Mental health is an integral part of our overall wellbeing. It affects virtually every aspect of our lives – from our emotional state, to daily activities and socialising with others. Different factors affect our mental health: individual biological factors, positive and negative lived experiences, family and relationships with social circles.
People from CALD backgrounds face unique challenges that put them at an increased risk of developing mental illness. Naturally, traumatic experiences, displacement, and problems related to integrating into a new society have a deteriorating effect on a person’s psychological wellbeing. And more than that, very often people from CALD communities are unable to access timely psychological help.
We’ll be discussing the following questions in this article:
What actually is mental health?
What makes people from CALD communities vulnerable to mental illness?
What are the barriers to seeking mental health support?
How can mental health services ensure they reach CALD communities?
But before we start, it’s important to clarify the two terms, which are sometimes confused or wrongly used interchangeably: mental health and mental illness.
Mental health vs mental illness. Definition.
The term mental health refers to our mental wellbeing: our emotions, thoughts and feelings, our outlook, our ability to solve problems, cope with difficulties, and maintain social interactions.
“Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community. Mental health is fundamental to our collective and individual ability as humans to think, emote, interact with each other, earn a living and enjoy life.” (World Health Organization)
Mental illness, also called mental health disorders, refers to a wide range of mental health conditions. These disorders have certain symptoms and negatively affect a person’s mood, thinking and behaviour. Examples of these mental health conditions could be depression, anxiety disorders, eating disorders and addictive behaviours, schizophrenia.
The challenges for CALD mental health and barriers to accessing mental health support
Mental health in CALD communities is a systemic issue. On the one hand, migrants, refugees and asylum seekers experience mental illness and suicidal behaviour at significantly higher rates than the general population (1). Therefore, they should be in a higher need of mental health support. At the same time, as research shows, they also underutilise healthcare and support services (2). What are some of the factors that impact people’s mental wellbeing and also stop them from taking prevention and treatment measures?
Stigma in diverse communities
CALD people are at an increased risk of developing mental conditions due to prevailing high levels of mental health-related stigma within their communities. How does this stigmatisation affect the mental health of an individual?
Firstly, some of the community’s cultural and religious traditions may prevent people from speaking about mental health and accessing help services. In some societies, mental health is never spoken about, and people grow up unaware of the issue (3). The state of mental distress may be even normalised so that it becomes a norm to be suffering (4).
Secondly, many CALD communities have conservative attitudes to health-related issues. In some cultures, problems such as mental illness are supposed to be kept private. Family honour is a crucial cultural aspect in many ethnic groups who live in close-knit communities. And having an ill member can put a family to shame. That is why people who are feeling unwell do not seek help from professionals and even family.
Either way, people from some CALD communities may be reluctant to seek treatment, care and support due to stigma (5). So, stigma becomes a serious obstacle to the early identification, prevention and treatment of mental disorders.
Different medical systems
The differences between the medical systems in migrants’ countries of origin and in Australia may play a big role. Mental illness is not treated the same way everywhere. For example, in some countries, mental health services only extend to custodial or hospital treatment for very ill or psychotic patients (6). So, newly arrived migrants may not be familiar with the new system. They may also not be aware whether they can access help services and when they should do so.
The impact of discrimination
CALD populations, such as newly arrived migrants, refugees and emerging communities are most susceptible to racism and ethnic discrimination. There could be numerous reasons for that – unconscious biases and insufficient cultural awareness within the society shape people’s attitudes to “a foreigner”. And also, negative portrayals of migrants in the media heavily influence public opinions about those who are “different”.
Lack of social inclusion and continuous exposure to racism have an inevitable harmful effect on mental wellbeing. Intolerance, judgement, and communication barriers lead to chronic psychological distress, which increases the risk of mental illness.
“The 2014 Victorian Population Health Survey found that Victorian adults who frequently experience racism are almost five times more likely to have poor mental health than those who do not experience racism” (Figure 21.3 from the report). (7)
By the same token, individuals who experience racism are less likely to seek and access mental health support services. That is because they might expect prejudice or a lack of cultural understanding from the practitioner. And in fact, some practitioners may have a discriminative attitude towards a “foreigner”, even if unintentionally.
