Race and racial identity
Mental health and race are two complex aspects of the human experience that intertwine intricately, often contributing heavily to lived experiences. The more diverse our societies become, the more important it is to explore the connection between mental health and race.
Here, integrative therapist Nathanya Legesse (MBACP BA Hons), explores themes like the social construction of race, racial identity and intersectionality, stigma around mental health, and how counselling can be helpful. To understand the link between race and mental health and how therapy can be beneficial, let’s take a look at some key terms and definitions.
Race as a social construct
To understand the intersection of mental health and race better, let’s look at the concept of race itself. Race as a social construct means that divisions between racial groups are not biologically determined but constructed by other factors, for example, societal norms, historical contexts, and power dynamics. Both the present-day and historical impacts of this construct are very widespread and can include an individual’s mental health.
Those who are from racial minorities are more likely to experience a higher risk of mental health issues because of contributing factors. Some of these include discrimination, socioeconomic status, lack of culturally competent care, and a lack of representation in professionals who work in the field.
Counsellor Fiyaz Mughal (OBE FCMI MBACP) talks about his experience of discrimination growing up in the UK as a person of colour and the mental health effects of racism in his article, Race, identity, racism and anxiety affect many people of colour.
Nathanya explains the term 'racial minorities' further:
"The term racial minority is not intended to undermine the experience of anyone who might otherwise use the identifier 'global majority'. It’s used to highlight the lived experience through the contextual lens of the environment most of the readers of this page are from, the United Kingdom. For example, evidence has been found showing that racial minority groups have more stigma toward mental health issues when compared to the racial majorities in the Western world." 1
Identity
Although race is a social construct, it’s impossible to deny the importance of race in forming someone’s identity in the 21st century. An important concept to consider when thinking about a person’s lived experience is intersectionality. Coined by Kimberle Crenshaw, intersectionality acknowledges that individuals hold multiple identities at the same time, such as race, gender, sexuality, socioeconomic status, and more. These identities intersect and interact, influencing one another and creating unique lived experiences.
A black heterosexual middle-class man will have a very different lived experience compared to a black bisexual working-class woman, even though they are both black.
It is crucial to acknowledge all the complex layers of a person’s identity to better understand their distinct lived experience. The Intersectionality: Wheel of Privilege2 diagram below illustrates the levels of privilege that are related to having a particular identity.
'Privilege' can feel like an unfriendly term that can lead to people feeling angry or ashamed of themselves. However, addressing privilege is important in helping us understand both our individual experiences and the experiences of others. This helps when it comes to looking at the link between mental health and race. The characteristics that are closer to the centre of the wheel are associated with being more powerful within Western societal dynamics. The same person can experience both advantages and disadvantages.
Stigma
Stigma is a barrier to seeking help and receiving care. It can spread negative stereotypes and attitudes, leading to shame, secrecy, and fear surrounding mental health issues. People from minority groups tend to come up against stigma toward mental health within their communities. If you’re a person from a minority group and have experienced this type of stigma, this may have led to feelings of fear, secrecy, and shame. The lack of representation amongst the professionals working in mental health can also add to the stigma of reaching out for help.
A recent study3 discovered that BAME individuals are disproportionately represented in the psychology profession. BAME is an acronym for Black, Asian and Minority Ethnic. For those who identify within the BAME category, it can be challenging to access any type of mental health service if you already feel you might not be understood due to your differences. This lack of ethnic representation in the mental health profession might mean a lack of cultural competency (awareness of personal cultural beliefs and how these may differ from other cultures) in the workforce. This can act as a barrier when trying to access services and lessen the effectiveness of any mental health treatment received.
The use of the term BAME as an umbrella term to include Black, Asian, and Minority Ethnic people in these types of research might seem helpful but further consideration of it shows that there is a ‘bunching together’ of vastly different ethnic groups with potentially extremely diverse sets of experience. By not specifying the experience of each ethnic group separately, the idea that they all face the same issues is perpetuated.
