More than half of the people in the South Asian community with a mental illness do not seek help.1 Specifically, South Asian immigrants have higher levels of life stress and anxiety in relation to other Canadian populations.2 Furthermore, the ongoing mental health stigma experienced by South Asian communities is linked to poorer personal wellbeing.3 These startling statistics show a need for care that is not being met for the South Asian community.
The South Asian community is growing considerably and makes up one of the largest non-European ethnic origin groups in Canada.4 According to the federal census, the South Asian community refers to those with ancestry that originates in South Asia, a region that includes but is not limited to the nation-states of Afghanistan, Pakistan, India, Nepal, Bhutan, Bangladesh, the Maldives, and Sri Lanka.4 I hope this article opens the minds of its readers and raises awareness for members within South Asian communities who face service access barriers that include personal beliefs of services, language incompatibility, culturally insensitive services, and culturally dissimilar styles of interaction.5
In terms of post-secondary experiences, South Asian college students have less positive attitudes towards counselling than Caucasian college students.6 This could be due to self-stigma, anticipated beliefs, and self-disclosure that is shown to influence help-seeking behaviours in college students from varied ethnic and racial backgrounds.7 Self-stigma and perceived stigmatization can be compounded by ethnic minorities' relationships with the dominant society, other ethnic groups, and their own ethnic groups.8 These barriers for South Asian college students are not being addressed by universities. As a student who has worked at mental health resource centers in Canadian universities, I can attest to services being tailored to the wider university demographic, in turn overlooking the specific needs of minority students in the South Asian community.
Gender should also be considered when creating specific and accessible mental health programs. South Asian women have higher levels of distress when they have low extended family support, and men have higher levels of distress when they have a low community position and conflict within the family culture.9 Moreover, personal stigma and being male are negatively associated with help-seeking behaviour.10 This exemplifies that different genders face different unmet needs for service in South Asian communities and these gender differences are not acknowledged within the mental health community. This lack of knowledge in combination with service barriers is negatively affecting the South Asian community.
Mental health services are tailored to a white heteronormative patriarchal society in terms of language, advertising, accessibility, and cultural fit. Various findings and real-life examples demonstrate the implications of this reality. A 2008 Canadian study which included over 16,000 ethnic minorities found that South Asian immigrants were less likely to use mental health services than Caucasian populations.11 In addition, a 2013 telephone survey of a random sample of the South Asian community aged fifty-five and older found cultural incompatibility, negative personal attitudes about using services, administrative problems, as well as circumstantial challenges to all create barriers to accessing services.5
Most recently, as the COVID-19 pandemic unfolded, Canadians witnessed a disproportionate number of the black, indigenous, and people of color (BIPOC) community contracting COVID-19 due to long-standing systemic health and social inequities.12 The South Asian community, particularly immigrants, have limited access to many of the social determinants of health. This limited access in turn increases the risk of not having fair opportunities for economic, physical, and emotional health.13 A lack of mental health resources for the South Asian community only compounds the oppression experienced.
These research trends indicate there is a need to address the inequality created by an unmet need for care exhibited by the alarming amount of South Asian community members with a mental illness not seeking help. A culturally appropriate plan of action should be developed and implemented. First, a plan which aids South Asian communities in overcoming barriers related to personal attitude. Second, a plan to give South Asian communities better access to needed services.5 Fortunately, the blueprints for such a plan do exist. In 2013, the Council of Agencies Serving South Asians had their third annual Health Equity Conference where they created a plan called Building an Effective South Asian Health Strategy in Ontario.
More broadly, policymakers should reduce service barriers affecting South Asian communities by setting policy targets, focusing on health promotion information, creating gender equality programs empowering both men and women in the South Asian community, and put in place services for cultural needs and language barriers.5 Unfortunately, health disparities remain unaddressed and there continues to be structural inequalities that are detrimental to the health and safety of BIPOC communities across Canada. This article allowed me to display one of many inequalities that must be addressed.
Edited by Maverick Smith & Curtis D'Hollander
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2. Islam, F., Khanlou, N., & Tamim, H. (2014). South Asian populations in Canada: Migration and mental health. BMC Psychiatry, 14, 13.
3. Chiu M, Amartey A, Wang X, Kurdyak P. (2018). Ethnic Differences in Mental Health Status and Service Utilization: A Population-Based Study in Ontario, Canada. The Canadian Journal of Psychiatry. 2018;63(7):481-491. doi:10.1177/0706743717741061
4. Statistics Canada. (2007). The South Asian Community in Canada. Retrieved October 30th, 2020. http://www.statcan.gc.ca/pub/89-621-x/89-621-x2007006-eng.htm.
5. Lai, D. W. L., & Surood, S. (2013). Effect of service barriers on health status of aging south Asian immigrants in Calgary, Canada. Health & Social Work, 38(1), 41 50. doi:http://dx.doi.org.myaccess.library.utoronto.ca/10.1093/hsw/hls065
6. Loya, F., Reddy, R., & Hinshaw, S. P. (2010). Mental illness stigma as a mediator of differences in Caucasian and south Asian college students' attitudes toward psychological counseling. Journal of Counseling Psychology, 57(4),484-490. doi:http://dx.doi.org.myaccess.library.utoronto.ca/10.1037/a0021113
7. Nam, S. K., Choi, S. I., Lee, J. H., Lee, M. K., Kim, A. R., & Lee, S. M. (2013). Psychological factors in college students' attitudes toward seeking professional psychological help: A meta-analysis. Professional Psychology Research and Practice, 44(1), 37–45. https://doi.org/10.1037/a0029562
8. Cheng, H., Kwan, K. K., & Sevig, T. (2013). Racial and ethnic minority college students' stigma associated with seeking psychological help: Examining psychocultural correlates. Journal of Counseling Psychology, 60(1), 98-111. doi:http://dx.doi.org.myaccess.library.utoronto.ca/10.1037/a0031169
9. Masood, N., Okazaki, S., & Takeuchi, D. T. (2009). Gender, family, and community correlates of mental health in south Asian Americans. Cultural Diversity and Ethnic Minority Psychology, 15(3),265-274. doi:http://dx.doi.org.myaccess.library.utoronto.ca/10.1037/a0014301
10. Arora, P. G., Metz, K., & Carlson, C. I. (2016). Attitudes toward professional psychological help seeking in south Asian students: Role of stigma and gender. Journal of Multicultural Counseling and Development, 44(4), 263 284. doi:http://dx.doi.org.myaccess.library.utoronto.ca/10.1002/jmcd.12053
11. Tiwari, S. K., & Wang, J. (2008). Ethnic differences in mental health service use among white, Chinese, south Asian and south east Asian populations living in Canada. Social Psychiatry and Psychiatric Epidemiology: The International Journal for Research in Social and Genetic Epidemiology and Mental Health Services, 43(11), 866 871. doi:http://dx.doi.org.myaccess.library.utoronto.ca/10.1007/s00127-008-0373-6
12. Stokes EK, Zambrano LD, Anderson KN, et. al. Coronavirus Disease 2019 Case Surveillance — United States, January 22–May 30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:759–765. DOI: http://dx.doi.org/10.15585/mmwr.mm6924e2external icon.
13. U.S. Department of Health and HumanServices. Social Determinants of Health [online]. 2020 [cited 2021 March3]. available from https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-healthexternal icon