How mental health issues get stigmatized in South Asian communities: Culturally diverse therapy needed

Captures some of the internal and external challenges:

A silent mental health crisis exists among South Asian communities. Many studies have shown that South Asian immigrants in Canada, the United States and the United Kingdom experience high rates of mental health disorders, sometimes higher than their peers. Some of the reasons include intergenerational conflict or the stress of adapting into western society

But mental health is deeply stigmatized in many South Asian communities and symptoms are often trivialized. To counter this, South Asian families need to be more deeply educated on risk factors that can lead to mental health conditions. With this knowledge, they can identify some of the early signs of mental health issues.

As a PhD candidate in clinical neuropsychology at the University of Windsor, some of my current research involves adapting cognitive assessment methods to people who speak Urdu or Hindi. I also started @Braincoach, an Instagram stream to share my science-based knowledge. 

Straddling different worlds

Children of South Asian immigrants may face challenges associated with the pressure of straddling two different worlds. While trying to fit into a western society that prides itself on individual expression, they may find themselves navigating a culture at home where personal boundaries are blurred, and self-identity is determined by the validation of their family and community.

The collectivist nature of South Asian culture can feel comforting and supportive with close-knit family ties and a sense of connection to something larger than the self. However, in South Asian families individuals can also feel pressure to sacrifice their personal desires for the expectations of their family.

Pursuing goals that diverge from the expectations of the family and community is perceived to be selfish. This leads to heightened levels of psychological stress and interference with the identity formation process, especially when a person feels a stronger connection to the dominant western culture.

Struggles about career or dating

Two prominent causes of family conflict arise when South Asian adolescents and young adults wish to start dating or pursue a career that is discerned to be unacceptable by the parents. This creates an internal struggle among South Asians who have been socialized to believe that family loyalty is of utmost importance. 

Some may still follow through with their desires in secrecy, but live in a constant fear of being found out. Others may comply with the expectations required of them, but at the cost of losing their sense of self, their self-concept. In both scenarios, mental health and resiliency is compromised in the long term.

When young South Asian adults pursue a career that their family approves of instead of one that they find personally fulfilling, they might feel proud for maintaining family expectations. But how long does this pride last? 

Research has repeatedly demonstrated that a fulfilling career leads to better life satisfaction, and as a result, lower psychological problems. This choice is ripped away from many children of South Asian immigrants who end up feeling stuck in careers they do not find meaningful, ultimately leading to a negative impact on their overall mental wellness and relationships. 

When it comes to dating, cultural expectations of South Asian families can conflict with western norms. For many youth, entering into a relationship prior to marriage is discouraged. Consequently, many young South Asians keep their relationships hidden due to internalized shame and a fear of being rejected by their families

This is another reason for mental health challenges like depression and anxiety, especially in women who may feel like they are putting the family’s honour at risk by dating. 

Culturally relevant therapy needed

South Asians seeking psychological services often feel misunderstood by health-care providers and then get discouraged from getting further help. Traditional psychotherapy has been founded on normalized versions of western, middle-class families. These approaches to therapy are difficult to translate across language and cultures without appropriate modification. 

This means that many western-trained therapists may find it difficult to comprehend the deeply ingrained cultural nuances of South Asian communities. 

There is a strong need for culturally sound therapy. 

To encourage culturally sensitive therapy, mental health professionals must actively make an effort in understanding their client’s cultural background and belief system through continued education and consultation with colleagues from a similar cultural background. 

It is also important that South Asian youth and families have discussions about their mental health struggles and learn ways to improve them. One way to do this is to ask mental health experts to host community workshops specifically for South Asian communities. This could lead to more awareness of the diversity of mental health conditions and knowledge on how to seek help and resources within their communities


USA: Using Cultural Competency for Mental Health Access Outreach

Relevant study:

College campuses need stronger cultural competency when designing mental health access outreach, as racial and ethnic minorities increasingly forego access to care, according to data from the University of California, Riverside.

The study, published in the Journal of Racial and Ethnic Health Disparities, particularly recommended college campuses look at the shared cultural values between Asian and Latinx students, two populations that researchers said often go without needed mental healthcare.

“This means counselors can identify a culturally sensitive, value-driven approach to encouraging greater participation in campus mental health services, instead of focusing only on students’ ethnicity in their outreach efforts” Kalina Michalska, the study’s senior author and a UCR psychology researcher, said in a statement.

