title: Moving beyond 'the cheapest kind of understanding': enriching policy responses to BAME mental health inequality
Creators: name: Harvey, S
Publisher: name: Bath Spa University
Year: 2021

description: For more than 70 years, significant disparities have been persistently reported regarding mental health trends and the England’s Black, Asian and minority ethnic (BAME) population. Today, these disparities are generally accepted as inequality, acknowledging that BAME status often carries social disadvantages that can materialise in mental health contexts. The current Covid-19 pandemic and global rise of anti-racism protests have brought such issues into sharp relief. Despite the State’s declared ambition to decrease rates of mental health issues/distress, little has been implemented at a national level to address BAME mental health inequality. This thesis considers what policy-makers of future national strategies might learn from people from BAME backgrounds experiencing mental health issues/distress. Taking a critical realist perspective and responding to gaps in the literature informing policy, I move away from a focus on in-patient experiences. Employing a pan ethnicity and mental health issue/distress sampling approach, I conduct an in-depth exploration of the testimonies of seven participants at various intersectional locations within the BAME mental health space. Semi-structured interviews and unstructured ethnographic conversations over an 18 month period enabled participants to foreground the issues they felt were most pressing to discussions of mental health. The length of individual engagements and locations were continually adapted to meet the needs and wishes of participants. This thesis explores the topic of BAME mental health inequality in three key ways: how the issue is defined; determinants of inequality in a mental health context; and interactions with mental health support services. These themes align with issues raised by participants and the way that policy makers often consider health inequality, whilst also providing opportunities to engage with more critical perspectives that challenge epistemological and ontological assumptions. Within these top-level themes, multiple sub-themes emerge. I found these broadly aligned with those in the critical literature. Primarily that racism and migratory experiences are factors in mental health issues/distress for many people. However, participants also placed greater emphasis on wider social inequalities and intersectional experiences than is generally represented. Though concerns differed according to participants’ intersectional locations, they were present in all testimonies. In particular, the experience of poverty was continually raised as a key aggravating factor in mental health issues/distress, as was having to engage with processes that re-traumatise so as to receive support. This re-traumatisation often related to people’s intersectional locations. Additionally, this research found a strong indications that experiences of disability and their psychological impacts warrant further investigation. Using my findings to enable decision-makers to better align national policy with the lived experiences here presented, I suggest conceptualising BAME mental health inequalities as a ‘wicked problem’. This is with a view to engendering an understanding of the issue that encompasses the diversity of perspectives relevant to this population group, and a greater acknowledgement of the interconnecting and ‘open’ systems at play when developing policy responses. Additionally, I promote the employment of an intersectional lens to enrich understandings of how these systems interact to produce and maintain such imparity. I conclude by offering the conceptual tools of the ‘wicked’ problem and intersectionality as a means of enabling policymakers to move beyond the ‘cheapest kind of understanding’ in policy making. Without embracing these concepts within policy making in this topic area, it is unlikely that more that minor improvements will be possible. Embracing these provides an opportunity to build services better suited to the needs of intersectionally located people experiencing mental health issues/distress.