Chris's work focuses on the unique needs of Black men experiencing suicidality and mental health challenges in the UK through Project Soul Stride. He advocates for increased funding for Black-led research, culturally specific services and peer support networks. Chris collaborates with various organisations to promote systemic change and reduce stigma.
Chris recently spoke at a meeting of the Race and Psychiatry Journal Club, and this is a summary of that conversation.
Maya: You've had a unique career living and working across multiple different continents before arriving back to the UK. How did your experiences abroad shape your understanding of mental health and racial identity?
I moved to Asia in 2000 just after my 30th birthday. I ended up living in Asia for just under 20 years. And, you know, when I first arrived in some of these countries, particularly Singapore, I remember in the tail end of 2002, I could count on two hands how many black faces there were in the Singapore business district where I worked at that time. And, it made me realise two things. One, how highly visible you are as a black man, but also how highly invisible you can be as a black man at the same time, whilst navigating some of these unfamiliar locations. But, it’s something that I threw myself into and I travelled far and wide visiting some amazing locations.
In Ulaanbaatar, the capital of Mongolia, I would guess so few of the of the locals had ever laid eyes on a black person. You have to grow thick skin, because people stop, stare and point, and, you just have to embrace those opportunities to not only adapt and know what it means to be a black man on foreign soil, but also, how recognise these microaggressions because it's very much in innocence - but it really does make you realise that you have to be quite secure in your own identity.
…knowledge should flow horizontally and not top down vertically.”
I walked to work one morning in the Beijing CBD, and as I approached a local family: grandparents, parents, kid. The kid stopped and pointed, and I could figure out what he was saying, something like ‘Mum what’s that?’ The grandparents stopped, I stopped, and they spoke to the kid and they actually bowed to me and apologised. And I bowed back and smiled and as I continued my walk to work.
I realised that, it was far less about me and much more about other people. And that's actually something I've tried to maintain in my therapy that when you hold all of those mental traumas, sometimes it's not just about you, it’s about the other people. There were so many lessons learned and some of those lessons still help me today in my everyday life.
Maya: Even though, obviously Mongolia or some of these other countries are a lot more ethnically homogenous, I think it's interesting to remember in the UK, 4% of people are black and a lot of them are in London, so there's still some pockets of the UK or other areas where being black - or other minorities - is quite rare.
Chris: Absolutely, I think about all the different forums and all the different advisory groups, I'm often the only black person – not even black man as they’re even harder to recruit for Patient Public Involvement (PPI) engagements. I sit in groups of mostly white academics, researchers, practitioners. It still intimidates me and it reminds me of that walk in Beijing.
Maya: What kind of systemic barriers do you see in how black people or other minoritised groups access and experience not only these people and groups, but also mental health services today?
Chris: Well, there's three distinct areas. The first one is distrust. Distrust rooted in historical harm and institutional racism. And, you know I left London in 2000, recognizing that at that time racism was still very much front and centre. I didn't want to have any part in it, so I ran away to Asia, thinking that when I returned, life would be very different in London. I'm sad to say that it has not changed. No doubt it's been spoken about a lot more, but a lot of the systemic issues that existed back in the late 90s are still present today which, in my view, is a shame.
The second point I want to mention is about the lack of competent cultural practices. Lots of people in the industry talk about culturally competent care. Actually, I like to peel that back and say culturally competent practitioners, because you can still have culturally competent care, but practitioners within that regime may not be culturally competent.
And the third point I wanted to make is that services are often designed without us, for us. So that tells me that there aren't enough lived experienced folks with a seat at the table with the opportunity to co-design services rather than just a recipient of them. And so those are the three major factors in that regard.
Maya: Talking specifically about suicide prevention, do you think there's any gaps in research and data that you think need urgently addressing to do with suicide prevention in the black community?
Chris: In 2023, the new National Suicide Prevention Strategy was launched, the first one in 10 years. In that document, there were 22,540 words. And the word ethnicity was mentioned six times and ethnic groups were not cited as one of the several protective groups in that document. And the reason for this is actually quite straightforward. Suicide in black communities is often misclassified, underreported or misunderstood. And at the heart of that, is stigma. So basically we need more studies focusing on risk factors for suicide in black men and women. And what we need is more intersectional data that reflects our lives, realities, and not just assumptions.
