It is really important to educate Black, Asian and Minority Ethnic (BAME) communities on Mental Health and Wellbeing but it is even more crucial to educate BAME women and families on Perinatal Mental Health (PMH) and wellbeing.
I recently attended a Perinatal Mental Health (PMH) event and watched a very important film about the experiences of women with mental health issues during the perinatal period. I loved the clip and thought – fantastic, I can use this in the PMH workshops that I deliver locally as part of pregnancy and birth education. Then it occurred to me – I don’t any see the Black or Asian women, New Arrivals - regardless of colour and vulnerable women such as teenagers or those living in the lower socio-economic strata. It seems that once again even though BAME communities especially Black women represent higher in mental health settings and health disparities in general, BAME pregnant women are not represented when it comes to looking at solutions.
Why are BAME women presenting late with perinatal mental health conditions?
In the same event a data analyst discussed the fact that White women present earlier with PMH issues and get treatment which essentially is similar regardless of socio-economic background or postcode. Whereas, BAME women present much later and their treatment has wide variations – meaning dependent on where they reside is dependent on the care they receive.
This got me thinking – what are the barriers stopping BAME women presenting earlier and why are they receiving such variations in their care? I have already developed workshops in the local community discussing PMH and how it affects women and families from different ethnicities. It covers the basics of the different kinds of conditions, signs and symptoms, risk factors and what helps in terms of self-help, professional help and help from family and friends.
However, in my opinion there are differences when it comes to BAME PMH and I want to go through them here.
Recognising signs and symptoms. BAME women go through so many stressors that sometimes they don’t even realise they are not well until it’s too late. There are a number of issues, ranging from race, culture and gender bias in institutions from work to antenatal venues, socio-economic factors, family and community beliefs around motherhood and mental health/illness.
Understanding the risk factors. Including socio-economic factors, trauma, birth trauma, race & racism, ethnicity, language, gender inequality, migration, domestic situation.
There are so many risk factors around perinatal mental health in general but women of colour face many different challenges that white English women do not face. It is important to also note that women of all colours with a number of vulnerabilities also face many risk factors but I am concentrating on women of colour and their experience of intersectionality. Intersectionality is in itself a major risk factor.
Barriers to seeking help. Language and cultural barriers, fear of discrimination and stereotyping when seeking help puts women off. Fear of the unknown – ‘what will happen to me?’, ‘what will happen to my children? The community knowing that she has a problem is also a barrier, in some communities mental health problems are kept hidden. Previous traumatic experience in a health setting can also be a barrier.
Social Service involvement and surveillance. BAME fear that if they disclose a MH issue they may/will lose their children through social services or safeguarding intervention. Black families are scrutinised more closely than white families, a small cry for help can turn into a woman losing her children to the system. While there is little research in this area it will be interesting to find out the rate at which BAME children are taken into ‘care’ compared to white children and the reasons as to why.
Stoicism and the strong black woman. The image of the strong black woman is not entirely a myth. The struggles of intersectionality such as racism, socio-economic status, prejudice and discrimination makes a BAME rise up when and where she needs to. However, this presents a problem, as when she is in real need of support, she may not acknowledge that there are issues around her mental health and overall wellbeing until it is too late.
Community stigma. Communities and families need education around mental health issues and what constitutes good mental health and the risk factors for poor mental health. The community is often the place people turn to when they are in need – we need to make sure it is ready and equipped to support people in distress.
Places of Worship. Religion can be a comfort but it can also be a hinderance to getting the right support – as with communities, religious settings need better mental health and wellbeing literacy. It matters not the belief but it matters how perinatal women and the wider community are supported when they have a mental health issue.
Stigma around MH issues and motherhood. For some women and their families, the fear of stigma around MH problems is greater than the need to seek help. Some communities can ostracise women and their families if there is any indication of a MH problem. If the culture does not support the perinatal woman it can be detrimental.
Hospital and medication. BAME in particular the Black community (speaking as a Black woman) fear hospitalisation with an intensity, having watched members of the community institutionalised, drugged and not recovering or living well with their mental health condition has put people off going to hospital. The well documented racial bias in the health system means BAME women do not trust the process that they will or can recover and they believe medication will make them worse off, affect their pregnancy or disrupt breastfeeding if this is how they choose to feed.
So, what are some of the solutions?
Education around the sign, symptoms and risk factors
These are only some of the issues I have come across while being a carer an engagement specialist and a Mental Health First Aid Instructor. I believe there is a lot more that is happening under the surface.
There are numerous studies in the USA about Women of Colour and PMH, the UK has limited research on this issue. I aim to look further into this and write more about it.
Places to go which are culturally safe and appropriate
PMH services tend to be in hospital settings. There is a need to have more community-based settings where women can go to feel safe and secure. There needs should be met in terms of their perinatal care as well as their MH issues in culturally safe spaces.
Education for family and community as well as mom
There is limited PMH education classes that target the whole family. Families can sometimes think that maternity services are only for women and MH services are for the mad. However, it is important to integrate PMH education as part of antenatal sessions and community education.
We also need:
· Trained and skilled BAME peer supporters for families going through a period of perinatal mental instability.
· Advocacy and empowerment services in communities so professionals can link with them and offer more wrap around services and not just the clinical model.
· Perinatal safe spots – places where mom can be listened to and heard.
· Social Services and the disparity around removing children of colour/religion or other beliefs need to be addressed if indeed it is an issue as I suspect - again more research is needed.
· Cultural competency training for professionals to address their own racial bias.
· To be sectioned or not to be sectioned – Education around voluntary v forced hospitalisation
· Knowing about Specialist Mother and Baby Units, what happens in them and how to access them.
· Understanding medication and its effects on mother and infant.
· Better research is needed for all of the above.
How can you help someone through these issues?
· Attend one of our free PMH workshops in Birmingham, Sandwell or The Black Country.
· Educate yourself in other ways around the signs, symptoms and risk factors that affect BAME women
· Be part of the solution
· Create culturally safe spaces where women can meet, talk and chill out.
· Be practical in your support
Join the conversation – please share your story with me.
If you have experienced any of these issues please contact the following organisations for help and support.
- Acacia Family Support
- Action on Postpartum Psychosis (APP)
- Association for postpartum Illness
- Maternal OCD - Peer support available, email info@maternalocd.org
- PANDAS
Helpline open from 9am-8pm every day – 0843 2898 401
Email support available – info@pandasfoundation.org.uk
- Samaritans
Tel: 116 123 (this is a free telephone number and will not appear on the phone bill)
Web: www.samaritans.org
Email: jo@samaritans.org
- Tommy’s
0800 0147 800 Mon – Fri 9am – 5pm
Email: midwife@tommys.org