active activity among groups who face greater discrimination as a means of maintaining self-esteem and group cohesion and connectedness.

Part V: Clinical Practice


This chapter opens with the current thinking about sensory processing difficulties acknowledging the works, opposing stand points of the Sensory Integration Community, Ayres and APA and discussing implications for current assessment, treatment options and provision.

An experiential perspective is then presented from Graves’ work as an occupational therapist in CAMHS, from identification of commonly recognised presentations which can indicate sensory processing difficulties which include: ASD, ADHD, ‘fussy eater’, ‘emotional dysregulation’ and ‘meltdowns’ to detailing how these difficulties can be assessed and formulated with use of the sensory profile. Then the authors provide the practical examples of how to screen for these difficulties, explain them to young people, parents and schools and manage them through esnsory activities and environmental adaptations. The contributions from Howl’s experiences by working in the African Caribbean Community Initiative and as a specialist psychological wellbeing ractitioner improve access to psychological therapies for the ‘hard to reach’ population, consideration has been given to adapting these resources with the intention of them being more acceptable and accessible for use in work within BAME communities.

The chapter concludes with questions about the future implications for service provisions for people with sensory processing difficulties and how raised awareness of these difficulties might impact on other evidence-based diagnoses and treatments such as cognitive behaviour therapy (drawing on the authors recent learning on the CYP IAPT CBT course) for anxiety presentations.


In this chapter, we describe the belief system of Izzat which is central among South Asian families. The idea of forced marriage is based upon the concept of Izzat or honor which is a cornerstone of family life in South Asian communities.

Rai (2006) suggests that South Asian community members are deeply affected by what others say about them. The closest English translations to Izzat and Sharam are honor and shame, respectively. Rai argues that Izzat and Sharam are mechanisms that safeguard patriarchal customs such as arranged marriage which are familiar to us from our own backgrounds as two Asian women. It is our belief that Izzat is the highest “context marker” (Pearce & Cronen, 1980) for forced marriages.

We will illustrate the concept of Izzat through two case vignettes and explicate theoretical ideas, based on Izzat to include Borzemyi-Nagy’s ideas about belief systems.

The research of Ryan Brown (2016) University of Oklahoma on “honour cultures” in the USA draws some parallels in gendered discourses about power of men over women. He suggests that high levels of murder rates as well as reluctance to address mental health issues are present in “honour cultures.” These ideas resonate with the strong influence of Izzat upon South Asian family and community systems which we have met in our practice. The development of our practice was in response to issues arising from our clinical work in these communities (Robinson, 2016).

We will explore the continuum of marriage to include forced, arranged and consensual marriage within the context of Izzat and compare with black African and African-Caribbean families.

We will also consider issues of cultural competence and expertness and how this interplays with strongly held belief systems such as Izzat. We will end with some clinical implications and pointers for practice.


This chapter explores the impact of delivering culturally community family therapy with strength-based strategies, to transgenerational Black Haitian families living in Haiti and the Dominican Republic following the 2010 earthquake. A series of workshop intervention over several years, which were co-facilitated by community pastors and leaders provided a cultural-based intervention drawing on Black British and Caribbean culture, Haitian culture, Christian spiritual belief systems, in conjunction with some bi-cultural attachment and systemic methods and techniques. Community feedback through testimonies contributed to evaluation and outcomes in developing new strategies to manage stress, and family conflict and distress, together with developing new strategies in sharing a vision for the future across the community.

Part VI: Recommendations

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