We need to find a way to rewrite academic papers, even the abstracts, so that piece of information speaks to people."
I still have an awful lot to learn, but, with the help and support of my academic allies, I'm learning at a rapid rate, and what I will be doing soon is kicking off something quite unique, which is what I call reverse co production. And that involves a lived experience practitioner leading an academic study with ten different academics across the country. They have all agreed to support in a scoping view of black suicides. The hope is that I want to turn this into not another academic journal report, I want to be able to translate that output into everyday language and visual representation that speaks to the person on the street.
This particular project is under the banner RIPPLE which stands for Raising Impact for Preventing Lives from Ending. The idea is that we will design this research so it lands in people's lives. If these academics want to turn these outputs into a journal they are welcome to do that, in collaboration, but for me the main objective is to translate what they tell me into something that a lived experienced person can actually understand. I know that some academics feel that if they bolt on a lived experience person to their study, they've done community research. Actually, that’s not community research, it’s community engagement. To me, research is getting out of your office as an academic, getting out into the community a sustained period, building relationships, gathering data, and having those individuals participate alongside you as a peer researcher and not just as an individual with lived experience.
This has not been done before, so I'm venturing into unknown territory, and I’m nervous but excited.
Maya: We often talk about mental health research or academia as quite separate from other people's lives. Could you talk a bit more about this proposed project and how you can build those bridges between academia and the average person using frontline services, so that research can lead to meaningful change?
Chris: I think what we need to do is start co-production and not just consultation. If I look back through my impact log of all of the different PPI (Public Patient Involvement) projects I've been involved with, it's upwards of 50 in the last 18 months. But if I actually analyse how many of them I was invited to consult - never knowing what the final outcome would be or what the final recommendation would be - I would probably say that 90% of my time has been focused on consultation and not true co-production. The idea of the co-production ladder is that when you get closer to the top, it's about actually having influence and design inputs. Unfortunately, in the current sector, many of us in the lived experience space very rarely have the opportunity to input at that particular part of the conversation. I still see the experience as essential, but rather than it being bolted on, it needs to be embedded from the start.
Maya: I think it's a really important point to keep in mind, especially as a lot of journals or funders are requiring that you do PPI as part of your project. And I've heard a lot of from other people involved in the PPI group, they don't really want to participate in these studies if they know, they’ll never hear about the results ever again and it doesn't really speak to them. You recently appeared at the House of Commons Health and Social Care Select Committee, tell us about that?
Chris: Firstly, what amazing experience that was, back in February. I sat on a lived experience panel. There were three of us there, and that was the first time that they had ever invited a pure lived experience panel to a committee like that. I was there to talk about my experience of community mental health services.
…co-production must involve shared power and not just shared space.”
Even for somebody like me who is very data savvy, I still find it hard to find the services that are fit for purpose at a particular time. Back in late 2023, I realised I’d been out of therapy for about six months, so I really needed to get back into because there were some things that had resurfaced. I was really struggling to find something, and it just so happened that Black Minds Matter, which is a leading charity in mental health services, happened to be posting something on their LinkedIn feed offering ten free ten therapy sessions with a black therapist. And I thought, ‘wow, that's amazing’.
So I self-referred and within two weeks I was onboarded and I was going through a ten week programme with one of their therapists. This is the fourth therapist I’ve been sat in front of in three years – but the first black therapist. Bearing in mind previously, I’d asked every single time: ‘Can I see a black therapist please?’, and the answer was, ‘no, we don't have any available, if you insist on that, you’ll have to wait maybe a year.’ And so you get so used to hearing the word ‘no’ as a service-user. What is it that I’m asking for that’s so unreasonable? The situation is improving incrementally, but certainly not at a rate that we would hope.
Maya: Your initiative Project Soul Stride is about tackling mental health inequalities through a lived experience lens. Could you talk about some of the most impactful lessons you've had so far doing that?
Chris: Project Soul Stride has become quite an endeavour for me. Back in July 2023, I realized I needed a three-month project just to get my arse out of bed, because I was at a risk of falling into some really bad habits. So I thought, here’s the skillsets I’ve got, here's the knowledge I’ve got, here's what I like to do. And I threw it all into ChatGPT and it said, okay, why don’t you run a lived-experience project for three months, speak to 30 people, tell them your story, ask them some basic questions and find out what’s going out there in the industry. That was the premise and it just started to rapidly snowball.
