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 characteristics, positive and negative lived experiences, family and relationships with social circles.
People from multicultural backgrounds face unique challenges that increase their risk of developing mental illness. Traumatic experiences, displacement, and problems related to integrating into a new society deteriorate a person’s psychological wellbeing. And more than that, very often, people from diverse communities are unable to access timely psychological help.
We’ll be discussing the following questions in this article:
What actually is mental health?
What factors cause migrants from multicultural communities to be vulnerable to mental illnesses?
What are the barriers to seeking mental health support?
How can mental health services ensure they reach multicultural 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 various mental health conditions. These disorders have specific symptoms and negatively affect a person’s mood, thinking and behaviour. These mental health conditions include depression, anxiety disorders, eating disorders and addictive behaviours, and schizophrenia.
Challenges for multicultural mental health and barriers to accessing mental health support
Mental health in multicultural 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 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?
Cultural stigma of mental illness
Multicultural communities are more at risk of developing mental conditions due to high 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 discussing mental health and accessing help services. In some societies, mental health is never discussed, and people grow up unaware of the issue (3). The state of mental distress may even be normalised so that it becomes a norm to be suffering (4).
Secondly, many multicultural 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 feeling unwell do not seek help from professionals and even family.
Either way, people from some multicultural communities may be reluctant to seek treatment, care and support due to stigma (5). So, stigma becomes a severe obstacle to the early identification, prevention and treatment of mental disorders.
Different healthcare systems
The differences between the healthcare systems in the migrants’ countries of origin and Australia may play a significant role. Mental illness is not treated the same way everywhere. For example, mental health services in some countries 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 of whether they can access help services and when they should do so.
The impact of discrimination
Multicultural 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 inevitably harm one’s mental wellbeing. Intolerance, judgement and communication barriers lead to chronic psychological distress, increasing 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)
Source: RCVMHS Final Report, Vol.3.
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.
Migrants do not always have sufficient English proficiency to converse comfortably with specialists and express their concerns. And obviously, health professionals are not expected to speak their native language. In-language services or community interpreters are also rare. This makes it impossible for a migrant to access healthcare services even when needed.
“Help” can be traumatising
Naturally, mental help facilities need to collect background information from the patient during intake. Then the patient is forwarded to the appropriate specialist, where the story must be repeated. For refugees, in particular, this experience is 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 is crucial in how we see the world, react to events, build relationships, and 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 unfamiliar with other cultural belief 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 adequate service provision.
Research is the key to reaching people
Some great organisations provide services to people facing mental health difficulties in Australia. Still, awareness among culturally and linguistically diverse communities is often limited, or if they are aware, they are worried they will face less favourable outcomes than non-CALD individuals. At The LOTE Agency, we provide professional research services and have worked with major mental health providers in Australia to optimise their reach and services. The most rewarding was community engagement and research projects, where we helped organisations identify the communities that need to be reached and understand their unique experiences, requirements, and socio-cultural barriers they face. Our clients find this a huge learning experience, where they recognise that their CALD audiences have specific needs that differ from what they are used to working with.
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.