Notes on: Arday, J. (2018a). Understanding Mental Health: What Are the Issues for Black and Ethnic Minority Students at University? Social Sciences. 7.196. 1--25 doi:10.3390/socsci7100196.

Dave Harris

[He wrote this while at Roehampton — PhD? The study is very similar to the one in Arday 2020, about students rather than academics. The description of the methodology is identical in parts. The emergent themes are the same The structure of the rest is the same too -- long repetitive sections of assertions about institutional racism,barriers to access and solutions ( nearly always greater representativeness)]

BME communities experience inequalities in the mental health system and access to HE remains problematic. There are barriers including those in accessing 'culturally appropriate services' including lack of cultural understanding, communication issues and where to seek help. This one looks at accessing mental health services at universities and how this impacts on attainment outcomes and well-being. There are 32 BME University students providing narratives about belonging isolation and marginalisation. The research utilises 'a thematic analysis paradigm' and shows that they 'experience overt discrimination and a lack of access'. There is a need for appropriate languages and greater diversification and a need to dismantle racial inequality within the mental health profession.

Mental health has become increasingly important, thanks to organisations like MIND. Ethnic inequalities are an increasing cause of concern in terms of how BME people access mental health — they are less likely to be referred by their GP, more likely to be arrested by the police, and more likely to have an impact on degree attainment [Equality Challenge Unit, and Tate and Bagguley]. There is a lack of culturally sensitive interventions [referencing his own work 2017] and this reduces confidence.

Data suggests variation between different BME communities — South Asian women have higher rates of anxiety and depression compared with white women, while Afro-Caribbean men have more psychotic episodes than white men [generally?] ,according to MIND. Different ethnic groups access mental health services differently in universities. Minority ethnic people are underrepresented in health research as well. Racialization has impacted on them especially 'institutionally racist structures' [referring to Andrews 2016 -- NB it is a Guardian article]. There are cultural differences in perception and acknowledgement and a global stigmatisation, but raising awareness has 'often been situated within a dominant white and Eurocentric backdrop' (2). Other inequalities are also apparent.

[Now familiar research] shows salient differences in minority group experiences, including issues that could be 'a consequence of continuously encountering varying forms of discrimination' [referring to Wallace et al. 2016]. There is an imbalance in representation, and the social justice element. The result often is incorrect diagnosis and over medication. Safeguarding and promotion of good mental health is however paramount for all communities, and we should especially avoid 'racial descriptions and objectification' of black men in particular, partly because this affects access to opportunity in education and employment. BME users have expressed dissatisfaction about over- diagnoses, over admission to secure psychiatric wards and dissatisfaction with student experience, including exclusion or 'experiences that are not culturally accepting, sensitive, or diverse' [not of his own work cited again]. Eurocentric curricula exacerbates this [so says A and M and Andrews again]. The Academy often fails to acknowledge these specific risks.

Racism is often central. Attitudes towards BME mental health are 'often conflated within cultural context that advocate "resilience" and "strength" over presenting and confronting mental health concerns' [among their own communities? It looks like it since 'stigmatisation within these communities is problematic', but it is exacerbated by a problem of accessibility of resources]

Health and attainment within HE 'have become interwoven against a backdrop of institutional racism' (4), often already experienced in earlier education, especially by young black boys [Andrews again], who can experience trauma and mental fatigue. HE operates within contradictory landscape, seeming to offer inclusion multiculturalism, but also ignoring racial discrimination 'that resides within the Academy' including 'a backdrop of societal and sometimes cultural ideologies that tend to present mental illnesses showing fear, distress, or displays of emotionality'. Some BME students will also have family pressure and high expectations, experiencing a particular stigma. They also face 'patterns of racialised oppression' linked with mental health problems, sometimes as a precursor. They need to be continuously resilient 'in the face of enduring institutional racism' in this can provide severe consequences including a risk of mental health issues and cultural alienation.

Student mental health issues are now more prominent, especially following an increase in suicide attempts. There are ethnic differences as MIND 2013 suggests — nearly 2/3 of those experiencing mental illness also 'often experienced discriminatory encounters with healthcare professionals' including hyper- surveillance within societal spaces, a tendency to advocate medication over cognitive therapies and coping strategies. White students often report more positive experiences. BME students report more isolation and marginalisation [references here include his own 2017 work, and Rollock 2016 — that slender Guardian article!]. That can produce hyper- consciousness exacerbated by 'unwanted surveillance' producing solitary experiences which get intensified in discussing 'culturally sensitive information. This is increased by a lack of diversify to staff and students especially at Russell group institutions and this 'will inevitably impact upon attainment', say Tate and Bagley.

So there is a problem and still a lack of literature on the impact on BME communities despite some recent attempts. In equitable access to mental health services 'create a discerning chasm [sic]' (5) between receiving support and sliding further into illness. There is a lack of culturally sensitive help and support, leading to more self-reliance, which is particularly poor for the early symptoms. This is not the case for white students. The absence of extensive networks is a pertinent factor. It is difficult to 'glean' the voices of those suffering because of the stigma, meaning there are difficulties in building trust in pastoral interventions or medical systems, and this is often mentioned by BME individuals [and by other research]. Language needs are additional barriers and healthcare services 'require modernising' for multicultural societies.