Currently, about three-quarters of Asian students and 65 percent of Latinx students go without needed mental healthcare, the researchers reported. Those staggering figures could be due to cultural differences, like commitment to family obligations and interdependence that could make the burden of stigma stronger for Asian and Latinx students.

That is not to mention the social determinants of health, like racial bias or financial barriers, keeping Asian and Latinx students from accessing mental healthcare as often as their White peers.

Through surveying about Asian and Latinx culture, as well as about perceptions about mental healthcare access, the researchers were able to determine they were right, at least about cultural differences.

The survey 25- and 35-question surveys for Asian and Latinx students, respectively, highlighted a culture of deference to one’s family that could dissuade students from accessing mental healthcare for fear of stigma or shame.

Additionally, the stronger a student reported cultural beliefs in interdependence, the less likely they were to signal a need or a likelihood to access mental healthcare. For these students, support in one’s family and social circle was deemed essential for addressing mental health issues.

Importantly, the researchers could not draw a direct link between a student’s desire to honor her culture with a conscious decision not to access mental healthcare. However, the surveys did suggest some links between cultural attitudes and mental healthcare access that differ somewhat for White students of Western descent.

This comes as US institutions, like colleges, are becoming increasingly diversified. At UC Riverside, about a third of the students are Asian and 41 percent are Latinx. Campuses like UC Riverside need to account for multiculturalism in numerous ways, including as it relates to health and mental healthcare.

“Given the increasing diversity among U.S. college students, there is an urgent need for universities to develop proactive and culturally informed programs designed to improve mental health support for students, especially those from underrepresented backgrounds,” Michalska said.

Although Michalska and her team did not outline specific steps for building culturally competent patient outreach strategies, they did note that understanding cultural beliefs about interdependence and support through family would be important for understanding how to better tailor mental healthcare efforts on college campuses.

And in doing so, colleges can help ensure better and more equitable patient access to care, the researchers concluded.

Source: Using Cultural Competency for Mental Health Access Outreach

American Muslims Are 2 Times More Likely To Have Attempted Suicide Than Other Groups

Of note. Wonder if there are compable studies for Canada:

For an entire year that involved emergency room visits, legal proceedings, involuntary unemployment and the death of loved ones, Mehran Nazir struggled with a depressive episode. He would find his mind flooded with self-destructive thoughts. He’d faintly hope his plane from Newark to San Francisco would crash or that he would doze off at the wheel of his car and end up in a fatal accident.

The normally extroverted Nazir would lie paralyzed in bed for hours doing nothing, not wanting to speak with family and canceling plans with friends.

It came to a head when Nazir found himself on the brink of suicide. In his darkest moment, he drafted a will and decided where it would happen.

Eventually, Nazir found comfort in journaling. And when he shared his writings online, he quickly found that other Muslims shared his struggles.

“I realized that this is not something that is unique in my history,” Nazir told NPR. “This was not a random occurrence.”

Nazir was right. U.S. Muslims are two times more likely to have attempted suicide compared with other religious groups, according to a study published last month in JAMA Psychiatry. Nearly 8% of Muslims in the survey reported a suicide attempt in their lifetime compared with 6% of Catholics, 5% of Protestants and 3.6% of Jewish respondents.

“Anecdotally and in clinical settings, we’re definitely seeing an uptick in suicides and suicide attempts,” Dr. Rania Awaad told NPR. She’s the director of the Muslim Mental Health & Islamic Psychology Lab at Stanford University and a researcher on the study.

At the heart of these numbers are several issues

Researchers attribute the high suicide attempt rate to two factors: religious discrimination and community stigma — both of which, they say, prevent Muslim American communities from seeking mental health services.

Earlier this year, a murder-suicide involving a Muslim family in Allen, Texas, sent shock waves through the community. Brothers Farhan Towhid, 19, and Tanvir Towhid, 21, both of whom reportedly battled depression, made a pact to die by suicide and kill the rest of their family so they wouldn’t have to live with the grief. Since then, public discussions on mental health, trainings on suicide response and healing circles have taken on new urgency.

“We have a very long way to go,” Awaad said. “There is just the beginning of a discussion that is happening now.”

There’s still a community stigma surrounding mental health

Naureen Ahmed, now 39, remembers how her family would visit her mother, Seema, at a psychiatric hospital. But the family never openly discussed why she was there.

Some days, Seema would sing along to Bollywood music at home wearing red lipstick. Other days, she’d walk around the house brandishing knives — or jump out of the car on the highway, threatening to kill herself.

