Angie Agrawal Holstein, MSW, RSW, Psychotherapist August 2022
Shanti Psychotherapy specializes in South Asian mental health for good reasons.
In such a diverse society, it’s been clear for a long time now and as indicated by research, that affinity and culturally diverse therapy is needed for South Asian communities to support the silent mental health crisis.
One size does not fit all when we explore the differences between ethno-cultural therapy versus the more widely available and traditional EuroCentric based therapies. South Asian mental health and wellness issues are unique based on background, ethnicity, and belief system. Most mental health providers who do not share a similar cultural background may hold certain assumptions and biases of what constitutes “normal family life” or gender roles that differ from those of their clients unless they are trained and practicing from a multicultural framework. Therefore and ultimately undermining the effectiveness of the mental health treatment and/or their client’s willingness, to not just seek it out, but to continue with it.
Finding South Asian therapists who can understand more about the intersections of identity has been difficult not only due to cultural stigma but more so due to the in-accessibility of South Asian therapists.
We actually need to stop saying that stigma is the only reason that people of colour do not seek out mental health services.
In 2015, the American Psychological Association reported that 86% of psychologists in the U.S. were white, 5% were Asian, 5% were Hispanic, and 4% were African American. That distribution doesn’t reflect the country’s demographics: 60.4% white, 18.3% Hispanic/Latino, 13.4% African American, and 5.9% Asian, according to 2018 census data.
Let's start examining the barriers within the mental health system as well, to see if the system is meeting the unique needs of our diverse population. What you will find is that many people of color do not access mental health care because they can’t find therapists that look like them, that ask them about race/culture or who have a language that relates to their cultural experience.
We know from longstanding research that the number one predictor of positive outcomes is the therapeutic relationship. This is the working relationship between the mental health professional and the client. Cultural affinity in these working relationships has shown to foster a higher quality relationship by assisting the client to feel more comfortable and understood, which in turn boosts the success of treatment and positive outcomes for the client and their wellness goals. Having a South Asian client see a therapist of South Asian background increases the likelihood that the client will feel more comfortable in therapy which supports doing the work.
Typically South Asian therapists serving South Asian clients have more competencies in understanding the following FACTS on South Asian mental health:
Mental Health Problems
1 in 5 South Asians report experiencing a mood or anxiety disorder in their life time. These rates of mental health problems are reported at higher levels for South Asian women versus South Asian men. Current data is urgently needed to reflect the full diversity of these statistics and the current socio political context.
South Asian immigrant females report more self-harm and certain mental illnesses, including depression, anxiety, insomnia, and eating-related psychopathology.
Data suggest older adults face a disproportionate burden of psychosocial stress in the community, especially older women. Leaving them with potential risk factors for depression include abuse and neglect, social isolation, intergenerational conflict, and acculturative stress. Depression in older adults can also exacerbate risk for poor physical health and lead to slower recovery from physical illness.
Depression, a Major Affective Disorder, is the most common of all mental health diagnoses among South Asians in general.
South Asian Youth are at greater risk for suicidal thoughts and behaviours than other minority groups. Typically these youth present with stressors based on academic pressure, risky behaviour, poor acculturation, discrimination, high parental expectations and pressure, limited supports outside the family system, physical symptoms, relationship problems with family, domestic violence, gender role expectations and cultural conflicts as first generation youth.
South Asian men more than women are at a greater risk factor for alcohol related mental health and physical health problems. Often with co-morbid mental health conditions, these lead to increased risk factors within the family such as family violence, financial issues, drunk driving and legal problems.
STIGMA
South Asian communities often express greater stigma towards mental illness than other cultural groups and thus becomes a barrier to getting help. Stigma often comes strongly from within the family. South Asian culture is a collectivist society - more of a “we” versus individualism in Western society. Collectivist societies tend to keep personal problems within the family, seek help as a last resort and may feel a sense of failure if problems are not able to be solved from within the family. Disclosure of mental illness is also believed to have negative attribution of shame to the family and a sign of weakness - further isolating individuals from seeking out health services.
Religion, often a central part of South Asian families, may also deter families from seeking help, as they tend to turn more towards prayer and counsel from religious figures in times of distress. While valuable to have as a resource - at times this can deter individuals from seeking mental health care or feel pressure to have religion being the saving factor.
Many LGBTQ+ BIPOC find it challenging to open up to close friends and family due to ongoing stigma as currently approximately 50% of LGBTQ+ individuals experience rejection from their families.
Somatization
South Asians with mental health issues commonly interpret their symptoms as physical illnesses and often do not seek needed psychological help. Mental health problems can absolutely show up as physical symptoms such as insomnia, stomach issues, auto-immune disorders and body pain. One Canadian study found that even when South Asians present psychological difficulties to their primary care physicians, they are often untreated and undiagnosed because they are presented as somatic rather than depressive symptoms. Disproportionately high rates of mental illness among South Asians may have implications for disparities found in chronic illnesses since psychosocial stressors have been linked to an increase in risk for the onset of cardiovascular disease (CVD) and cancer.
Lack of Education and Awareness
There is a general lack of awareness regarding mental health issues and contributors to mental health difficulties within South Asian communities. For example a lack of awareness of acculturation stress, intergenerational conflict in first generation families, conflict with parents, etc.
Limited awareness of mental health services and mistrust of organizations outside of the family or cultural system.
An overall lack of research in the area of South Asian mental health and the specific populations within the demographic.
Don’t give up.
Learn more about issues facing your community to validate and normalize what you may have experienced yourself. The most difficult barrier to healing is isolation. Finding a good fit with a therapist may require some work and perhaps the first therapist you find may not be the right fit.
Don’t give up.
The right therapist is there for you to help you make positive strides for your health and well being.
Angie Agrawal Holstein, MSW, RSW, Psychotherapist
#mentalhealth #SouthAsianMentalHealth #ethnocentric #psychotherapy #breakthestigma #toronto #stressresponse #AngieAgrawalHolstein
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