I kept on asking in every call if there’s someone else you might benefit with this conversation, who might that be? They started to come back and say ‘Chris, there’s this person, or this person you should be speaking to’. Over 14 months, 180 calls were conducted from my bedroom on this laptop. What that resulted in was just hundreds of pages of notes and anecdotes, quotes, that kind of stuff.
Them the Project Soul Searching page just went mad. From that, I just had an endless list of different opportunities that ended up presenting themselves to me because I was being seen as a journalist and not as somebody pretending to be an academic. I wanted them to know that I’m a black man who’s been through this, who’s smart enough to be able to speak to academics, and I'm going to translate. The biggest thing I got out of it so far, is the opportunity to have a seat at the table. I realised that I was not going to wait to be asked - I'm not waiting for permission anymore.
Maya: It's obviously a quite a different approach than we use here. A very important type of knowledge production. As academics, we know how hard it is to recruit people, so it's amazing that you spoke to that many people. What other methods are there for knowledge production that actually respects people with lived experience?
Chris: I always say that inclusion without influence is tokenism. If you ask every single PPIE to write down on a scale of 1 to 10 at the end of the project cycle, what their level of inclusion and influence was on that project, I would imagine the vast majority would score it pretty low, and that they would feel as I do, that they were there to tick a box and nothing more. And that is a sad reality. So we need more funding, we need more structures, we need more learning and development that values community and expertise as much as academic credentials.
I’ve been mentioning “distributing academic power” a lot more recently, and by that I mean knowledge should flow horizontally and not top down vertically, which is what's been happening for so many years. We need to find a way to rewrite academic papers, even the abstracts, so that piece of information speaks to people. Whether it's through a two minute video, whether it's through an infographic or a cartoon or something like that. The power dynamic will never change unless you are prepared to acknowledge that some participants may not have your academic power, but they still have power in their own way.
Are people with lived experience getting an opportunity to learn and develop and improve our skills so that we can add even more value? Very, very, rarely. Ask them, ‘what is it you want to get out of this? Where do you see yourselves? What are your own aims and ambitions? How can we help you achieve your goals?’ Rather than, ‘how are you helping us achieve our goals?’, which is to get more funding for more studies and produce more journals – that is it. I think that if that conversation was happening a lot more frequently, I think you’d be keen to see that collaboration dynamic moving and shifting in a way that it should be. Give us some of your resources, teach us what it is to become more expert in this field, then we can really start to influence. I always say that co-production must involve shared power and not just shared space.
Maya: What can researchers learn from community driven approaches and how can they better support them?
Chris: Grassroots work is far more nimble, relational and culturally-rooted - things traditional systems struggle with. I always cite one example in every conversation, and that is The Friendship Bench - Zimbabwe, developed by Professor Dixon Chibanda, which has now been proven globally as one of the strongest examples of community intervention for mental health. I've been supporting the Friendship Bench for London project in the last year. I also know that it's been extended to other parts of the UK, but also in other parts of the world.
I always say that inclusion without influence is tokenism."
Isn't it interesting when you think about low/middle-income countries and the lack of resources that they have i.e. distance from home to go and visit a therapist. Often that financial journey, the cost of that journey is impractical for many people living in rural villages. So the question Dixon came up with is, how do we use people within the village to support the village? So what they did is that they started to train lay members, grandmas, to provide, early intervention services to the community. Now they’ve trained well over 3,000 grandmas in Zimbabwe, providing an unbelievable amount of free therapy to local community members on the friendship bench.
And when I mentioned this to people, they think, oh, there's a friendship bench where you can go and sit if you’re lonely and go and speak to a stranger and have a conversation. But this is far more than a basic bench. This is actually six planned sessions on the bench with a trained lay member of the public, trained in early intervention for mental health services and problem-solving skills. This has come from a lower/middle income country, so let us not think that first world countries like the UK, Australia and America, have all the answers. Actually most of the problems come from first-world countries. The answers and solutions exist within low middle income countries. If only we would go and see them and learn from them and adapt them to our different communities here and abroad. These sorts of opportunities exist, without a shadow of a doubt.