Ahmed, a social butterfly at school, was hesitant to invite friends over because she never knew which side of her mother she would get that day.

It wasn’t until she was 25 that Ahmed finally learned why her mom acted that way: she had bipolar depression and schizoaffective disorder, her grandparents told her.

“It was difficult to say it out loud, this secret that I had held inside my entire life,” Ahmed told NPR.

Of the many factors that prevent families or individuals from seeking mental health treatment, stigma is “perhaps the most significant,” according to a 2013 study that looked at the cultural backgrounds of Muslims.

“If you believe that your mental illnesses will bring shame on you or your family, then you tend to stay silent about it,” said Dr. Farha Abbasi, founder of the Muslim Mental Health Conference. Through the conference, hosted by Michigan State University for 13 years, Abbasi hopes to destigmatize mental illness within the Muslim community using open dialogue.

After Ahmed’s mother died in 2012, she created SEEMA to support families like hers who are shamed by the stigma of mental illness, are isolated by their communities or are suffering alone.

SEEMA, launched in 2018, hosts support groups with licensed therapists at community centers and mosques and awareness workshops highlighting the importance of mental health and how to care for someone struggling with a mental illness.

“We need to have these conversations to destigmatize and bring awareness because people think that they’re alone,” Ahmed said.

Religious discrimination makes them more vulnerable

Abbasi, who has studied the impact of growing Islamophobia on Muslims’ mental health, says she was not surprised by the results of the Stanford study.

“Right now, the exposure to toxicity is making us more vulnerable,” Abbasi told NPR.

U.S. Muslims were more likely to report suicide attempts than those from Muslim-majority countries, according to the Stanford study. As a religious minority in the U.S., Muslims are highly vulnerable to religious discrimination, which is associated with depression, anxiety and paranoia.

According to 2020 polling from the Institute for Social Policy and Understanding, 60% of Muslims reported personally experiencing religious discrimination. And the FBI’s latest hate crime statistics in 2019 suggest that, of the reported 1,715 victims of anti-religious hate crimes, 13.2% were victims of anti-Muslim bias.

“There’s just trauma over trauma over trauma,” Abbasi says. “The impact of growing Islamophobia, the violence that is being directed against Muslims, all that is having a huge impact on mental health.”

They sometimes find it hard to reconcile their feelings and their faith

Last November, 39-year-old Chicago investor Jessica Ali broke down after separating from her husband.

“I felt that I was unworthy and there was no reason for me to live,” she said. Ali, a mother of three, had attempted suicide for a third time. The first two were in 2008 and 2018. “I started believing that I was crazy, that I must be a bad Muslim.”

That was until she joined a Muslim support group. It was there that Ali, who was diagnosed with severe depression, first came to terms with her mental illness.

“It’s very likely that when you’re sitting at the masjid, somebody in your praying row has felt this way,” Ali told NPR.

Now, Ali takes medication and visits a therapist.

But unlike Ali, some Muslims may not get the help and support they need.

To help jump over these hurdles, Muslim mental health professionals across the country are providing more culturally appropriate and religiously sensitive resources for Muslims.

Culturally appropriate resources can help

Dr. Sameera Ahmed, executive director of The Family & Youth Institute, a Muslim nonprofit, developed a suicide prevention toolkit in 2017 that helps Muslim American families navigate suicide risks, intervention, assessment and prevention.

“There may be mental health providers available, but if an individual doesn’t trust the system, they’re not going to use it,” Ahmed told NPR. “We try to translate the research into culturally and religiously tailored mental health resources that are community informed and disseminated by Muslim American mental health professionals.”

In 2017, the Khalil Center, which offers Muslims faith-based mental health services, launched a hotline that provides a “safe and empathic space” for those in crisis situations. “There’s more awareness happening,” Khalil Center psychologist Dr. Fahad Khan told NPR. “We have seen a rise in those who are seeking services.”

Imams have an integral role in community mental health because Muslim Americans may be more willing to seek help from religious leaders. That’s why Awaad started a campaign to train 500 Muslim leaders on suicide response in their communities by 2022.

“A number of imams came forward and said, ‘We as the religious and community leaders of the Muslim community really need to step up to this discussion,’ ” Awaad said.

Dr. Heather Laird, founder of the Center for Muslim Mental Health and Islamic Psychology, found that Muslims were more likely to seek psychotherapy if it aligned with Islamic values. So she ignited a movement toward Islamic psychology. By Laird’s definition, Islamic psychology is the treatment of the mind and soul within an Islamic context.

