Forewords

Dr Charlotte Harrison, Clinical Director, Acute and Urgent Care, South West London and St George’s Mental Health NHS Trust  

The Listening Project listened to children and young people from Black, Asian and Latin American communities talk about their mental health, what affects it, and their experience of mental health support in London. It is a privilege to introduce this report which sets out how we did this and what they told us. 

To support young people from these communities differently, it is important that their racialised experience is considered and their voices are centred.  

This Listening Project report focuses on supporting our NHS and the wider health and care system to both better understand and, crucially, to act upon, what Black, Asian and Latin American children and young people are telling us about their experiences and what they want from their mental health services.

As a leader in London’s health and care system, I will be using the recommendations from this report to inform my own work to advance equality of access, experience, and outcomes in my local area. I hope you will do the same.

Dr Jacqui Dyer MBE, Director, Black Thrive Global and NHS England National Mental Health Equalities Advisor

Addressing the long-overdue inequities experienced by children and young people from racially minioritised communities is a key focus of the NHS Long Term Plan. The plan aims to enhance service availability, efficiency, and accessibility. The reasons for inequities are complex, and the role of structural factors is often absent from the discussion.

The Patient and Carer Race Equality Framework (PCREF), introduced by NHS England elevates and centres the voices of patients, carers, and community members from minioritised groups and places them at the centre of decision making. It offers an opportunity to improve access, experience, and outcomes through partnerships and a participatory approach. However, the lack of quality data and insight into community experiences remains a common barrier.

The Listening Project, featured in this report, sheds light on barriers and enablers within the mental health system for Black, Asian, and Latin American young people. It reveals the impact of racism and other forms of oppression on mental health outcomes, and highlights instances where services that are meant to protect and support young people cause harm. It emphasises the need to recognise the connection between racism and health inequality and address the structural factors perpetuating inequities.

Senior leaders must demonstrate commitment to addressing inequities and foster a workforce that understands racism’s influence on decision-making, resource allocation, policy development and practice. Equity impact assessments, informed by quality data, can aid in implementing anti-racist policies and practices that do not exacerbate harm to minority groups. Collaboration among services, the voluntary, community, and social enterprise (VCSE) sector, young people and community organisations is crucial for a preventive approach.

The report signals the beginning of a conversation, challenging individuals to seize the opportunity, commit to personal growth, and take action to protect and nurture marginalised communities, as well as ensuring that we create an environment where young people can thrive. To ensure the report’s legacy, future work to implement recommendations should be led by young people from Black, Asian, and Latin American communities, in collaboration with parents, carers, and allies, leveraging their lived expertise.

Children in Care Council, facilitated by Partnership for Young London

We need to make sure young Londoners who are racialised as minorities have their views and opinions heard and acted on across London. It’s the only way for young people to have access to the right sorts of services when they need it. This project brought together diverse groups of young people to listen to them and work out ways we can create better services. COVID-19 and the current cost of living crisis have disproportionately affected young people and we need to offer better support for their mental health.

A recent report showed that 50% of children in care meet the criteria for possible mental health disorder, and 26% of the homeless population are care-experienced. Each young person’s experience is different, and services must be flexible to meet those needs and recognise what they need to change. Many young people are unaware of what support and services are available or do not trust that those services can meet their needs.

“First interaction can make such a difference; at my first contact they want into far too much detail on the telephone, and I didn’t know them, that really put me off.” 

“I have Multiple Sclerosis. The hospital nurses ensure I feel calm and comfortable in the room before getting the IV infusion medication. They ensure all my needs are taken care of before discharging me home. During the COVID-19 pandemic I asked my GP to refer me to therapy as I felt isolated and lonely. When Talking Therapy contacted me for an assessment, I felt it was a checklist exercise and I later had a response stating I did not meet the criteria which made my mental health deteriorate.”

Young people shared their views and experiences for this project, and it is our role to ensure that this report leads to change. We can’t just listen; we need to act. We know that young people from minoritised communities have been seriously impacted by structural racism and discrimination and we must use our power and influence to deliver services across London that meet their needs. Individual voices need to be heard by everyone.

Manjinder Kaur, Young person, Taraki

As a young Asian person living in England, I have experienced difficulties in accessing and receiving effective mental health services. In my experience, one of the biggest obstacles is the lack of culturally appropriate care.

For young Asian people in England to receive the support and resources they need, we need mental health professionals who understand the unique challenges we face, and the ways our mental health concerns may show themselves.

This research is crucial not just for Asian communities but for all individuals struggling with mental health issues. I hope it will continue to be a priority in the years to come.

Click below to read the executive summary, key findings, and full report content.

A note on language

Race is a social construction, a form of identity used to demarcate social groups based on a range of characteristics (for example skin colour, hair texture etc). ‘Racialisation’ refers to the political process by which dominant groups use a person’s phenotype to ascribe racial identity to continue domination and exclusion with economic, political, and social consequences’ (Hoyt, 2016).

In the UK, several terms are used to categorise a person’s race and ethnicity. There has been a move away from using ‘BME’ and ‘BAME’ to describe people who are non-white British. BME stands for Black and Minority Ethnic and BAME stands for Black, Asian, and Minority Ethnic. These blanket terms risk homogenising groups and centring white ethnicities as the norm. A decision was made by the UK Government to abandon these acronyms from 17 March 2022 (Gov.uk). We recognise that the language we use is powerful. To acknowledge that racialisation is a social/political process, we have chosen to use the term racially minioritised communities when referring to all ethnic minority groups. We identify the specific heritage of young people as they self-identify, and we feel it is important to segment the data in this way to highlight how young people from different racially minioritised groups experience mental health and the support available to them. We have spoken to young people who have self-identified as being Black African, Asian including Indian, Bangladeshi and/or Pakistani, Black Caribbean, Latin American , and Mixed ethnicities. Following the UK Government preferred style for writing about ethnicity, we are referring to people from a Mixed ethnic background rather than ‘mixed race.’ For further insight and definitions of language we have used throughout the report, please refer to the below glossary.

Key definitions

Below are important words or concepts which feature heavily across this report and a glossary of terms can be found on page XX.

CAMHS: child and adolescent mental health services (CAMHS) support young people experiencing emotional, behavioural or mental health difficulties.

Institutionalised (systemic/structural) racism: refers to differential access to the goods, services, and opportunities of society by race. Institutionalised racism is normative, sometimes legalised, and often manifests as inherited disadvantage. It is structural, having been codified in our institutions of custom, practice, and law, so there need not be an identifiable perpetrator. Institutionalised racism is often evident as inaction in the face of need. Institutionalised racism manifests itself both in material conditions and in access to power. Regarding material conditions, examples include differential access to quality education, sound housing, gainful employment, appropriate medical facilities, and a clean environment (Jones, 2000).

Intersectionality: is the social justice theory and concept which encourages professional and organisational curiosity to understand oppression and discrimination as inter-related, overlapping combined experiences (Crenshaw, 1989) for people who possess one or more protected characteristic under the Equality Act 2010, or other specific characteristics (Advancing Mental Health Equality, 2019).

Personally mediated racism: prejudice and discrimination, where prejudice means differential assumptions about the abilities, motives, and intentions of others according to their race, and discrimination means differential actions toward others according to their race (Jones, 2000).

Racially minoritised: Refers to the racialisation of individuals or groups who are framed as social minorities based upon their demographic representation within a population. These groups often face systemic marginalisation and discrimination based on their racial or ethnic identity.

Seldom heard: people who are less likely to be engaged or acknowledged by professionals and decision-makers in health, social and other public services they use or might use.