Lionel Biu, a 31-year-old black British man, was brought up in a culture that emphasised “not telling [anyone] your business, being strong, and being confident”.
“In my family it was very much known that you don’t tell anyone about your issues,” Biu, whose parents are Nigerian migrants, told BuzzFeed News. Mental health, therefore, was barely spoken about. “In my parent’s culture there is no such thing as depression…it's all just part of life,” he said.
In many African and African-Caribbean communities, the stigma associated with admitting you have a mental illness is acute. As a result, Biu said, he suffered with severe depression and anxiety for years without opening up to anyone: “I told myself that I didn’t have any issues and that there was nothing wrong with me, even though I knew there was."
Biu struggled with his illness alone. “I isolated myself physically, I gained so much weight, I wasn’t leaving my house at all,” he said. It affected his studies and he had to retake the last year of his chemistry degree at Kingston University.
“I literally couldn’t go to my lectures at all because I was an absolute wreck," he said. "I couldn’t look people in the face; I wore a baseball cap to cover my eyes, I wore a hoodie – all because I couldn’t look people in the eye, and my confidence was completely shattered."
For Biu, it wasn’t only the stigma and the idea he should “keep his business, his business” that prevented him from talking to a medical professional about his problems. It was also because of a social stereotype that black men are hyper-masculine both physically and mentally, and not feeling able to show vulnerability.
“Society expects black men to always be strong,” he said. "But there’s no emphasis on showing a little bit of weakness and vulnerability to say, 'We do need help, we do need that support.'"
"Many black men probably don’t think –or want to admit – they have a mental health problem."
Biu believes a large number of black men in Britain could be going about their day-to-day lives with undiagnosed mental health problems, the same way he did for years. Many of them, he said, probably don’t think – or want to admit – they have a mental health issue.
Perhaps one of the most concerning reasons for not telling anyone about his problems was Biu’s debilitating fear that after seeking help he would unquestionably end up worse off. “There is the idea that your mental health problem will be kept on your record, which might stop you from getting a job," he said. "And getting a job is already so difficult, particularly when you’re from a BME [black or minority ethnic] group."
Biu said he was afraid of being “drugged up” instead of being offered talking therapy. He worried about being “locked up” in a mental healthcare system perceived by many in the African-Caribbean community as being institutionally racist.
This is why, in collaboration with the mental health charity Mind, Biu is coordinating an initiative called Arise – a project that aims to encourage black British men to open up about mental illness. Through auto-photography (a type of therapy that encourages people to take pictures to help explore their feelings), focus groups, and one-to-one interviews, Biu wants to help men like him feel comfortable talking about their mental health and addressing the stigma surrounding it.
A disproportionate number of African-Caribbean people in the UK, particularly men, are diagnosed with severe mental illnesses. A recent report showed that across the country black men are 17 times more likely than their white counterparts to be diagnosed with a serious mental illness.
Instead of being referred to hospital by a GP or getting community-based support, people of African-Caribbean descent are 40% more likely to be diagnosed through the back door – the courts or the prison system, or through community treatment orders, for example.
“There is a very narrow way in which black men get mental health support," Biu said. "It’s generally in the most secure, aggressive settings as possible. It’s a pretty damming story."
One of Biu's frustrations is that people are already aware of the statistics. “We already know that black people overall are more likely to be diagnosed with any severe mental illness,” he said. “There are so many studies and surveys that get thrown around by the NHS and all sorts of organisations, but people don’t really look too much into what can be done to change it."
The mother of another African-Caribbean man diagnosed with a mental illness as a teenager told BuzzFeed News about her experience supporting her son when he was admitted to a psychiatric hospital.
“We are close so everything that he went through, I felt like I went through it too," said Ekanem, who preferred to reveal only her first name. "He was exposed to psychiatric services at a very young age, and as a mother I walked that journey with him.”
The mother of four, who has worked as both a senior social worker and a mental health carer, said she felt broken after her only son was sectioned under the Mental Health Act. She was referred to a support group where she found other parents, mostly mothers, who had similar stories.
Ekanem believes there were a number of reasons why her son, who wishes to remain anonymous, felt as though he couldn’t open up about his issues and why he was reluctant to disclose how he really felt to professionals.
One of those reasons, she said, was the strained relationship between black men and the police, and the way they are dealt with by the criminal justice system. The first time her son was stopped and searched he was only 13 years old and walking to school.
"Black men are already seen as criminals before they even end up inside a hospital."
In some parts of the UK, black people are up to 17 times more likely than any other ethnic group to be stopped and searched, according to analysis by The Independent last year. Studies also show that people from black and ethnic-minority groups are more likely to be forcefully restrained. In the most troubling cases, these encounters have been fatal and have become etched into the community's memory.
Among them is the death of Roger Sylvester, in 1999. The 30-year-old, diagnosed with bipolar disorder, was restrained by Metropolitan police officers in Wood Green, north London, amid a mental health crisis. He lost consciousness and later died.
Musician Sean Rigg, 40, suffered a cardiac arrest in 2008 after being restrained by officers in south London. Four years later, an inquest into his death found "unsuitable and unnecessary force" had been used. More recently, in 2013, Luton man Leon Briggs, 39, died in hospital after being stopped by officers and held under the Mental Health Act.
In 2009, an investigation into black people’s experiences of mental health services found nearly half of those interviewed had been physically restrained by staff. Of that group, 79% described the restraint as aggressive and 34% were physically injured. One recalled being "being pinned to the floor, having a knee on the back of the neck and feeling violated".