As for Nazir, he uses a combination of therapy and journaling to tend to his psychological wounds.

“This battle for mental health is not necessarily you solve it, you cure it, you move on,” Nazir said. “For me, it’s an ongoing journey.”

Source: American Muslims Are 2 Times More Likely To Have Attempted Suicide Than Other Groups

Older refugees have high levels of depression even decades after immigration to Canada


Most research on the mental health of refugees focuses on the first few years after resettlement in the host country, but little is known about their long-term mental health.

A new study of Canadians aged 45-85, released this week, found that refugees were 70% more likely to suffer from depression than those born in Canada when age, sex and marital status were taken into account — even decades after immigration.

“Our findings indicate that the refugee experience casts a long shadow across an individual’s lifespan,” says the study’s first author Shen (Lamson) Lin, a doctoral student at the University of Toronto’s Factor Inwentash Faculty of Social Work (FIFSW).

“While our data did not capture reasons for the high levels of depression among refugees, we believe it may be influenced by exposure to pre-migration traumas such as genocide, forced displacement, human trafficking, sexual assault, famine, and separation from family.”

In order to untangle the potential contribution of post-migration challenges, which face all immigrants, from the pre-migration trauma unique to refugees, the research team also investigated depression among immigrants who did not arrive as refugees. Post-migration problems may include downward socioeconomic mobility, racial discrimination, higher levels of unemployment, language barriers, and reduced social networks.

The prevalence of depression among non-refugee immigrants (16.6%) was much closer to that of their Canadian-born peers (15.2%) than to that of refugees (22.1%).

“Our results suggest that post-migration challenges are less important than pre-migration traumas when it comes to depression,” says senior author, FIFSW Professor Esme Fuller-Thomson, who is also cross-appointed to U of T’s Department of Family & Community Medicine and is is director of the University’s Institute for Life Course & Aging.

“The greater prevalence of depression among refugees — half of whom arrived more than four decades ago — underlines the importance of providing mental health resources for our refugee community both immediately after arrival, but also in the ensuing decades.”

The study investigated factors that may have influenced levels of depression among participants, including age, sex, marital status, income, education, health, chronic pain, health behaviors and the frequency of social contacts. But even when these characteristics were accounted for, refugees still had much higher odds of depression than individuals born in Canada.

The researchers found that social support is a key. A lack of social support was associated with higher levels of depression among refugees — they were also more likely to have less of it. Refugees were more likely than those born in Canada to report that they lacked: 1) someone who showed them love and affection (17% versus 8%), 2) someone to confide in about their problems (27% vs 16%), and 3) someone to give them good advice about a crisis (27% versus 16%). (The level of social support among immigrants who did not arrive as refugees was relatively similar to the Canadian born group, and much less vulnerable than the refugee group.) When the availability of these three levels of social support was high, the relationship between refugee status and depression significantly diminished.

“Our study indicates that the quality of relationships, rather than the quantity of social connections, matters most for refugees’ mental health.” says co-author Karen Kobayashi, a professor in the Department of Sociology and a research affiliate at the Institute on Aging & Lifelong Health at the University of Victoria. “This highlights the importance of investigating ways to promote powerful positive social relations among refugees and asylum seekers in their families, neighbourhoods, and communities.”

The study’s findings also have important policy implications.

In Canada, two different sponsorship programs are currently in place. Government-assisted refugees (GARs) get basic financial aid and assistance offered by professionals to help with the settlement process. Privately sponsored refugees (PSRs) are supported by a network of engaged volunteers, often members of a church, mosque or synagogue who are able to provide extensive assistance with all kinds of settlement issues including housing, health needs and job searches.

According to recent studies on Syrian refugees in Canada, PSRs report having more help in daily errands, fewer unmet needs and a higher employment rate than GARs.

“We anticipate that refugees sponsored under the PSR program may be more likely to thrive post-migration because of a stronger social support network and this may set them on a positive employment and mental health trajectory for decades after their arrival.” says co-author Hongmei Tong, Assistant Professor of Social Work at MacEwan University in Edmonton.

Consistent with earlier studies, Canadian adults in this study who were poor, experiencing chronic pain and those with more co-morbid health conditions had a higher prevalence of depression.

“It is not surprising that Canadians who have household incomes under $25,000 per year have double the odds of distress compared to those with incomes above $75,000. Struggling to pay the rent and feed one’s family can be extremely distressing,” said co-author Simran R Arora, Master of Social Work student at the University of Toronto.

