3.3 The mental health of young black men
According to the Health Development Agency, ‘Young black men are over-represented in the mental health statistics’ (McManus et al., 2016), particularly in terms of diagnosis for schizophrenia, which is generally seven times higher for the African-Caribbean population than for the UK white population (Fearon et al., 2006).
Young black men are over-represented in hospital admissions for mental health problems, contact with psychiatry via the police, courts and prison, and at the same time are under-represented in outpatient and self-referral services (Powell, 2016). They are more likely to be admitted to mental health facilities compulsorily, and once there, more likely to be placed in locked wards. African-Caribbeans generally are over-represented in statistics for psychiatric disorders and under-represented in neurotic disorders, a global term used to cover minor psychiatric conditions such as anxiety, depression, obsessional and phobic neuroses (Shen et al., 2019). Schizophrenia and ‘cannabis psychosis’ are often given as the diagnosis, but the validity of both of these has been questioned by researchers (Ksir and Hart, 2016).
Activity 6 Young black men and mental health
How can young black men's experience of the mental health system be accounted for? Make a list of any possible explanations that occur to you.
Writers and researchers have offered a range of different reasons for young black men's apparently disproportionate experience of mental health difficulties, and for their particular experience of mental health services. The remainder of this section provides a brief summary of some of the most common explanations.
Explanations that rely on racist stereotypes of black people in general, and young black men in particular, are now academically and politically discredited, but it can be argued that their influence lingers at the level of popular assumptions. In the fairly recent past, it was not uncommon to read ‘explanations’ of poverty, unemployment or health problems among minority ethnic groups that pathologised black people, their family structures and cultures. This kind of stereotyping persists in more recent debates about young people of Asian origin, which attribute their mental health and other problems to the supposed roles and relationships within Asian families. Avtar Brah has criticised this kind of ‘ethnicism’ which ‘defines the experience of racialised groups primarily in “culturalist” terms’, and views cultural needs as ‘independent of other social experiences centred around class, gender, racism or sexuality’, with the result ‘that a group identified as culturally different is assumed to be internally homogeneous’ (Brah, 1992, p. 129).
Along similar lines, Hall et al. (2015) criticises the ‘racialisation’ of health research, as individuals can often be divided into ‘ethnic’ or ‘racial’ groups and these categories can be used for explanatory purposes. Research has demonstrated that compared with white people, people of colour face more barriers to accessing care, which includes preventive services, acute treatment and chronic disease management.
Critics of ‘culturalist’ explanations, such as Brah (1992) and Hall et al. (2015), tend to attribute young black men's experience of mental health problems to the impact of institutional racism. However, even if the impact of racism is admitted, there are at least two distinctive ways in which it can be said to have impacted on mental health.
One account offers what you might call a ‘realist’ model, seeing young black men's mental health difficulties as real rather than imaginary, and laying the blame squarely on their experience of institutional racism. For example, Tony Sewell (1997) argues that the UK school system provides young black men with a choice between two strong models, either to conform and be more British than white people or to play up to the stereotype of the rebel. He suggests that expectations by the wider society can create identity problems for young black men, and that these may lead to mental health problems.
A more ‘constructionist’ argument is proposed by Hankerson et al. (2015) who suppose that misunderstanding around diagnostic analyses might lead providers to misdiagnose young black men as a result of negative perceptions, lack of knowledge and stereotypical expectations.
These two accounts are not necessarily contradictory. It is possible that young African-Caribbeans are both more vulnerable to mental health difficulties – due to their experience of racism at school and in the wider society – and treated in a discriminatory way by mainstream mental health services. As you saw in the case study of eating disorders in Section 2, a critical perspective on young people's wellbeing sees the development of health ‘problems’ as complex and multi-layered, with individual, institutional and broader social factors interacting with each other.
This section has used the example of mental health to explore some of the ways in which young people's wellbeing is shaped by social divisions, such as those of gender and ethnicity. Although class has not been discussed in this section, there is evidence from the work of MacDonald and Marsh (2005) and others that poverty and social exclusion also play a significant role in shaping young people's mental and emotional wellbeing. The ways in which diversity and inequality impact on wellbeing challenge generalised narratives that tell of a general ‘decline’ in young people's health. The complex interactions of social and cultural contexts with individual experience that you have seen demonstrated in these examples also undermine any attempts to produce straightforward or simplistic explanations.
Section 4 of the course moves on from analysing young people's experience to exploring ways in which their wellbeing can be developed and promoted, taking forward the critical framework that you have been using here.
While mental and emotional difficulties can be viewed as a feature of ‘normal’ adolescent development, there is evidence that some groups of young people are more vulnerable than others and that the experience of mental health is influenced by factors such as gender, class and ethnicity.
Young people's experience of mental health is strongly gendered, with young women at greater risk of eating disorders and self-harm, and young men having higher rates of suicide.
Young black men appear to experience a disproportionately high rate of mental health problems and to suffer from institutionalised racism at the hands of mental health services.