Source: RCVMHS Final Report, Vol.3.
Migrants do not always have sufficient English proficiency to have a comfortable conversation with a specialist and express their concerns. And obviously, health professionals are not expected to speak their native language. In-language services or community interpreters are also not commonly available. This makes it practically impossible for a migrant to access healthcare services even when needed.
“Help” can be traumatising.
Naturally, mental help facilities need to collect the background information from the patient as a part of the intake process. Then the patient is forwarded to the appropriate specialist, where the story has to be told again. For refugees, in particular, this experience is particularly undesired, as they are put to recall and relive the traumatic events, so they may prefer to avoid seeing a psychologist.
Lack of cultural sensitivity and inclusiveness of service providers.
Culture plays a crucial role in how we see the world. How we react to events, build relationships, think of the past and the future. To correctly interpret one’s mental condition and provide adequate psychological help, it is crucial to understand the person’s culture. But most often, health specialists are not familiar with other cultural beliefs systems. And CALD patients describe mental health services in Australia as being almost exclusively ‘Western’ (8) in their approach to mental health and wellbeing. The result is that the patient and the doctor have two different narratives that cause misunderstandings and barriers to effective service provision.
Research is the key to reaching people
There are some great organisations providing services to people facing mental health difficulties in Australia, but awareness among culturally and linguistically diverse communities is often limited or, if they are aware, they are worried they will face less positive outcomes than non-CALD individuals. The LOTE Agency has worked with a number of the major mental health service providers in Australia, and the most rewarding projects have been research engagements where the organisation establishes who they’re not reaching that need to be reached, what their experiences are within their own cultural identity – including racism that they might face, what the barriers are and how they can be overcome. Our clients find that this is a huge learning experience, where they recognise that their CALD audiences have specific needs that are different from what they are used to working with.
Some of the barriers to successfully engaging CALD audiences on the topic of mental health are that some people don’t recognise when they are on the receiving end of racist behaviours, as they tend only to categorise direct verbal and/or physical abuse as racism. Whereas racism is a very broad experience that can manifest in many different ways, in subtle forms, or “micro-aggressions”, or disguised as humour. Another barrier is that, in many CALD communities, “mental health” and “mental illness” are used interchangeably, and can be associated with harmful stereotypes, or the view that God is punishing the sufferer for something shameful. While these views are mainly held by older generations, the stigma is handed down and is still felt by younger generations. This sense of stigma creates another barrier, in that it negatively impacts help-seeking. For non-CALD young people their parents can be their first line of help-seeking, but if CALD young people don’t have that pillar of support, they may not reach out for help until their problems are much more severe.
With the right research, our clients can better understand the needs of CALD people and tailor their services accordingly, ensuring that all Australians have access to mental health support.
We explored the issues with ReachOut, headspace and the CMY – watch now
We recently spoke with friends from ReachOut, headspace and the Centre for Multicultural Youth to find out more about mental health in culturally and linguistically diverse communities, particularly among young people, and the importance of cross-cultural research in mental health communications.
1 Mental Health in Multicultural Australia, Introductory Guide: Framework for Mental Health in Multicultural Australia towards Culturally Inclusive Service Delivery, 2014, p. 7
2.Orygen, International Students and Their Mental Health and Physical Safety, 2020, p.6.
3 Evidence of George Yengi, 18 July 2019, p. 1250.
4 Foundation House, Submission to the RCVMHS: SUB.1000.0001.0868, p. 43
5 RCVMHS, Culturally and Linguistically Diverse People Roundtable: Record of Proceedings, 2019
6 Foundation House, Submission to the RCVMHS: SUB.1000.0001.0868, p.12
7 Department of Health and Human Services, Racism in Victoria and what it means for the health of Victorians, 2017, p. 16.
8 Victorian Refugee Health Network, pp. 7–8; Foundation House, Submission to the RCVMHS: SUB.1000.0001.0868, p. 50; Deaf Victoria, p. 9; Ethnic Communities’ Council of Victoria, p. 9.