On 23 January, Prime Minister Rishi Sunak announced a £150 million funding boost up to April 2025 to the mental health services as a part of the NHS’s Long Term Plan commitment to boost mental health spending by £2.3 billion a year. Sunak said: “People in mental health crisis deserve compassionate care in a safe and appropriate setting. Too often, they end up in A&E when they should be receiving specialist treatment elsewhere. This important funding will make sure they get the help they need, while easing pressures on emergency departments and freeing up staff time – which is a huge priority for the government this winter.”
The funds are supposed to aid in procuring up to 100 new mental health ambulances, building crisis cafes and shelters, new or improved safe spaces for people with special needs detained by the police, creating spaces outside A&E, and creating up to 150 new projects. In a winter like never before, the government is doing all it can to relieve the NHS from the stress that it is creaking under.
But how effective are these measures likely to be in addressing problems related to mental health in the South Asian community? Sure, any help is good help, but regardless of the differences within it, the community as a whole is not only conservative but also encounters multiple repressions in a new land and culture. Asian Voice spoke to a few experts to understand how the current cost-of-living crisis has impacted South Asians, to identify what keeps South Asians away from seeking help when they cannot buck up and adopt the stiff British upper lip, and what is the way ahead for them.
The impact of the crisis on South Asians
Dr Sohom Das, who specialises in criminal psychiatry (Twitter: @Dr_S_Das) and has a YouTube channel that examines the cross-section between mental illness and offending, has the following to say on the situation, “As a psychiatrist working on the front line, I have directly observed how the cost-of-living crisis has damaged the mental health of many people, particularly those pushed towards the poverty lines. From my clinical experience, there seems to be a particularly troubling impact within the South Asian community. As well as worsening pre-existing depression and anxiety, those who are struggling financially, tend to have obsessive rumination about money. In the worst cases I’ve seen, they often cannot enjoy other aspects of life, such as spending time with family because they are preoccupied with constantly calculating how much things cost. Another side-effect is insomnia, with people literally not being able to sleep with these concerns, or even having nightmares. This leads to utter exhaustion, which exacerbates mental health issues. Another indirect issue that I’ve seen in South Asian patients is being forced to cut down on activities that help their mental well-being (such as going to the gym and socialising). I found their mental health deteriorating during the cold winter months, when people’s overall mood is often worse, due to lack of sunshine and of course with heating bills being even higher.”
The statistics fully support Dr Das’s views. According to a report by the Office of National Statistics titled ‘Impact of increased cost of living on adults across Great Britain: June to September 2022’, said, “Around 4 in 10 (44%) White adults reported finding it difficult to afford their energy bills, compared with around two-thirds (69%) for Black or Black British adults and around 6 in 10 (59%) Asian or Asian British adults.”
And funding alone will not solve these problems. The non-profit organisation ‘People Like Us’ surveyed over 2000 workers from a BAME background and found that more than half (52 per cent) said government support will not see them through the next six months, which was seven per cent higher than their white counterparts felt. The survey revealed that professionals from ethnic minorities were more likely to borrow money, move in with family members and skip meals due to the cost-of-living crisis. Redundancy worries were also worse for these workers with 41 per cent worried that they would lose their job due to rising costs, compared with 27 per cent of those from a white British background. More than half (56 per cent) felt despondent about the increased cost of living.
Professor JS Bamrah CBE, FRCPsych, Senior NHS Consultant Psychiatrist and Co-Chair, Mental Health Working Group, NHS RHO told Asian Voice how embattled NHS service providers themselves are at the moment. He said, “Mental health services were already stretched during the pandemic, and this crisis has pitted many services to stress levels we have not seen in a generation. In this regard, it is worth noting that almost 40% of the NHS medical workforce comes from an Asian background. We are the backbone of the NHS, with Indians constituting the largest majority. And yet people from Black, Asian and Minority Ethnic groups are more likely to be subjected to disciplinary procedures, less likely to get jobs of their choice, more likely to fail their examinations, less likely to get promotions, more likely to be disciplined by the regulator, and less likely get awards.”
Why don’t South Asian seek help for their mental health problems?
Talking about the challenges that are unique to the South Asian community in seeking help for mental health issues, all the experts Asian Voice spoke to mention the stigma associated with mental health issues within the community. Professor Dinesh Bhugra CBE, professor of mental health and diversity at the Institute of Psychiatry at King’s College London, honorary consultant psychiatrist at the NHS, and a former president of the Royal College of Psychiatrists, broke it down further.
“There is the aspect of bringing shame on the family. Some of the work that we did a few years ago showed that people wouldn't seek help because they were frightened that if it got out that they'd been to seek help, nobody would marry into the family, nobody would visit them. Also, quite often, particularly among the older population, there are still those explanations which are to do with the evil eye and eating something cursed or bad, rather than acknowledging depression with a psychological social cause. So those individuals are more likely to seek help from pundits or ‘gyanis’ or imams than seeking medical help. We did a series of focus groups with Punjabi women some time back to get their idea of depression. And they just saw depression as part of life's ups and downs. So, they would rather go and pray or listen to the sermons or sing hymns or bhajans or whatever, rather than go and see their GP or a psychiatrist.”
Professor Bhugra also mentioned the structural deficiencies within the NHS. “The NHS doesn't have the competence to understand the cultural values. If people get admitted to the hospital, quite often, they will not get the right kind of food, like vegetarian food, and may get pork or ham instead. Also, it's not always possible, for example, to find an interpreter at a short notice or to provide the right kind of makeup or food or environment- things like having information in other languages, having access to books, or a library for people who don't read English. So, there is an overwhelmed NHS on one hand, and pressures related to cultural expectations on the other.”
