“We keep asking Black communities what the barriers are and then don't act on the answers”

We have all heard people say, “therapy is for white people”. We know that isn't true, but that doesn't mean mental health support is equally accessible to everyone. There are a variety of factors that can prevent Black people from engaging with therapy. What do you believe are the key barriers to accessing mental health support for Black people?

Many sit with services rather than with Black people. Most of the therapy we offer was built on research with white Western populations, so it can feel like it wasn't made for us, because often it wasn't, which is a problem. Then there's stigma closer to home as many of us may have grew up hearing "pray about it" or "what happens in this house stays in this house." Faith and family matter, but they shouldn't be the only support we have. Then in addition, there is racism in healthcare, everyday micro-aggressions that are anything but micro in their impact, and rarely seeing a therapist who looks like you. What frustrates me is that we keep asking Black communities what the barriers are and then don't act on the answers. Services need to go into communities, listen, adapt, and keep checking it's working. Getting it right once doesn't mean it's finished. yes, we are black, but there are so many differences as there are communities within communities.

Your article “Dear Black People, You Deserve CBT Therapy too!” discusses adapting cognitive behavioural therapy (CBT) to people’s cultural experiences. What would that look like in practice when supporting someone affected by racism?

CBT has a reputation for being rigid and black and white, and it has a history rooted in Western ideas of what distress looks like. I don't think that means it isn't for us. It means it has to be adapted. Culturally adapted CBT takes racism seriously as a real experience rather than a "thinking error" to be challenged. It makes room for faith, family, community and the beliefs people carry about themselves because of how they've been treated. It starts from cultural humility: the therapist doesn't assume they know, and

keeps asking and it's also intersectional. A Black lesbian woman with a disability doesn't experience these parts of herself separately, and her therapy shouldn't treat them separately either. More therapists should be adapting therapy and being open and delivering it in this way but we know that this is lacking in services. The field is still growing, and that's a reason for hope as well as a call to keep going.

Being based in Yorkshire can be a struggle when trying to find a therapist that not only looks like you, but respects and understands all the different subcultures a black person may belong to. Do you have any advice for Black LGBTQIA+ people worried a therapist won't understand or respect their identities?

If you've been misunderstood or judged before, including by professionals, holding back trust is a reasonable response. Check your therapist is accredited or registered with a professional body such as the BABCP, BACP, UKCP or HCPC. Then use the first conversation to find out how they work as you’re allowed to ask: have you worked with Black LGBTQIA+ clients? How do race, sexuality and gender show up in your practice? One training course doesn't make someone culturally competent, so listen for what they've actually done with it. A good therapist won't know everything about your life and won't pretend to. They'll be curious, open to correction, and take what they don't know to supervision rather than expect you to teach them. If the first therapist isn't right, that's okay. Online therapy can widen your options, and you deserve someone whose values sit alongside yours.

Traditional therapy isn’t everyone’s cup of tea, and some people enjoy talking with their friends more than professionals. What do you think the role of peer support is in reducing isolation?

Isolation often comes from feeling that nobody around you gets the whole of who you are. Sometimes you might feel at home in Black spaces but not able to be fully you or accepted in LGBTQIA+ spaces but the only Black person in the room. Peer support speaks to that directly, I think as being with people who share your experiences means you don't have to explain or defend yourself before you can be heard. Many Black cultures are built around community, so we already know this works. Peer groups won't replace therapy when someone needs it, and they're not meant to. They're often a stepping stone: a place to feel less alone, to hear how others have coped, and to build the confidence to take the next step. Charities like MESMAC's aim to provide that kind of space.

Mental health support can be quite expensive depending on what you’re looking for. What free or low-cost first steps towards mental health support would you suggest?

Start by learning a bit about what you're going through some professionals call this psychoeducation, which simply means understanding how things like anxiety, low mood or trauma work. It helps you make sense of your experience and put what you need into words. Free sites like Get Self Help (getselfhelp.co.uk) have worksheets and guides, and if you're in Leeds, MindWell (mindwell-leeds.org.uk) has resources, lists local services and groups. Next, look at what's around you as Voluntary and community organisations often get missed, but many offer free support: MESMAC, for example, offers six free counselling sessions for LGBTQIA+ people. In England you can also refer yourself to NHS Talking Therapies without seeing your GP first, though your GP is still a good place to start. And if you're struggling right now, Samaritans are free and open 24/7 on 116 123.

About this interview

This interview was written by a Black member of the Yorkshire MESMAC team as part of our Black History Month content series. The questions and themes explored were informed by lived experience and intended to centre the voices, perspectives and experiences of people from Yorkshire's Black communities.

Find out more about Dr Carlyn Boyce here: Dr Carlyn Boyce