We need to talk about race and mental health; lessons from the research

“Racism isn’t a product of race: race is the (invented) product of racism” — Prof. Dorothy Roberts

Black Minds Matter UK (led by amazing Zinc Pioneer Agnes), connects black individuals and families with certified black therapists. If you’d like to support this important initiative, please click here

It’s impossible to write on this topic without touching on what’s happening right now. Systemic racial inequalities have been exacerbated by a global pandemic, playing a huge toll on our collective physical and mental health. Today’s article shares lessons learned from Dr Stephani Hatch’s research on the relationship between race and mental health, and considers the impact of racist algorithms and perspective-shifting VR.

Next week 👉 Are we measuring national success by the wrong metrics? The importance of improving population-wide wellbeing

If you just landed here — this article is part of a ten-part series providing bite-sized expert insights on mental health topics (from world-class speakers via Zinc) and my thoughts on the role tech can play in addressing these themes (part of my day job at Kamet). All smart ideas come from the speakers and my peers — all poor phrasings and misunderstandings are my own.

What you’ll learn from this article 🧠

Our expert speaker on this topic, Dr Stephani Hatch, discussed the interrelation of race and mental health and the state of our current research. Big idea 1: racism is embedded in our institutions, and discrimination impacts mental health. Big idea 2: before we conduct research or suggest interventions, we need to ask ourselves what we’ve done for a community and why they would want to engage. Our discussion centred the subjective nature of race in data collection and the use of the term ‘BAME’. Technology thoughts range from VR tools to help leaders understand the reality of discrimination and the impact of racist algorithms on teenage mental health.

The big ideas 💡

• Racism is embedded in the institutions we live and work in, and studies show that cumulative exposure to racial discrimination has incremental negative long-term effects on the mental health of ethnic minority people in the United Kingdom. There needs to be more research on healthcare practitioner biases and discrimination but EMR data from Northern California showed that Black and Hispanic men were 2x less likely to get pain medication when arriving to A&E with a complex factor, due to biases around drug-seeking behaviour. This bias unfortunately continued into paediatric A&E. Race-based discrimination can change over time — around Brexit, ‘white-other’ individuals (including migrants from Eastern Europe) reported similar discrimination levels to black or mixed ethnic minority groups.
• The value of community engagement: we won’t fix the race data gap by ‘helicoptering’ in to conduct more research. Mistrust of public services is justified by peoples’ experiences and anticipation of discrimination across services (e.g. policing, local government, healthcare). Before you engage with a community for research purposes — consider what you’ve done for them & how you can engage with the wealth of knowledge already present in community leaders. Reframe from ‘what are the barriers to seeking treatment’ to ‘why would you seek out health services?’ to think from the patient perspective. Also, recognise that harmful behaviours look different by community: self-harm for some might mean punching walls, going to areas where you’re likely to get into fights — unless you know this, you won’t know what to look for.

Discussion points 🗪

• Is the term BAME problematic? It lumps together a wide range of people with different experiences and levels of discrimination. Especially for driving research and interventions, we need to be focused when delivering against limited budgets. As a group, we reflected on the various ‘ethnicity’ responses we’ve put on forms — those from multi-ethnic backgrounds said it could depend on their mood. Without specificity, we’re potentially losing out on valuable data and research insights
• What roles can we all play in driving racial inclusion in the workplace? Inclusion requires leadership and accountability, so it’s important to consider how it aligns with your company’s vision, how it can be practiced on a regular basis and any impacts on ways of working. Starting these conversations can be tough, but they are important to start to embed racial equality into your company culture.

Technology thoughts 💻

• Algorithms can perpetuate racial discrimination — either in their design or in amplifying discriminatory voices. This Atlantic article sets out the challenge clearly: Black teens experience an average of five or more instances of racism daily, many of which are experienced online. Echo chambers and radicalisation pipelines are dangerous in reducing empathy, but especially worrisome for younger users. Teenagers have less intense fear responses than adults, making them more curious but also impulsive and likely to engage in risky behaviour, whilst instances of race-based trauma have longer-lasting effects when experienced in adolescence.
• ‘Walking in the shoes of’ is a VR NHS education tool funded by the Wellcome Trust to allow people to witness discrimination and bullying as the victim. It’s being supported by longitudinal qualitative and quantitative data from NHS employees. (For a more cinematic take — there’s The Look from P&G). It’s important to make sure that the tool is widely accessible, and the declining cost of VR equipment has helped with this, as will getting it to the right system leaders. Interestingly — anecdotes suggest this VR approach could help minority staff who currently undertake the emotional labour of sharing their views and perspectives, without necessarily seeing results. VR could be a scalable way to change perspectives

Reading list 📚

• Discrimination and common mental disorder among migrant and ethnic groups: findings from a South East London Community sample
• Levels of racism: a theoretic framework and a gardener’s tale
• Self-reported experiences of discrimination and health: scientific advances, ongoing controversies, and emerging issues
• A systematic review of studies examining the relationship between reported racism and health and wellbeing for children and young people
• Cumulative Effect of Racial Discrimination on the Mental Health of Ethnic Minorities in the United Kingdom
• How racism makes us sick
• How the Racism Baked into Technology Hurts Teens

Speaker bio 🔈

Dr Stephani Hatch is a Professor of Sociology and Epidemiology at the Institute of Psychiatry, Psychology & Neuroscience, King’s College London. Stephani leads an interdisciplinary research programme and public engagement activities focused on urban mental health; inequalities in mental health and health services; discrimination; and young adult mental health.