A significant issue with using the term BAME is that it collects different ethnic minorities, who face different challenges from one another and compares their experience to the white majority. Ultimately, this is a disservice to all the people who fit underneath that umbrella. The experience of people within the same ethnic group will also be unique. This is where using the wheel of privilege as a lens can be helpful to explore your unique experience further.
The Commission on Race and Ethnic Disparities recommended that the government stop using the term BAME in March 2021.
When we look at mental health and race, intersectionality and identity show the need to consider the diverse experiences of individuals belonging to various racial and ethnic backgrounds. A person's mental health challenges cannot be understood in isolation from their racial identity. Cultural, societal, and historical factors shape how mental health is perceived and experienced within different racial communities. This is important to get to grips with before exploring the benefits of counselling and mental health treatments.
Racial identity: Counselling
Now we have looked at some potential barriers to mental health support, let’s talk about the benefits of counselling. Counselling can play an important role in addressing the intersection of mental health and race. It can provide you with a safe and supportive space to explore your thoughts, feelings, and experiences.
How can counselling help?
Within the therapeutic space, you, as the client, can begin to discover the impacts of mental health and race in your lives alongside a trusted professional. Having a witness to this journey can lead you to feel seen and validated in ways that may have not been possible in other relationships. Counselling can be a powerful tool for addressing mental health concerns within the context of racial identity.
What can I expect from a counselling session?
From a typical counselling session on this topic, you can expect the counsellor to engage in some of the following:
- Address the barriers of stigma and discrimination.
- Offer culturally competent care.
- Explore your racial identity and how it relates to your mental health.
- Promote self-care.
- Offer a trauma-informed approach.
- Advocacy and signposting resources.
If you would like to know more about how counselling can help you deal with racism, you can read more information on our Racism page. This talks about how to practice active self-care and goes through the steps you can take to find a counsellor.
The responsibility of counsellors
Below, Nathanya explores the responsibility of therapists from both the perspective of being a client in the therapy room and as a trained counsellor. This can help when understanding why it’s important to talk about race in the therapy room.
"Counsellors have their unique ways of working with our clients. What I suggest below is informed by my lived experience as a black male counsellor in the UK; a black person who has been in counselling as a client, and through my therapeutic training. Counsellors must educate themselves on subjects they are inexperienced in. Education and awareness can help bridge the understanding of some major differences between counsellors and clients while leading to more culturally competent care.
Some counsellors are unsure or have differing views on whether or not to speak about race with their clients. I believe it is crucial that counsellors do this. Both ethnic differences and similarities between a counsellor and client are physically visible in the therapy room and remain non-verbal unless they are spoken about. One issue with this is that a lot can be assumed on both ends. For example, if I begin working with a black male in therapy, it would be easy for me to think that we have similar lived experiences when in reality this might be very far from the truth. Another issue about avoiding discussions around race, especially as a white counsellor working with ethnic minority clients, is that the client might feel that race is a taboo in the therapy room and is not welcome. This has the potential to be very damaging.
One example question that I ask my clients quite early into the therapeutic journey is what it is like for them to work with a black man. There are other ways to talk about race in the therapy room and counsellors should find ways that work for them. Acknowledgement like this can go a long way to enabling a client to feel seen and potentially express themselves honestly. If there is a discomfort around speaking on this subject, I’d encourage counsellors to undertake some personal exploration to understand why that is the case."
Further help
- Racism
- Mind: Racism and mental health
- Let’s Talk About: Race in the Therapy Room
- Anti-racism resources March 2023: Intersectionality of privilege
References
- 1 Eylem, O., de Wit, L., van Straten, A., Steubl, L., Melissourgaki, Z., & Danışman, G. et al. (2020): https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-08964-3
- 2 Wheel of Intersectionality: https://www.dpag.ox.ac.uk/work-with-us/equality-diversity-inclusion/anti-racism-working-group/anti-racism-resources-march-2023-intersectionality-of-privilege
- 3 York, K. (2020). BAME representation and psychology. The British Psychological Society, 33(1), 4: https://www.bps.org.uk/psychologist/bame-representation-and-psychology
This page was written in September 2023 by integrative counsellor Nathanya Legesse (MBACP BA Hons).
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