“Mental health professionals must be careful not to neglect physical health concerns such as chronic pain,” said co-author Karen Davison, Health Science Program Chair at Kwantlen Polytechnic University in Surrey, B.C. “We really need to be treating the whole person in order to address depression.”

Source: Older refugees have high levels of depression even decades after immigration to Canada

The unknowns of US immigration policy are increasing anxiety among first-generation Latinx teens

Not surprising:

Despite the fast-moving news cycle nowadays, shifting immigration policies and policy guidelines make headlines every week. At the end of one dizzying week that included a serious discussion on the decriminalization of border crossings and a Supreme Court ruling againstadding a citizenship question on the 2020 U.S. Census, the Supreme Court announced it would hear the Trump administration’s appeal to end Deferred Action for Childhood Arrivals (DACA) next fall, just in time to issue their ruling the summer before the election. And that was just one week in June.

Dreamers have faced uncertainty about their immigration status since September 2017 when the Trump administration moved to terminate the program and the federal courts took up several lawsuits challenging these actions. Now, new research shows that immigration policy concerns are taking mental tolls on first-generation Latinx (Latino/Latina) adolescents.

Using data from a long-term study of primarily Mexican families living in California’s Salinas Valley region, researchers surveyed 397 sixteen-year-olds with at least one immigrant parent. In the year following the 2016 presidential election, nearly half of the teens reported that they worried about how immigration policies could affect themselves and their families. Compared to before the 2016 election, the teens who worried more about immigration policy also reported an increase in symptoms of anxiety. Particularly among teenage boys, higher anxiety was correlated with poor sleep quality.

As we debate changes to U.S. immigration policy, many immigrant families are having difficult conversations about planning for the worst-case scenario. This research shows that the uncertainty regarding immigration status has effects on mental health in children as well as adults. More studies need to be done to address the long-term health consequences of these policies on immigrant families, both directly and indirectly through their access to healthcare services.

Source: The unknowns of US immigration policy are increasing anxiety among first-generation Latinx teens

A fear of others in Australia’s ethnically diverse neighbourhoods is affecting mental health

While not captured in the study, suspect that some of the anti-immigrant rhetoric among some Australian politicians may be a contributing factor to lack of trust:

We’re often told to ‘love thy neighbour’ in order to build a more harmonious society, but when it comes to multicultural communities, it seems concerns about ‘others’ are rife – and it’s impacting peoples’ mental health.

A new report by RMIT University has found higher levels of neighbourhood ethnic diversity are associated with poorer mental health outcomes for people living there.

And it appears it’s because they don’t trust each other.

The study, Neighbourhood Ethnic Diversity and Mental Health in Australia, is the first of its kind to empirically examine the effects of ethnic diversity in an area on mental health. It was published this month in the journal Health Economics.

Based on 16 years of data from the Household, Income and Labour Dynamics in Australia (HILDA) survey, up to 2016, it found a lack of trust in ‘others’ is having a negative impact.

Respondents to the HILDA surveys were asked how often they felt “nervous”, “down”, and “so down in the dumps that nothing could cheer them up”.

Dr Sefa Churchill, a senior research fellow at RMIT who led the study, said coping with difference tends to brings a greater mental load, which “not everyone finds easy or wants to make work”.

“In communities that are quite diverse we tend to see people that are a bit different in different ways, because we do not know them,” he told SBS News.

“It raises some sort of natural anxiety and suspicion about what they are doing because they are ‘different’.

“And that level of anxiety and unsettledness that is associated with this lower levels of trust, tends to hinder mental health.”

That lack of trust was the key factor behind poorer mental health outcomes in diverse communities, he said.

Dr Churchill said it is a natural compulsion to be wary of strangers, and the research shows it is not diversity itself that is the problem, but more likely the lack of trust that often accompanies it.

“If you do not know someone, if someone is different from you, you will not go be willing to go all in, in terms of trust, so from a fundamental perspective as part of nature, trust comes the more you get familiar with someone.”

“Trust is the glue that binds social networks, and social networks and feelings of inclusion are important predictors for mental health and wellbeing.”

But it’s not all bad news for those living in Australia’s ethnic melting pots.

When comparing diverse and homogeneous neighbourhoods which both had similar levels of trust, people living in diverse communities had better mental health outcomes.

