I live with several mental illnesses. In spite of this I am privileged.

To mark Black Maternal Health Week (U.S.A) , Hannah King – midwife, mother of two, lecturer in public health and co-founder of @midwivesagainstracism – reflects on her white privilege in relation to her mental health.

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I write this, not to invalidate my own experience of trauma or anyone else’s, but to know that mental health care in the U.K. is inequitable and inaccessible to many British people.  

Society affords me the vulnerability which it does not afford to women racialised as Black. Women and birthing people who are racialised as Black are mislabelled with the strong and resilient trope by society. This legacy of slavery persists in the U.K., oppressing already marginalised populations and dehumanising them systemically.

“My whiteness has cushioned the sharpness of living with mental illness”

Privilege
I ask you to reflect on your most vulnerable time in life. My most vulnerable times in life include my experiences of birth, of accessing mental healthcare and of accessing the justice system. None of these experiences have been perfect, yet I was privileged to be unaware of the white supremacy at play. I did not have to navigate being ‘othered’ by an unjust system or experience oppression relative to my race. My whiteness has cushioned the sharpness of living with mental illness. This privilege must not go unnoticed.  

Child Q
In the wake of the Child Q report and this week being Black Maternal Health Week, I think of Child Q and her mother. As a fellow mother, I can only begin to imagine the mental anguish and suffering the mother of Child Q is enduring. Knowing that her child is another link in intergenerational trauma. Living with the knowledge that her baby girl has been made a victim of sexual violence within the confines of an institutional ‘safe space’. And of course, I think of Child Q who has endured significant sexual violence and subsequent trauma. Will she become a mother herself one day? Will she have opportunity to heal from this trauma only to be retraumatised in pregnancy or birth? Will institutions fail to protect her throughout her life course?

“We must recognise the burden of living in a society built on white supremacy”

Perinatal outcomes
Those working in the space of birth must ensure that every individual you serve is made to feel respected, dignified and to hold agency over their own care. Before we are given the privilege to care for women racialised as Black, we must recognise the burden of living in a society built on white supremacy. We know the perinatal outcomes in both morbidity and mortality are worse for women racialised as Black when compared to their white counterparts. The journey to pregnancy and birth is similarly disparate when compared with white women. Women racialised as Black are more likely to experience miscarriage, stillbirth, infertility and wait on average longer for IVF treatment when compared to white women. We can therefore assume that before women racialised as Black enter a clinical pregnancy setting, they are likely to carry the burden of significant perinatal trauma.   

Mental health
A combination of societal conditioning and cultural stigma surrounding mental illness means individuals racialised as Black are less likely to seek care for their mental health, causing a huge treatment gap. When care is accessed, literature suggests individuals are often met with discrimination, bias and poor communication. My privileges in mental health are significant and almost never ending. When compared to a woman racialised as Black, I am less likely to have a mental health disorder. I am less likely to be treated with the depo antipsychotic injection. I am less likely to be physically restrained in a hospital setting. I am less likely to live with other chronic illnesses such as cardiovascular disease and diabetes which may be complicated by mental disorders such as depression. I am less likely to be forcibly detained under the Mental Health Act. I am less likely to live in a highly polluted area.I am less likely to suffer from medical gaslighting. I am less likely to endure discrimination in the medical system. As I have not experienced racism, I am less likely to develop psychosis or depression when compared to an individual who has experienced racism.

“The disparities are leaving traumatic imprints in Black British families, with far-reaching and irreparable effects”

Just a scratch in the surface
I am more likely to be given a correct and timely mental health diagnosis. I am more likely to be referred to talking therapy. I am more likely to be able to access cognitive behavioural therapy (CBT). I am more likely to have racial concordance with my psychiatrist or therapist. The medications I take are more likely to work. I am more likely to have access to green and/or blue space. I am more likely to access mental health care via primary care rather than crisis care. This just scratches the surface of what white privilege looks like in the U.K.’s mental health services.   

Traumatic imprints
From the perspective of my own motherhood and if the statistics remain unchanged as my children reach teenage years and adulthood. My daughter will be afforded the vulnerability of her age, avoiding adultification in both the educational and justice system. My son will be less likely to be excluded from school when compared to a boy with Black Caribbean heritage. My son will be less likely to be forcibly detained for a Section 60 or Section 1 of the Police and Criminal Evidence Act (Stop and Search) when compared to his peers racialised as Black. If detained in police custody, my son would be half as likely to die where force or restraint is used, when compared to his peers racialised as Black. If found to be carrying illegal drugs by police, my son is five times less likely to be arrested for drug offences when compared with an individual racialised as Black. Needless to say, these disparities are leaving traumatic imprints in Black British families, with far-reaching and irreparable effects.   

Toxic power
There are gaps in Black families where there should be mothers. We know this from every maternal mortality report since the 1990s. The fact that it is possible for trauma to permeate multiple aspects of Black British family life, whether that be through poorly managed mental health, loss of life through violent crime, disproportionate maternal and neonatal death, death in police custody or harsher sentences for incarcerated family members, is testament to the toxic power and traumatic impact of contemporary white supremacy.  

Hannah King is a midwife, mother of two and lecturer in public health living in the North West. Hannah is co-founder of @midwivesagainstracism and a founding member of SHERA, a research group investigating the health outcomes of women who have experienced domestic abuse and family court.