“It doesn’t help that black men are normally depicted through the media with some level of violence,” Ekanem said. “If you’ve already got that picture of a dangerous black man conjured up with the exaggerated stereotypes of mental illness then you’ve got the picture of the ultimate criminal.
“Black men are already seen as criminals before they even end up inside a hospital."
Last year, home secretary Theresa May launched an independent review into the issue, chaired by Dame Elish Angiolini, recognising that such incidents had "the potential to undermine dramatically the relationship between the public and the police".
Fifteen years after her son was admitted to hospital, Ekanem wrote a play inspired by her reality of supporting a child with a mental illness, and by knowledge gained from working in the mental health system.
The play, So U Think I’m Crazy, was staged on a shoestring budget and performed by 11 volunteers two years ago at Croydon Town Hall, in south London. The play, written from the perspective of a black man placed in a psychiatric hospital, touches on the social influences, like police stop-and-search, that can often contribute to a young black man ending up in the mental health system.
Ekanem said it also explores the “implicit racism” within mental health services, as well as the negative side effects of antipsychotic medication.
Around 300 people, including Croydon’s mayor, turned up for the launch; response from the audience was fantastic. “It blew me away,” Ekanem said. “They were definitely touched by the story." The play has since been shown in a number other venues across south London, and she would like to tour it across the UK.
Despite having spent more than 25 years working within the field of social care and mental health, Ekanem admitted it took her a while to challenge the myths and misconceptions she believed about people with mental illness.
She recalled fearing for her safety while visiting her son inside a closed psychiatric ward, where patients were walking around freely. “The whole experience with my son changed my mindset," she said. "It wasn’t a psychiatric ward of locked doors and men any more; it just became a place where people were just getting help and treatment."
Ekanem said the stigma and misconceptions about mental health are just some of the many reasons why society needs to have “open and honest discussions” about the “shocking” statistics of black men and mental illness in the UK.
Instead of doing “just another a survey” about mental illness within African-Caribbean communities, Biu – with the help of others at the Brent branch of the charity Mind – decided to use alternative methods.
Rather than simply talking to a support worker or researcher, Biu asked participants to take photographs of whatever expressed how they were feeling. He found the images were an icebreaker for getting the conversation started.
"We look at the picture together and talk about it together," he said. “Even though their emotions are coming through, the picture it doesn’t feel intrusive. It gives them the power to tell their story and express what they need to express."
One man who took part in the Arise project agreed to speak to BuzzFeed News about his struggle with mental illness, but wished to remain anonymous.
William, not his real name, is a British-born 58-year-old whose parents are both from the Caribbean. He has bipolar disorder and borderline personality disorder.
While walking through Brent, a borough in northwest London, William said he came across some car tyres piled up on the side of the road. He decided to take a photograph of them with his phone.
He said the tyres reminded him of the time before his diagnosis when he self-medicated with drugs and alcohol because he didn’t know how to deal with his mental health problems. “It sort of took me back to a period of feeling desolate and a real sense of hopelessness,” he told BuzzFeed News.
"I didn’t want to talk to my family about my mental health, because I was afraid of being a burden."
He said he once felt so low and depressed that chunks of his past felt like periods of darkness: “I remember walking up one morning, looking out the widow, seeing blossoms on the trees and thinking, Oh, it’s spring again. A whole year had passed and I hadn’t even noticed."
Like Biu, William was conscious of the stigma and lack of understanding of mental illness within African-Caribbean communities, which he said prevented him from getting help. He also didn’t want to talk to his family about his mental health, because he was afraid of “burdening” them with his problems. He feared being labelled “mad” and being defined by his mental illness.
It was shortly after William turned 30 that his mother became concerned for his wellbeing when he began acting strangely. She called a GP and he was eventually taken into hospital where a psychiatrist diagnosed him with bipolar disorder.
William has since been hospitalised for his mental illnesses on 12 separate occasions over a six-year period. Already conscious that as a black man he is more likely to perceived as dangerous, he said he has felt this more acutely since being diagnosed.
He added that hospital staff seemed more concerned with keeping patients away from the community in order to keep the public “safe”, rather than focusing on treatment and recovery.
On open mental health wards, William said, there was a mixture of patients from various racial backgrounds. “But on the closed wards it was about 90% black people – they were walking around completely gone because of the high doses of medication,” he added.
William described his mental health as a cycle of being well, depressed, and high. On one occasion after suffering a particularly severe manic episode, he committed robbery with a younger man, which put him in a mental health unit inside a prison for “the best part of three years”.
Prison was a harrowing experience. During his first nine months inside he said there were five suicides on his wing, and two on his landing. He grew to hate the sound of jangling keys and locking doors, and hated prison officers touching and searching him every day.
But it was also in prison that William finally found the support and medication that worked for him. Alongside bipolar disorder, the prison psychiatrist diagnosed him with borderline personality disorder and changed his medication to two mood stabilisers instead of one, and a small dose of antipsychotics. He could speak to professionals about his mental health issues whenever he wanted to, whereas in hospital he found it hard to built rapport with “cold staff” who didn’t seem to have time for him.
“In prison I could speak to two of the mental health nurses about my problems once a week, or even twice a week on a bad day,” he said. “Just having a neutral figure that was able help me find answers and coping strategies was so important for my recovery."
William said that he has been stable for the past nine years and is now “in a happy place”, with a supportive wife and children. Although he believes that Biu’s Arise project is a good starting point for getting black men to talk about their mental health, he also feels that there needs to be more education surrounding the reality of mental health within African-Caribbean communities.
“There’s no easy answer, but a change needs to take place in our own societies, and in our own families,” he said. “We need to talk about it more and not run away from it. With the right support more people can stay out of hospital.”