The 'centrality of whiteness is continuously facilitated through aspects of curricular, poor diversification, and racial descriptions regarding the attainment capabilities of ethnic minority students' [referencing Alexander and Arday 2015 and Law 2017, which also does quite a lot of work] (6). In equitable terrain means mental exhaustion and an impact on attainment. Discourses mentioning resilience or a connection with religious faith are common and have often trivialised mental illness as frailty and this can only accelerate loneliness and marginalisation. There is now also a strain on pastoral services as universities expand and we need to glean the voice of BME people to re-evaluate our discussions, to promote access to health research, better engage ethnic minorities, provide more inclusive platforms, build relationships through community representatives.

Many ethnic minority students have already 'traversed systemic and institutional racism in some form throughout their lives', and this has impacted their worldview. The Academy is an exclusionary place for the same reasons given above, and with the same consequences. There is a lack of pastoral interventions 'with an ethnic focus. 'Traditional enrichment activities often ostracise BME students', or may conflict with their cultural or religious beliefs. Student accommodation might provide experiences of discrimination and exclusion creating 'feelings of angst, marginalisation, and exclusion' [again] (8) the same might apply to other minority groups. There might be gender differences — one study at the University of Bristol found that '66% of black men found it easier to assimilate… Through integration with clubs and societies… [But] 71% [of black women]' found it more difficult. Eurocentric curricula is particularly important as a catalyst.

The barriers [again!]. 'A predominantly dominant white environment'and the non-diversify pastoral service. The difficulties of catering for well-being for BME students who are often excluded. [An awful lot of repetition again pages 8 and nine — wider recognition, racial ascription of mental illness, stigmatisation, the need for more diversity and all].

The solutions [again]. Diversification [and here we see the problems with BME as a classification — recruit lots of Philippine councillors so they understand the problems of black African men] [same old same old. Culturally inclusive spaces. Inclusive dialogues]

Hurray! The study! On page 10!

14 UK-based universities, from Russell group to post 92. 32 BME individuals between 18 and 34 year old, from UG and PG. 32 semistructured open ended questionnaires on their ethnic origin, gender and age range 'for monitoring purposes'[typicality?] and general information on experiences with mental health 'either personally or with friends or family to help inform the development of the focus group and individual interview questions' (10). Two unstructured focus group interviews and 32 40 minute semistructured individual interviews with all participants. They got the participants after 'recommendations with several African and Caribbean University societies, [and] with social media platforms'. They also used convenience sampling to diversify the pool… To ensure that the samples as representative as possible [an identical rubric to the study in Arday 2020, including depositing the questionnaires in the ballot box, and classifying ethnicity according to the ONS. It looks like standard boilerplate from some methods textbook. They also asked for level of education and marital status — why? Monitoring?]

The objectives of the study were explained to the focus group participants and discussions were facilitated by the researcher they were all audio recorded [boilerplate again]. This time they did have 'candid conversations' [no they didn't -- see below] . The researcher again developed a 'topic/discussion guide about access to mental health services at the University and the local communities – '(1) what are your perspectives on mental health? (2) how do ethnic minorities deal with mental health issues? (3) do you think mental health and psychological services are made accessible to BME individuals within universities and wider society more generally (4) culturally, how mighty encounters with mental illness differ for ethnic minority men and women in comparison to white people? (5) how can the current mental health/well-being services provided be improved for BME individuals within universities and society more generally? (10 – 11). [Bloody awful again].

Then a thematic analysis and NVivo to identify key themes, full coding iterative processes, some recognition of 'some organic bias' although 'all protocols were administered to ensure objectivity' (11) and another researcher was enlisted for data analysis. Anonymized quotes were used. However first it is important to 'unpack the paucity of mental health interventions available'. Nevertheless, some very familiar general themes were identified [partly from Bhopal]  — 'personal environmental factors, relationship between the service user and healthcare provider situated around power and hierarchy, together with some sub themes. There is a natural crossover between University health provision and NHS provision. The research is not invasive but wanted to glean potential issues.

Guess what? Discussing more candid accounts did not transpire because the researcher was advised by mental health professionals that it might trigger phases of trauma [my guess is virtually identical phrasing here as well]. [I wonder what the themes and sub themes will be?]

Recognition of health problems and fear of stigmatisation was a theme, and one respondent said that she was afraid of being stigmatised, enhanced by arriving in an all-white university. Social networks were lacking. Health professionals had no knowledge of your '"racialised plight"', and a black male said that they were already aware of being stigmatised.

Social networks were lacking, while health professionals were often '"quick to make misinformed judgements"' about the ones that people did belong to like single parents or gangs. Some social networks could be supportive but also a barrier by demonising official services or advocating alternative treatments, or stressing historical distrust.

Gender differences were important for 'many participants' (13), so men are expected to keep things to themselves, and classic male identity was seen to involve private strength and resilience. Sometimes this was strengthened by ethnic families who viewed mental illness negatively also it is a collective stigma.