“Our analysis considered potential scenarios where we have diverse communities and homogeneous communities both with high levels of trust, and the results actually did suggest if you are in a diverse community with higher levels of trust you tend to have better mental health than insular, homogeneous communities,” Dr Churchill said.

Australia is often touted as one of the most diverse countries in the world, with more than a quarter of residents born overseas.

Mohammad Al-Khafaji, CEO of the Federation of Ethnic Communities Councils of Australia (FECCA) told SBS News: “As in all parts of our society, mental health is a major issue in ethnically diverse communities that desperately needs greater attention”.

“What this study also demonstrates is that programs that promote cultural awareness and understanding make our communities happier and safer.

FECCA has partnered with Mental Health Australia and the National Ethnic Disability Alliance to deliver The Embrace Project – a platform raising awareness of mental health and suicide prevention and providing resources and services for those from culturally and linguistic diverse (CALD) backgrounds.

Mental Health Australia CEO Frank Quinlan told SBS News the project “recognises social isolation and stigma surrounding mental health in culturally and linguistically diverse communities can negatively impact mental health.

It “aims to engage people in CALD communities in a conversation and provide information about what comprises good mental health and where to seek support if needed,” he said.

Dr Churchill says the results of the study show the need for more policies that foster social inclusion and promote awareness of the benefits of diversity. That should help to build trust and reduce the negative effect of diversity on mental health, he said.

“We need to, at the local level, organise programs and events that bring us together, allow us to communicate, allow us to talk, allow us to know each other and go beyond the differences.”

“The fact that you do not know someone and all that, this will build that level of trust.”

Source: A fear of others in Australia’s ethnically diverse neighbourhoods is affecting mental health

Douglas Todd: B.C. coroner fails to release suicide data for international students

Surprising that they are not releasing the data. In my experience, British Columbia is better than most in responding to ATIP requests:

International students in Canada and around the world are not only under pressure to achieve high grades. Many are increasingly expected to become permanent residents in their chosen country so they can eventually sponsor their parents and siblings as immigrants.

Given the intense expectations placed on many young students navigating existence in a foreign country, reports of suicide among them are rising in Canada, the U.S., Australia and Britain, their most sought-after destinations.

The China Daily newspaper recently ran a story headlined, ”Suicide stalking too many Chinese studying overseas,” which detailed a spate of suicides among the 330,000 Chinese students studying and working in the U.S.

The large newspaper, which many see as a guide to China’s government policy, urged public officials to find out why. Is it because of “fear of failing and disappointing their parents” or “the loneliness that comes with having to struggle on their own?”

After the suicide last year of Linhai Yu, a young Chinese foreign student in Richmond, China’s consul general for Vancouver also expressed worry about suicide among the 53,000 Chinese students in Metro Vancouver. “Incident rates among the group,” Xuan Zheng said, “have been quite high.”

The grim stories of foreign-student depression and suicide are pouring in from across Canada and the world. This fall, friends of an Indian student in Ontario blamed his self-inflicted death on Canada’s immigration department not granting him a work visa to stay longer. Similar stories from around the world show foreign students at higher risk of mental-health stress.

Given that B.C. has the most foreign students per capita in Canada — being home to more than 130,000 of the Canadian total of 500,000 — my senior editor suggested contacting the B.C. Coroners Service to put some numbers on how many international students have taken their lives.

We thought the information wouldn’t be difficult to determine, since the Coroners Service says it is a “fact-finding” agency responsible for investigating all “unnatural” and “sudden” deaths and making recommendations to “prevent death in similar circumstances.”

My first contact with the Service was in May. In the ensuing seven months, despite numerous communications, the service has failed to provide any information at all about suicide rates among international students. It has, however, offered a steady string of delays and excuses, mixed with large doses of obfuscation.

The B.C. Coroners Service either has no idea how many international students in B.C. have been committing suicide. Or it worries that being frank about it would be insensitive; politically, socially, educationally or psychologically. Perhaps its leadership team, with Lisa LaPointe as long-time chief, just doesn’t think the public has a right to know. We’re just guessing.

Meanwhile, a dire mental-health phenomenon continues to expand along with the unprecedented rise of international students, which politicians and educational administrators welcome for the billions of dollars they pour into local economies and educators’ salaries.

The suicide rate among all students in higher education has long been grave. A British report found university students were killing themselves at the rate of one every four days, the large majority being male.

But emotional stress is even more extreme on students coming in from other countries, according to Australian researchers, who are ahead of professionals in Canada in tracking the emotional difficulties they face with isolation, housing, language, education and immigration status.

