31 August 2021

Mina Hadi is one of two BAME Experts by Experience leading the PCREF (Patient & Carer Race Equality Framework) project across ELFT. The first stage is a questionnaire aiming to make mental health care more racially sensitive. Mina shares her views on why the PCREF project is so important.

What has inspired you personally to take such an active role in working to improve mental health services for BAME service users? 
 
I think the biggest factor in my involvement with the PCREF project and more broadly across mental health services is the continued impact of stigma surrounding mental health. I feel that stigma in BAME communities is often misunderstood: the conversation begins and ends at acknowledging an increase in stigma in attitudes towards mental health. We never get into why that is, and I've always felt that the onus is placed on BAME communities as a whole for that stigma. 
 
But I have a counterpoint - maybe the reason why accessing mental health care is so steeped in shame and stigma is actually because of the inequalities that service users of colour face. Racism is structural, and I want to do more to get to the roots of the injustice that my community and others face. At the heart of that is ensuring we listen to Black voices, Asian voices, Roma voices, Jewish voices - being a minority means not being heard, more often than not. This project and People Participation as a whole is a way to turn that narrative on its head, which is why it means a lot to me that the PCREF project is being led by two Experts by Experience who are respectively Black and South Asian. We're acknowledging the importance and value of lived experience as ethnic minorities, and that's a crucial through-line of this campaign.
 
2020 was a year when millions of people here and globally, angered and saddened by the brutal murder of George Floyd,  drew a line in the sand and demanded that real change to counter racism should get underway, in every area of our lives. Do you think this movement has had a positive impact on the work going on to improve mental health services for BAME service users in the NHS? How? 
 
As a non-Black person of colour, 2020 was monumental for me in really understanding the relevance of Black Lives Matter, not just as a political movement but a personal one. I've never been stopped and searched by the police, and to be honest, I didn't realise the extent of police brutality and the intensity of inequality faced by Black people around the world, including in the UK. That speaks to my privilege, as someone who isn't Black and who has witnessed a great deal of antiblackness within my own community as a South Asian. 
 
So 2020 was a year of growth for me, in recognising the sheer extent of racism and white supremacy. I'm glad that this has meant being actively anti-racist has become more normalised than previously, though of course, 2020 has also shown us just how far we still need to go to eradicate racism. 
 
I definitely think it's had an impact on mental health care, and it has the potential to radically change how we view structural racism in the NHS. That starts by admitting that it exists in our own practice, and by looking for ways to improve things not just in terms of individual practice but on a structural level. It means acknowledging one's own privilege as a clinician when a BAME service user speaks about a racialised experience and recognising that therapeutic materials need to be coproduced by BAME service users and staff to make them representative of the populations they serve.
 
Statistics show that there is a higher proportion of BAME people accessing mental health services than white people here in the UK. How much is this down to the everyday experience of racism and institutional racism, in your opinion? What role has the NHS got to play in narrowing this gap? 
 
I think institutional racism plays a huge role in the deteriorating mental health of many BAME people. Generally, perceptions of what constitutes racist tend to be narrowly focused on overt racism, like the use of the N-word or P-word, or outright discrimination that is clearly based on race. But covert racism is far more insidious, and it can be just as impactful on someone's mental health when it's steeped in ambiguities. I know from experience that someone acting surprised when I speak perfect English with a British accent could be for many reasons, but when it happens several times with different people and the common denominator is me, my hijab and brown skin, it feels more like a microaggression. And the uncertainty of this, the fact that I may be overthinking things and reading too much into it - that has a huge impact on my mental health.
 
The NHS could do a great deal to narrow this gap. Sam Ogunkoya's 'Let's Talk' report goes into some of the specific suggestions, given by BAME service users. These range from unconscious bias training to increased accountability of staff by service users of colour and a more culturally representative workforce. For the latter suggestion, that means actively recruiting ethnic minority staff, treating their lived experience as people of colour as valuable and just as much of their skillset as clinical experience. 
 
Do you think there are any 'easy wins' that can help to improve BAME peoples' experience of using mental health services? Initiatives that can take place locally, and involve people at the grassroots of our communities? If so, what might these be? 
 
I'm not sure about easy wins, because with the pandemic's unpredictable nature, it's difficult to say what would work today but not tomorrow. That said, I would love to see more training specific to intersectionality, starting with the simple acknowledgement that people of multiple minority groups exist and experience a great deal more barriers. For instance, I'm a visibly Muslim woman of colour, meaning I face barriers as a woman, as a person of colour and as a hijabi Muslim. But there are so many in society who face even more barriers than me, falling through the cracks, or invisible within the community structures of their respective minority groups. Whether we're talking about queer people of faith, Black trans women or disabled people of colour, at the heart of mental health struggles is often a lack of belonging, or a helpless feeling that even community support won't alleviate. Recognising this, and acknowledging that people's identities constantly intersect with race, is a key part of any anti-racist struggle.
 
But the longer term, where the challenge is to uproot institutional racism, where the problem is deeper and more intractable - what should be the longer term aims to improve services for BAME service users, as a society, in your opinion? 
 
The biggest aim - and I'm glad that this is now a possibility - is to reject the idea of anti-racism being considered overly radical or political. We want to move away from the idea that "privilege" is a bad word, or that "Black Lives Matter" is a purely political slogan, and instead move towards a future where being anti-racist is personal. Instead of politicising such matters, we instead see racial equity as a matter of human decency. 
 
I'm so glad that these themes are already coming through in the PCREF project and also more broadly in ELFT's Transformation, which focuses specifically on the populations that ELFT serves. Having these different endeavours working in tandem tells me that ELFT is committed to improving mental health services significantly, both in terms of individual practice and trustwide.
 

Please help us to keep improving our services by thinking about who you can approach to take part in the questionnaire over the next couple of weeks.

Fill in the PCREF Questionnaire here.

To use the Accessible PCREF Feedback Questionnaire - click here

A paper version of the PCREF questionnaire can be downloaded here. Please return completed copies to  elft.elft_pcref@nhs.net

Download the ELFT PCREF flyer here. Please display in public areas where appropriate.

For more information, contact  elft.elft_pcref@nhs.net

Go straight to the PCREF Questionnaire by scanning the code: