Mrs. Singh is a 45 year old South Asian woman. As a child, she would hear her parents tell her, “You are lazy” or “possessed”, and nobody in her community was able to identify or obtain much-needed support for her. Nobody understood that her paranoid thoughts may be a sign of a mental illness. And while Mrs. Singh always knew that she was not ‘paagal’ (‘crazy’ in Punjabi), she had been labelled so by her own family, as well as her husband’s.
It was only five years ago, with the support of her husband, that she was able to identify her experience as a mental illness and begin working with a psychiatrist. Her husband was pivotal in this process. “He understood my illness, and did not get mad, he was patient with me while I struggled with my illness. His family often told him to ‘get rid of me’ as I was ‘crazy’ but he knew he could get me better”.
This story may resonate with anyone, regardless of ethnicity, but it’s a common one among South Asians across Canada. Mrs. Singh’s cultural experience – the stigma and shame affecting family honor – is very impactful. Her experience left her unable to seek support for her mental health. And it was only upon receiving the support and unconditional acceptance from her husband that this became a possible route to her well-being.
Baldev Mutta, CEO of the Punjabi Community Health Service, stated that addressing “internalized and externalized stigma” must be a priority if we are to help move the South Asian communities forward in their understanding of mental health. He follows with a need to “overcome the myths of mental illness”. Our own research on South Asians with psychosis revealed a similar story. Despite there being a long legacy of agencies and activism in this area, research and reports from clients accessing services continue to speak of being ‘doubly failed’ by their communities and services.
South Asians are the largest and fastest growing visible minority group in Canada, accounting for 4.8% of the Canadian population. A quarter of all visible minority groups in Canada identify as South Asian (Statistics Canada, 2011). According to the 2011 National Household Survey, two thirds of the South Asian population originated from East India; 9.3% were Pakistani, 8.5% Sri Lankan and 4.7% Punjabi.
“It is important to work with the understanding that the South Asian community is a very diverse community with representation from many different countries and from varying socio-political contexts” states Dr. Nalini Pandalangat, Director of Newcomer Health & Specialty Services at Sherbourne Health Centre. “Resettlement is a huge stressor in the South Asian community and this contributes to stress and depression. Addiction is also an issue that is concerning within certain South Asian communities”.
We also have to meaningfully engage with communities of origin and geographies. “Some people come with a history of trauma or torture because of political unrest, and there are others who have been marginalized and discriminated due to sexual orientation and identity. This impacts mental health and well-being”. The multiple forms of marginalization experienced can compound ones sense of exclusion, sense of belonging, well-being and participation in Canadian society.
In January this year, some researchers at CAMH gathered to discuss mental health in South Asian communities. During the conversation, it became evident that a number of knowledge gaps exist to impede the development of inclusive mental health services for South Asians. This group grew into The Collaborative for South Asian Mental Health, bringing together researchers, service providers and policy makers. Mr. Mutta believes it is an “excellent way of moving forward with each partner bringing their expertise to the table”, ensuring that “tasks can be broken down so that one agency doesn’t get overburdened by the task of addressing mental health/illness in the community”.
Much of the previous research focusing on the mental health of South Asians in Canada has been exploratory and descriptive. These studies allow us to unpack issues, and highlight the cultural nuances that exist in the experience of mental health and recovery. The Collaborative is tasked with finding ways to bridge these explanatory studies so they can impact service model designs and clinical practice. We want to advance this rhetoric and move onto tackling issues that impact individuals, communities and systems.
“The collaborative is a great platform for researchers, practitioners, policy makers and program leads to come together and work with the community to promote better mental health,” Dr. Pandalangat affirms. “The research generated will help inform policy and move advocacy forward. The other exciting component is that Action Research can become a reality through this work. We should look at the interface between health, settlement and social services, to inform relevant programming. It is a much needed initiative.”
As I reflected on Mental Illness Awareness Week earlier this month, I can’t help but wonder about the ways we can do more. How can we contribute to making our services more inclusive? How can we mobilize other members within the community to advance existing efforts?
A few things come to mind; anti-stigma initiatives developed within the South Asian frame of reference, expanding definitions of recovery and psycho-social treatment, harnessing the natural supports that exist in communities such as faith spaces and leaders, and utilizing cultural media more effectively to widen reach of this message.
Mrs. Singh had many ideas too. She would like to see videos and resources in her mother tongue, learn from South Asian people with lived experience about “how they got better”, and encourage doctors to talk more about the symptoms of mental health and the role of psychiatric medication in recovery.
The Collaborative is committed to making these and many other important ideas a reality. It’s time for change!
For more information on The Collaborative for South Asian Mental Health, click here or email Gursharan Virdee.