Just ethnic matching? Racial and ethnic minority students and culturally appropriate mental health provision at British universities

Abstract

Purpose The need for “culturally appropriate” support for racial and ethnic minority (REM) students has prompted several British universities to embrace targeted interventions such as “ethnic matching” to encourage professional help-seeking on campus (i.e., pairing REM students with ethnically similar practitioners). There remains, however, little clarity on what culturally appropriate support entails. This study explores how REM students define culturally appropriate support and the approaches they view to be effective in promoting help-seeking. Methods Semi-structured interviews were conducted with 48 REM students in two British universities. Data analysis was guided by principles of constructivist grounded theory and reflexive thematic analysis. Results REM students discuss three ways universities can provide culturally appropriate support; via ethnic matching; a broader cultural appropriateness; or a person-specific service. For these students, a service narrowly focusing on race/ethnicity has the potential to remove rather than enhance accountability and engagement within mental health service provision, and not adequately valorize the experience of the student as both individual and racialized. Conclusion A protocol-driven and instrumental understanding of “culturally appropriate” support may serve to reduce REM student willingness to seek professional help. Universities, therefore, should commit to a student-centred process, combining racial diversification and cultural recognition with a reflexive person-specific approach.

Understanding ethnic inequalities in mental healthcare in the UK: A meta-ethnography

“…These include experiences of interpersonal verbal and physical racist attacks as well as institutional and societal racism. Participant narratives resonate with the concept of “racial battle fatigue,” which described the cumulative effect of racist micro- and macroaggressions on personal resources [ 71 , 72 ]. As highlighted in previous work [ 73 ], our synthesis shows that racist violence does not need to have been experienced personally for it to have an impact on an individual’s mental health and help-seeking for mental illness.…”

“…Black men experience multiple stereotypes "weed smokers, violent, aggressive, schizophrenic." [57,63,65,67,71,74,93,94] Fear of medical harm Not feeling safe within service. Mistrust of doctor and fear of consequences of treatment, mainly medication "zombies," coercive treatment, and retraumatisation with talking therapy for refugees.…”

“…Participants, including service providers, described how services based on (typically) biomedical/reductionist understandings of ill health deny the impact of wider structural determinants of health, as well as the importance of faith for managing mental illness for religious patients (see metaphor "Epistemic tensions", Table 3). In addition, some participants perceived that mental health services were epistemologically "white"/"Eurocentric"/"racist" and not designed to meet the needs of people from ethnic minority groups [55][56][57][58]71,[92][93][94][95]. Such experiences contribute to a sense of trauma and marginalisation.…”

“…It is here that refutational accounts are the strongest. There were refutational narratives relating to turning towards and away from general practitioners (GPs), ethnically similar/dissimilar practitioners [71,[93][94][95][98][99][100][101], and informal support [54,64,69,75,76,78,[84][85][86][87]89,99,103]. In mainstream NHS services, GPs are positioned as the first port of call for help-seeking for mental illness, but most participants do not consider this approach useful.…”

A scoping review to identify opportunities and challenges for communities of South Asian (SA) origin in accessing mental health services and support in high- income countries

“…Improving MH literacy while deconstructing mistrust and stigma was raised as an opportunity. Effective strategies included tailored opportunities for psychoeducation, service diversi cation and feasible multi-agency collaborations with communities (40, 43,47,[51][52][53].…”