The preceding sections have outlined the issues and the process that was undertaken to engage with those who are racialised in Scotland. We were invited to undertake this work as it was recognised that the suicide prevention strategy had not managed through the usual consultation process to engage with racialised people. This work is to support strategies that develop.
Racism was only recognised as an urgent threat to health in November 2020 by the American Medical Association. This is significant, not only in how long it has taken which is likely an indicator of systemic racism itself, but what it actually means for the public health landscape and for our collective understanding of the social determinants of health more generally. There is no Scottish exceptionalism.
When engaging with people who are racialised in Scotland for this research it was found that racism permeates many aspects of their life and is understood as deeply affecting their mental health. The harm racism causes seems intensified because people and services who are there to support them do not seem to understand how racism functions in society and health. This seemed of particular significance when participants spoke of suicide. Intergenerational immigration experiences were also reported as a significant factor impacting on people's health and well-being, individually, families and communities.
Finally, it seems important to note that there was a sense that the learning needs for health services and for families and communities seemed somehow similar in relation to mental health, suicide ideation and completion and the factors which impact on those who are racialised within society.
"And in a population as a whole - yes, we as I know we are small, number in the community yes - but I think, the policies, have to start thinking, how they are going to include us not as an extra not as an equality issue. Otherwise, we are going to see, the impact of not reaching to us is going to be immense. In every way we need- they need to engage with us… they need to stop excluding us and putting us on the side and start accepting that we are there, we exist there's generations are coming up and they need to understand us" (1-1 participant 4)
This small piece of qualitative research, undertaken with care but also with some haste with people and community organisations who have first-hand experiences of providing, getting, wanting or losing support in relation to suicide prevention, ideation and completion. The report has outlined the context, the process and the issues which were evidenced through this research. Racism, immigration, mistrust of services and community stigma in relation to mental health, suicide ideation and completion were dominant issues and are the focus of much of what was reported.
The research team were not asked to formulate specific recommendations, it was asked to engage with and report from those who are racialised about their experiences in relation to suicide. However, it is clear that racism in all its forms is a key factor which is viewed by those who experience it as misunderstood and often not even seen by the systems of health support in Scotland. This reflects the current global conversation about systemic racism, how it operates in society and how living a racialised life in a predominately white society needs to be engaged with and understood in order to develop appropriate services. The need for the mental health workforce to reflect the people it serves is clearly expressed in the research and again reflects the wider global conversation highlighted during lockdown and expressed through #BlackLivesMatter. All the issues reported are already well documented and this fact and the current challenges for mental health are explored in expert detail by Kinouani (2021).
This work has been undertaken to support the strategic development of service and policy implementation. What is clear is that individual people in the communities and the small, often fragile, support organisations want the Scottish mental health landscape established NHS, third sector and well-established supportive charity funders to engage with them and those they support in a more meaningful and centring way.
The conversation and knowledge of the experiences of those racialised in society has been changed by the global pandemic. A moment of understanding seemed to be shared. This work contributes to the spirit and ambition of that conversation and the channels for engagement are open if the Scottish Government wishes support to develop implementation strategies for mental health services.
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