Does race make it harder to diagnose a mental health issue?
Becoming a mother can affect mental health in ways that are not always easy to name. Even when someone knows they need help, saying it aloud can feel exposing, particularly when mothers are expected to cope. And disclosure does not guarantee care.
Many of the mums we speak to were left waiting for weeks and months; others are told they do not meet the threshold for support.This can happen to anyone, but not every mother meets our healthcare system from the same position. Personal circumstances influence how easy it is to access care and whether that care feels safe.
Race is part of this picture, often intertwined with income, language and immigration status. Some Black, Asian and other racialised mothers enter maternity care already carrying experiences of being dismissed or stereotyped. That history can affect what they share and how readily they trust the response. It can also affect how professionals interpret what they hear.
When being heard depends on being understood
A diagnosis is not simply a label waiting to be discovered. It depends on whether a mother feels safe enough to disclose her distress, whether the right questions are asked and how her answers are interpreted.
Research highlighted by the NHS Race and Health Observatory found that in North Central London 28% of White British women were identified as having mental-health needs at maternity booking, compared with only 8% of Black African women. This is local data, not a national estimate, but it raises an important question: does a lower diagnosis rate point toward less distress, or that distress is being missed?
Some mothers may be assumed to be coping because they appear calm, capable or “strong”. Others may avoid speaking openly because they fear judgement, being misunderstood or attracting unwanted attention from social services.
And as much as we’d love for screening tools to be objective - they are not. Every tool carries the inherent bias of its culture and language of origin, which makes it blind to experiences that do not fit familiar norms. This creates a difficult contradiction. A mother may not be considered unwell enough for early support, but later enter care through crisis. The issue is not only whether a service exists; it is whether someone can reach it before their choices narrow.
The difference between support and detention
A 2020 study examined NHS records for over 600,000 women who gave birth in England. Black African, Asian and White Other women were less likely than White British women to receive specialist mental-health support while living at home. Among those admitted to psychiatric hospital, a higher proportion were detained under the Mental Health Act.
That distinction matters. Community care offers support without removing a mother from her home and usually gives her more say in what happens. Detention means that treatment has become compulsory. Once Black African, Asian and White Other women reached community services, they attended more appointments and missed fewer of them than White British women.
Therefore, rather than pointing to a lack of willingness, the data raises questions about what happens earlier: whose distress is recognised, who is referred and who can get through the door before reaching crisis.
When unequal care becomes a safety issue
The gaps in recognition and access described above matter because they sit within a maternity system where outcomes are already unequal.
The 2025 MBRRACE-UK report found that Black women remained more than twice as likely to die during pregnancy or shortly afterwards as White women. Asian women also faced a higher risk. Mental health is part of this wider safety picture. Between 2021 and 2023, 88 women in the UK and Ireland died by suicide during pregnancy or within a year of pregnancy ending. Suicide was the leading cause of direct maternal death between six weeks and one year after pregnancy, and psychiatric causes accounted for 34% of deaths during that period.
The timing is important. After birth, attention often shifts quickly towards the baby, while routine contact with maternity services reduces. A mother may still be living with depression, trauma from the birth or a mental-health condition that has not yet been recognised. For those who already face greater barriers to community support, this can leave serious distress without consistent care.
The MBRRACE review found that most women who died were living with several pressures at once. Mental-health difficulties often existed alongside experiences such as domestic abuse, deprivation, substance use or involvement with social services. Racism can deepen these pressures and influence what happens when a mother seeks help: whether she is believed, whether her symptoms are recognised and whether support arrives before her situation becomes an emergency.
Maternal suicide prevention therefore begins much earlier than a crisis. It begins with taking distress seriously during pregnancy, recognising the psychological impact of birth and ensuring that support continues after the usual maternity appointments end. If Black, Asian and other minority ethnic mothers are less likely to be recognised or reach voluntary care, addressing that inequality is part of keeping mothers safe.
What safer care looks like
Representation is not simply using diverse photographs or translating a leaflet. It means asking whose experiences shape research, assessment tools, staff training and service design.
There is no single experience of being a mother of colour. Broad categories such as “Black” or “Asian” can reveal inequality, but they can also hide important differences between communities. Services need better data alongside genuine involvement from the people they are trying to support.
Safer, more equitable care means: recognising that low diagnosis rates may reflect missed need; examining who receives early support and who enters care through crisis; treating racism, traumatic maternity care and social adversity as relevant to mental health; providing continuity so mothers do not have to repeatedly retell their pain; offering interpreters and culturally responsive care without making assumptions; and involving mothers from racialised communities in designing and evaluating services.
Being heard must lead to something: a clear plan, a follow-up, a referral - and always the reassurance that professional care is a safe space.
Being heard must lead to something: a clear plan, a follow-up, a referral - and always the reassurance that professional care is a safe space.
Continuing the conversation with Mumbrite
This article was written as an introduction to the Mumbrite community - a digital platform created to support and connect Black mothers. We are glad to be joining the conversation during Black Maternal Mental Health Week UK and to contribute to a space where Black mothers’ experiences of mental health, maternity care and motherhood are heard in their full complexity.
Download our free guide: Getting Heard — Perinatal Mental Health Appointment Guide — practical prompts, questions and scripts to help you prepare to discuss your mental health with a GP, midwife or health visitor.
More support
Mothering Minds offers online therapy focused on perinatal and parental mental health - while keeping the racial dimension in mind. Further support is available through The Motherhood Group, Black Mothers Matter, and Five X More. If you or someone else may be in immediate danger, call 999 or go to A&E. In England, call NHS 111 and select the mental-health option for urgent support.
Sources
MBRRACE-UK: Saving Lives, Improving Mothers’ Care 2025 — full report
NHS Race and Health Observatory: Tackling inequalities in perinatal mental health
Jankovic et al. (2020): Differences in access and utilisation of mental health services in the perinatal period for women from ethnic minorities — a population-based study
NIHR Evidence: Mental health care during pregnancy and afterwards — women from some ethnic minority backgrounds face barriers to access