Mental health

A study from 2001 found that black African patients at a London HIV clinic were three times less likely to be referred for specialist mental health care than patients of other ethnicities. Those black African patients who were referred tended to have more severe disorders than other patients, suggesting that milder levels of psychological distress were not being recognised. Some of the possible reasons suggested for the disparities include health workers’ difficulties in recognising psychological illness in black African people and a reluctance on the part of black African patients to be referred to services deemed to be threatening.1

It is not clear whether mental health care for HIV-positive black African people has improved over the course of the decade. In 2007/2008 the What do you need? study found that 65% of black African people reported problems with anxiety or depression while 64% reported problems with self-confidence or self-esteem.2 Looking at the wider population, a large 2009 survey of mental health inpatients found that 22% of patients were from minority ethnic groups (whereas 9% of the country’s population are from minority ethnic groups). There were also high numbers of people from some ethnic minority groups, including black African people, who were detained under the Mental Health Act.3

One barrier to the uptake of mental health services could be attitudes towards mental health within black African communities and different ways feelings are understood. Some suggest that having a problem with mental health is as stigmatised as having HIV, and that black African people believe that being seen with antidepressants will draw accusations of being ‘mad’. Improving uptake of interventions addressing black Africans people’s mental health needs requires efforts to show the value and rationale behind them and to make them feel relevant. It has been suggested that some black African people prefer to express themselves using vivid narratives – for example, ‘a head full of snakes’ to describe anxiety – and that alternative counselling techniques to sitting and talking, such as drama therapy, may be useful in such instances.4

See also


  1. Malanda S et al. Are we meeting the psychological needs of Black African HIV-positive individuals in London? Controlled study of referrals to a psychological medicine unit. AIDS Care, August, 2001
  2. Weatherburn P et al. What do you need? 2007-2008: Findings from a national survey of people with diagnosed HIV. Sigma Research, May 2009
  3. Care Quality Commission Count Me In 2009. See, 2010
  4. Elliot A A head full of snakes. Positive Nation (issue 127), November, 2006
NAM would like to acknowledge AHPN's contribution to the content of this
This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.