It becomes even more difficult for people from sexual minorities. Dr Bhugra added, “What people experience and have continued to experience can be called double jeopardy or triple Jeopardy. So, if you are South Asian and you're sexual minority, and you've got mental illness, that's three things that may feed into each other that you may be dealing with. Though the services are sensitive, the South Asian community may not be sensitive to your sexual identity so two out of three are acknowledged and the third one does not get acknowledged. And similarly, if you are gay and old and have mental illness, again, that's triple jeopardy because there's a different perception of how the old people should be, how they should behave, how they should seek help.”
However, while some action is taken at a local level by individual NHS Trusts according to affordability, in the absence of long-term comprehensive investments, they amount to very little. Arati Das, Interim Deputy Chief Finance Officer at Buckinghamshire Healthcare NHS Trust who had also worked in a mental health and community hospital Trusts in the past, said, “As a finance professional in the public sector, and particularly within the NHS, I am also testimony to the attempts being made by employers to support staff experiencing hardship. However, at the end of the day, with rising inflation, these are just token gestures. Integrated Care Systems (ICSs) are partnerships of organisations that come together to plan and deliver joined up health and care services, and to improve the lives of people who live and work in their area. Real investment is needed at ICS level in supporting those families at risk of financial crisis and with it the impact of mental health whether it be staff or the patients and carers coming within the care of the local Integrated care systems (ICSs). What the current financial crisis has highlighted is the impact on the middle income or professional workers who can't get financial support other than through additional borrowing or making serious lifestyle decisions such as moving into joint family arrangements or going without meals.”
Staff at her Trust have been invited to make financial hardship applications in the workplace for buying essentials like fridges, cookers and washing machines in a world where gas and electricity bills have gone up by as much as 80 per cent.
In her locality, she has seen people who previously donated their extra household items to charity now actively selling them on eBay and other selling portals for a pittance to cover their expenses. She referred to her own experience while talking about how health outreach work can positively support a family through difficult times.
“Almost 12 years back, when I had my first child after an emergency c-section, as a new mother, I wasn't that familiar with the concept of postnatal depression, let alone identify my situation as that. I had my baby, and I wasn't happy. It was the routine after-care provided by District Nurses to new mothers that addressed my situation.
“My ‘low mood’ was detected by one such nurse while taking my blood pressure and chatting to me. The nurse motivated me to cheer up, to celebrate for having given birth to a healthy baby and enjoy the time that was not going to come back. This level of support is particularly important in this country for South Asian families as there isn't a wide family network. People are usually living in individual nuclear families. So young parents don't have that network.
“Even as a professional individual, I wouldn't have gone for mental health support for postnatal depression immediately after birth, but I did benefit from the early intervention through the District Nursing before it became a more serious issue. I was never diagnosed with postnatal depression but was helped by the outreach work through that system for young mothers where during the first few weeks, the nurses used to visit and all of that, that was so important to me as a young mother. There are cost implications for provision of such services now.”
What is the way out?
The experts we talked to recommend a holistic approach which involved looking beyond the stereotypes. For example, religion, which is often considered a barrier to acknowledging problems and seeking scientific help, can provide structure and present people with much-needed social support. People of South Asian descent can personally attest to the efficacy of support groups formed over communal activities like cooking, performing rituals, chatting, and gossiping, especially among women who are often at the receiving end of mental health problems among other members in close-knit families and are themselves vulnerable to severe mental health problems due to poverty, lack of nutrition, domestic violence, and the like.
Professor Bhugra suggested integrating community leaders and places of religious worship into the process as it would be less stigmatising to visit religious places to seek help for mental health problems than hospitals and clinics. “Having cultural mediators on mental health teams who can educate the team about what the needs of the community are, and who can educate the community in terms of realistic expectations is a good model to follow. Working with non-governmental voluntary organisations, community organisations, teachers, religious leaders, community leaders, is the way forward”.
Arati added that funding or community integration by themselves would not be enough in the long run. Merely putting in a lot of money would create unhelpful situations like hospitals competing to get funds without addressing core issues. Collaboration on well-designed services is the key to using funds effectively and sustainably, she added.
Professor Bamrah emphasised the need of being early when it came to mental health issues, whether it be in seeking help, or in learning about them. “We need a lot of education starting from schools to de-stigmatise mental illness. Sadly, we cannot escape the fact that almost one in four adults will experience a mental health problem in their lifetime, so it is pretty common. Also, more and more children are now showing symptoms of mental illness. And because of the stigma, many will not seek help until their illness is advanced. But as we well know, early treatment means a better prognosis. A range of voluntary and charitable organisations like Samaritans and MIND offer free advice and support.
“Also, there is a range of psychological and pharmacological treatments that we know work in reversing or containing mental illness, regardless of whether that is a severe mental disorder like schizophrenia or bipolar disorder, or stress, anxiety, or depression. My advice is to seek help early. Ask the GP for advice and support or go to your NHS crisis services if things are escalating. Make your mental health a priority for all your life and you will reap the rewards of happiness, contentment, satisfaction in relationships and work, and what’s more, your physical health also improves if your mental health does. There is no health without mental health. Indeed, I would go further – there is no financial health either without good mental health!”
