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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.

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

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.

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.

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.

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.

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.

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.