Aspects of power and hierarchy included language [the quote here looks awfully like the one in the 2020 study]. Universities were blamed of course for failing to provide multicultural and diverse student populations. It was exhausting to always have to explain black experiences. Poor diversification is exhausting as well. White discomfort was also noted together with a failure to conceptualise or empathise [this is also familiar] clinicians sometimes a scene is showing patronising or condescending behaviour or abusing their power, and again greater diversification is recommended. Professional opinions were hard to challenge.

So this study identifies key barriers and says these are likely to be shared with other minority groups. One theme stresses the inability by mental health professionals to 'recognise and accept symptoms as mental illness when engaging and diagnosing BME patients' [I didn't think this came over particularly well (16). This was a particular problem if individuals already came from cultures and communities where mental illness was trivialised or stigmatised. These minorities felt they were continually on the periphery. Use of mental illness are too narrow or associated with culturally unacceptable behaviour, so symptoms were often unrecognised — including 'among families communities and friends' who often preferred 'intervention such as prayer and family and community mediations' (17).

Negotiating discriminatory or racial environments 'was a significant determining factor in the onset of potential mental illness' [and Sivanandan is cited here], apparently revealed in a 'general consensus'. There are somatic associations, physical symptoms which are often diagnosed, hence the stereotype of being 'aggressive, violent, economically poorer, unemployable and welfare dependent'. Language was barrier and often led to misunderstanding and misinterpretation. Some research found in fact that ethnic differences in experiences were 'largely due to language', and the problems of articulating symptoms and concerns, extending to dialect and accents. Poor English is also used as an excuse and 'culturally specific nuances and subtlety' in expressing mental health problems may provide a further barrier [none of this appears in the study].

There was a continued emphasis on the stigma within their own communities leading to people concealing symptoms and delaying seeking help or not sticking to treatment. [This is blamed on] 'cultural naïveté and insensitivity within healthcare services' (18), and, 'in many ways the mental health service does not, unfortunately, recognise some of the deeply entrenched institutional racism that permeates wider society'. Research apparently shows different findings on whether ethnicity has influenced experiences of care, although this is a common 'narrative posited around the University', it was found in the research, and it was 'consistent with previous research'.

The importance of social networks appeared, and a recognition that these can sometimes act as a barrier or alternative meaning that people from a BME background are sometimes less likely to contact their GP. Of course 'in part, this may be due to feelings of marginalisation and exclusion within universities, especially those situated within majority white populations… A lack of trust in mental health services'. Ethnic minority men in particular 'were a hard to reach group' and had 'a feeling that mental services tended to exclude and stereotype them' supported by previous studies [none of this emerges from the actual study either].

[To no one's surprise] greater diversification seem to be an important factor, and the fostering of positive relationships, the perception that there was 'overarching centrality and hegemony of whiteness' (19) [but referenced to Grey et al., not the actual study]. [However we can be reassured because] 'the findings in this study coincide with previous research… Which indicates that this power could represent a hierarchy [!] And present difficulty if service users or families challenge a professional diagnosis'.

So mental health services were limited. There was a reluctance to offer cognitive alternatives, although other research provides a more mixed picture about treatment options. Other studies also show that factors such as distance play a part, which only goes to show how important diversity is [geographical though?] .

The majority of participants in his study were currently studying at university, so 'the perspectives expressed throughout may not represent the views/perceptions of all strata of the BME population', and other studies show differences. They could not do a comprehensive analysis of 'ethnicity specific barriers'. Some questions were not answered for personal reasons especially for Black men. There might also have been selection bias. However 'there is scope to suggest that BME individuals are subject to significant barriers, which are situated within an institutionally racist society' (20).

There are implications for development of more effective and culturally applicable mental health services, a more 'practical and systematic discussion focused on better outcomes, overcoming the barriers, 'disrupting inequitable structures which omit ethnic minorities'. The findings 'presented advocate and endorse penetrative and policy driven actions' and contribute to 'ongoing dialogue' and could provide a stimulus for further development. [ a note says that he should have looked at complementary and alternative medicines, especially as 'this particular phenomena [sic] has proven to be particularly successful among ethnic minorities']

[Yet another] conclusion and recommendations. We've gleaned the perspectives on barriers and we can now translate them into tangible effective actions to remove them. We need to raise awareness of mental health issues, reduce stigma, diversify healthcare staff, better inform service users from BME communities. Change 'the cultural paradigm' to raise awareness of available mental health services and empower individuals and communities. This will require additional financial services, 'to undertake compulsory continuing professional development training for further understanding cultural issues and differences in the sensitive the diverse needs of ethnic minority service users'. Everyone wanted more diversification because practitioners 'may be more empathetic towards understanding the plights and experiences of ethnic minorities' and this will also improve ethnic representation and reduce racism and isolation. Black students and BME people do 'experience mental health differently. These experiences are often situated and tinged within racist connotations… Deeply rooted in different systemic issues' (21). We have to dismantle institutional racism.