Even though Australian coroners, consulates and universities were found to be suppressing details about overseas students’ deaths, the country’s federal government admitted earlier that 51 foreign students had died in one 12-month period. But it took outside investigators to point out that suicide was a key cause of the deaths.

One study in the Australian Journal of Psychology found that Chinese international students experienced significantly higher levels of stress than their Australian counterparts. Education Minister Simon Birmingham this year responded to pleas to better support international students by promising to release more detailed comparative data on their mental health.

Australian sociologist Helen Forbes-Mewett discovered some parents send their mentally unwell children overseas in the hope the health system in their host country is superior to that at home. But extra pressures and traditional cultural stigmas about mental illness, said the Monash University professor, typically compound foreign students’ vulnerability.

Forbes-Mewett says it is impossible to lay blame for foreign students’ mental health or elevated risk of suicide on any one agency. As she suggests, it’s “everyone’s problem.” But at the least more B.C. officials could follow the lead of Australia and release relevant data on suicide rates.

Otherwise the public is kept in the dark, and the private anguish of many overwhelmed international students will silently persist.

Source: Douglas Todd: B.C. coroner fails to release suicide data for international students

Tailor immigrant and refugee mental health services for culture, language, report urges

Hard to argue with the overall message of tailoring programming to communities at greater risk but given that government’s need to choose where to allocate resources, I would place more emphasis on improved settlement services to reduce mental health issues.

The article, if not the report, is also silent that many immigrants may be reluctant to access mental health services:

Canada must match its multicultural, open-door immigration policy with tailored mental health services or face inflated costs for crisis care down the road, warns a new report being released today.

The sweeping study by the Mental Health Commission of Canada, obtained by CBC News, finds that immigrants generally arrive with better mental health than the Canadian-born population — something referred to as the “healthy immigrant effect.”

But their condition tends to deteriorate over time, and they don’t get help due to stigma, fear of being removed from the country, or a lack of treatment that meets their cultural or language needs.

Refugees afflicted with post-traumatic stress disorder, anxiety or depression are even less likely to access services.

The report says Canada must “urgently” develop a mental health strategy aimed at boosting service uptake, on the grounds of both equity and cost-efficiency.

Reduce overall costs

“By working to reduce disparities in access to services, the appropriateness of services used, and mental health outcomes, Canada can reduce overall system costs,” the report concludes.

Failure to access early treatment leads to more expensive emergency department visits or hospital admissions. There are also indirect economic effects, such as lost productivity and costs to the criminal justice system.

Entitled “The Case for Diversity,” the report calls for greater investment in programs and treatments that are adapted for culture and language and tailored to trauma and migration stress.

Dr. Kwame McKenzie — director of health equity at the Centre for Addiction and Mental Health, a psychiatry professor at the University of Toronto, and one of the report’s authors — said a newcomer’s ability to make money, land a job, learn the language and find housing and social supports are key factors in mental health.

Mental health problems can often be prevented by easing the resettlement process and breaking down barriers to early treatment, he added.

Early intervention, reduced costs

“If you have evidence-based interventions and they have easy access to it, we’ll be able to get people better and get them on their way,” McKenzie said.

Yet despite evidence early intervention not only helps outcomes and cuts costs over time, a study of data in Ontario in the report shows a “stark disparity” in service use. Only 6.3 per cent of refugees access treatment, compared to 9.6 per cent of immigrants and 12.5 per cent of non-immigrant Canadians.

Pointing to the intake of Syrian refugees to Canada, McKenzie said positive resettlement steps that have been taken could help mitigate mental health problems.

“I think for the Syrian refugees, there’s a lot of evidence accruing that the response, and the particular response in Canada, has been really good,” he said. “So it may be that we’ll see lower levels of mental health problems than we’ve had in other groups because of that.”

Culturally adapted programs

“The Case for Diversity” project reviewed 408 studies involving 41,920 people, offering “significant evidence” that culturally adapted therapies are more effective than programs targeting culturally mixed groups.

“Diversity has been a hallmark of contemporary Canadian society and it should be foundational to the planning and delivery of mental health services at all levels,” the report concludes.

“Meeting the needs of IRER [immigrant, refugee, ethno-cultural and racialized] populations is an urgent priority for the Canadian mental health system and its service providers.”

Source: Tailor immigrant and refugee mental health services for culture, language, report urges – Politics – CBC News

Stigma, shame behind ethnic delays in seeking help for mental illness

Not the first study that I have seen but appears to be one of the more comprehensive.

