"we have to want to know about the whole, complex picture"
On Tuesday 11th May, the Stuart Hall Foundation and the Centre on the Dynamics of Ethnicity (CoDE) hosted #ReconstructionWork: Racial Disparities in Mental Healthcare – a conversation between James Nazroo, Fellow of the British Academy and Professor of Sociology at the University of Manchester, and award-winning director and choreographer, Lanre Malaolu, to explore the racial inequalities and injustices that surround mental health in the UK. The event included an introduction from Child Psychotherapist, Psychoanalyst and Trustee of the Stuart Hall Foundation, Becky Hall:

It is with great pleasure that I welcome you all here this evening for the 5th in our online series of #reconstruction events – this one in partnership with CoDE – the Centre of Dynamics of Ethnicity. These are public conversations with an intergenerational and interdisciplinary flavour which have to date included writers, historians, journalists, students, politicians and activists. The Foundation is a small but confident charity with big hopes – and a zesty website. Inspired by the life and work of Stuart Hall it remains committed to matters close to his heart: public education, power and inequality, race and identity, representation and visual culture. Stuart was also committed to complexity – not only the asking of difficult questions (for which he is often quoted), but the need to wrestle with the difficult answers that present themselves. Our #reconstruction series is offered in that spirit, hoping to generate further enquiry and help us in the task of imagining a more just and equal society for all.

This last year has seen a rapid rise in the recognition that the life of the mind matters: mental health is suddenly everywhere! Few would now dispute our primary need for human contact and the devastating impact of loneliness, deprivation and loss. There has been much to make all of us feel mad with rage, fear and helplessness, not least being locked in with the daily diet of news confirming that greed is wrecking the planet, injustice is rife and the effects of being locked out by poverty, being a woman or having brown skin: potentially catastrophic. NHS services have seen a troubling rise in depression, self-harm, and the relentlessly controlling habits of eating disorders amongst children: a response perhaps in part to a grown-up world that feels increasingly careless and dangerously out of control.

You would search in vain for a Hall paper on something called Mental Health, and yet Stuart’s preoccupation with the ‘conjuncture’ – what we might call the conditions in which we become a person – and his concern with questions of belonging, experience, identity and identification are lines of enquiry that are central to the matter of psychological integrity, which depends so much on the fundamental need in us all to have a proper home in somebody’s mind. His preoccupation with his sister’s breakdown during adolescence and his reflections on Fanon distil something of the psychic cost of imperial history and invite complex questions about how the world outside gets under our skin and how our inside life – the life of our mind – meets and is met by our most immediate and wider environments. We know that domestic violence between parents gets into the blood and bones of young children (by which I mean their very core, not their DNA) through their ears and eyes and the pores of their skin. We know that parental states of mind – prolonged depression, undigested trauma – work into the layered fabric of a child’s mind. There is now increasing clamour for indexes of inequality to be a serious part of the enquiry into psychological vulnerability and how to treat it.

For some time now there has been compelling evidence that Black British men are among those most likely to suffer the most severe mental illnesses. This troubling fact suggests a complex conspiracy between external structural inequalities such as poverty and other key factors of vulnerability: early childhood experience, disrupted patterns of relationships, parental mental health and intergenerational trauma. There comes a point when a mind has too much to bear. The lack of proper care and timely support for this vulnerable group is another disturbing fact and speaks to the wider dismantling of early intervention, the over-medicalisation of mental health models and a historical disregard for the kind of mental pain, grievance and distress that the repeated injuries of racism can foster. Such arguments expose a national deficit of attention to the accumulative psychological harm that feeling pushed out (of an equal chance at life) can do. They insist that to disregard the invasive experience of being projected into, distorted and bloated by all the most hated and feared bits of the human condition, is a national dereliction of care.

In the course of my life as an NHS employed Child Psychotherapist, a number of experiences could be brought together in the composite sketch of a primary school age Black British boy, referred for or already burdened with the ubiquitous diagnoses of ADHD and ODD (saying no). A boy already excluded from one or more primary school, diagnosed by a range of caring, thoughtful professionals as aggressive, lacking empathy, mindless; a cause of despair for his already struggling family. Usually a closed off, lonely, homeless feeling sort of boy, who has stuffed his vulnerability deep into the pockets of his already too low-slung trousers and mastered a swagger to show in every possible way what a ‘bad boy’ he already believes himself to be.

Such a child is already on the edge of life, making a home from the homeless state in his mind: a state with roots in his family, their history, the eyes of his teachers and the wider world. This is a state of emergency for an 8 year old boy. Such deep and disturbed states of mind, will not simply be solved by a diagnosis or medication, a mentor or diversity training, more money, a revised curriculum, cold water swimming or six sessions of online counselling – useful as all of these things might be. If we are really to talk about what has gone wrong, we have to want to know about the whole, complex picture, which includes, but is not determined by being a little brown-skinned boy growing up in postcolonial Britain. We also have to be prepared to wrestle with the difficult answers that might present themselves.

I am very pleased to introduce our two discussants this evening James Nazroo and Lanre Malaolu to begin a conversation about inequalities and injustice in mental health.

James Nazroo initially trained in medical sociology at St George’s Hospital Medical School and is now, amongst other things, Professor of Sociology at the University of Manchester and founding and Deputy Director of the ESRC Centre of Dynamics of Ethnicity (CoDE). He has an extensive history of research on issues of inequality and social justice in relation to ethnicity, age and gender and how these relate to health. He is currently investigating ethnic inequalities in severe mental illness.

Lanre Maloulu is an exciting director, choreographer and writer for film and theatre who uses collaborations of text, movement psychology and dance to mesmerising and unforgettable effect. His award-winning film The Circle, is one of a number of projects addressing the complexities of being a black man in 21st century Britain. Some of you may have been lucky enough to see his stunning live performance of Elephant in the Room and otherwise I hope you have been able to access the link.

As usual, our format for the evening is that Lanre and James will be in conversation for 35 minutes or so, followed by a Q and A which we hope you will join via the Q and A button.

Final words:

It just remains for me to give deep thanks to James and Lanre for their time and contributions this evening. They leave us with much to think about and I hope will encourage further conversations amongst you all.

Among our many institutional partnerships at the Foundation, we have developed a model with the Tavistock Clinic to address the under-representation of Child Psychotherapists in the NHS from Black, Asian and Minority Ethnic backgrounds. Owing to the success of this model we have recently joined the Tavistock and Health Education England to support four further students this year. We can only continue to do this work of this kind with your generous support. Times are hard we know, but any small amounts you can spare will be well used.

– Becky Hall, Child Psychotherapist, Psychoanalyst and Trustee of the Stuart Hall Foundation