Noteworthy in that it applies to both first and second-generation immigrants:

Chinese and South Asian patients experience more severe mental health problems by the time they seek professional help, says a new study that looked at severity of psychotic symptoms and ethnicity.

“When compared to patients from other populations, Chinese and South Asian patients were on average much sicker by the time they got to hospital,” said Dr. Maria Chiu, lead author of the study, “Ethnic Differences in Mental Health Severity,” to be released Wednesday.

“Cultural factors play a big role in these findings. While Asian people tend to have stronger family support, they are also faced with a higher level of stigma and it prevents people from seeking help early. Families may try to cope and keep the illness within the family until there is no choice but to go to hospital.”

Based on the Ontario Mental Health Reporting System database, researchers with Toronto’s Centre for Addiction and Mental Health and the Institute for Clinical Evaluative Sciences examined information on more than 133,000 patients — including 2,582 Chinese and 2,452 South Asians — hospitalized for psychiatric conditions, such as schizophrenia, bipolar disorder and depression, between 2006 and 2014.

Chinese and South Asian patients represented 2 per cent and 1.9 per cent respectively of the in-patient population in the study, while they respectively account for 5.6 per cent and 7.9 per cent of the overall Ontario population.

Researchers assessed the severity of the subject groups based on four measures: if they were admitted to hospital voluntarily, whether they demonstrated aggressive behaviour, and the number and frequency of psychotic symptoms (hallucinations, delusions and abnormal thought process) they presented.

The study found that involuntary admissions were significantly more common among Chinese (67.1 per cent) and South Asian (59.7 per cent) patients than among the general population (46 per cent).

Both groups were also more likely to demonstrate aggressive behaviour at 20.4 per cent for Chinese and 16.3 per cent for South Asian patients, compared to just 14 per cent among other patients.

Patients from these two groups were also significantly younger than other populations being hospitalized and were more likely to experience multiple psychotic symptoms (55 per cent of Chinese versus 49 per cent of South Asian patients versus 38 per cent of other populations.)

Although immigration experience has often been linked to stress and mental health challenges, the study found both immigrants and Canadian-born patients of Chinese and South Asian descent shared similar illness severity when admitted to hospital.

“We need to consider Chinese or South Asian ethnicity, independent of immigration and diagnosis, as an important determinant of multiple dimensions of illness severity,” said the study published in the August edition of the Journal of Clinical Psychiatry.

The report suggests Chinese and South Asian communities may be more reluctant to seek help due to shame and stigma as well as cultural differences in the recognition and conceptualization of mental illness and mental health care.

Those challenges, it said, can be further compounded by language barriers and culturally insensitive health services.

“The longer mental illness goes without treatment, the more difficult it can be to get people back on track,” said Dr. Paul Kurdyak, psychiatrist and researcher with CAMH’s mental health policy research and lead scientist for the ICES mental health and addictions research program.

“This study highlights that ethnicity and culture are factors that should be considered when developing outreach strategies and treatment approaches, particularly at earlier stages before a patient’s illness worsens and hospitalization becomes necessary.”

Source: Stigma, shame behind ethnic delays in seeking help for mental illness | Toronto Star

Study examines mental health in common ethnic minorities in Ontario

Not surprising, both the increased prevalence and the lower use of mental services:

Ethnocultural minorities are more likely to report suffering from mental health issues but are less likely to access treatment, a study out of York University using Ontario Health Study (OHS) survey data has found.
Participation in the OHS includes an extensive online survey that asks each user to review a list of ethnocultural groups and check those they thought they belonged to. The survey also included questions related to common mental health problems such as depression, anxiety and social isolation. Researchers looked at self-reported data from some of Ontario’s most common minority groups, such as South Asian, East Asian, Southeast Asian and Black Ontarians, and measured them against a comparable group of OHS participants who identified as white.

“Minority groups were much more likely to report mental health problems and stressful life events,” said Professor Sherry Grace, also of the University Health Network. “And with the exception of Aboriginal Ontarians, we also found that they were less likely to use the mental health services that we have here. This is unfortunate because there are proven treatments for depression and anxiety that really work.”

The stresses of adapting to a new country could be one of the reasons driving this, suggests Professor Grace.

“Most people who immigrate are very healthy, but studies show that being away from family, as well starting over in one’s career, and the financial repercussions of this, are tough” she says.

Study examines mental health in common ethnic minorities in Ontario