Mental health among South Asian immigrants
Guest post from project research assistant Ruchika Jain
To kick off the new year, we have a guest newsletter from the project’s research assistant Ruchika Jain, a PhD student at the London School of Hygiene and Tropical Medicine.
Growing up as a second-generation South Asian immigrant in Canada, I noticed that many of the people in my community felt unwilling or unable to share their mental health concerns with their healthcare providers. I remember asking one person if they had shared their feelings of sadness and isolation with their family doctor. They responded that they felt their doctor would just “push pills” on them or would offer therapy (which would also not be a viable option because mental health problems should only be shared with immediate family).
Not much is known about the unmet mental health needs of immigrants in high-income countries like the UK and Canada, but it is clear that culture has a profound effect. My PhD seeks to work with South Asian immigrants to uncover how this particular community thinks about and experiences their mental health.
The cultural factors that shape mental health care for South Asian immigrants include fear and stigma, religion, differences in expectations of the role care providers play, and how distress is described. Arthur Kleinman, an anthropologist, coined the term “explanatory model” in the 1980s to encapsulate the idea that individuals have unique beliefs regarding health and disease, which are influenced by their social, cultural, and political environments. An explanatory model informs the way that an illness is understood and expressed.
For example, people of South Asian origin may convey their distress as somatic symptoms, such as chest pain, which are often less stigmatised than psychiatric symptoms. Additionally, in South Asia, many people hold a holistic view of health, including a spiritual component, and it is possible that people retain these values, even after they emigrate to Western countries. Along with language barriers, these interactions can influence the quality of care for mental health disorders, exacerbate misdiagnosis, and delay treatment, which can, in turn, perpetuate health inequalities.
I would like my project to help give community organisations, healthcare providers, policymakers, academics and the general public a culturally informed understanding of mental health and service use among South Asian immigrants. I will run interviews and focus group discussions with first- and second-generation South Asian immigrants in London, UK, and Toronto, Canada because I want to centre service users’ voices within the research. I will also interview healthcare providers with experience of working with the South Asian community, which includes but is not limited to, general practitioners, nurses, mental health professionals, as well as community health and non-governmental organisation staff.
I plan to work closely with community organisations at every stage of the research. This may include co-designing research questions, recruitment materials and topic guides, co-running interviews and focus groups, and disseminating and discussing my research outputs to see if they are interesting, relevant and useful to the study participants and wider South Asian community. Finally, I would like to work with the South Asian community in both study locations to help ensure that the results are translated to, and used by, policymakers and other key stakeholders.
There are obvious synergies between my work and the Healthy Scepticism x Centric project, for which I am a research assistant. Both aim to transform the ways that healthcare and diverse communities intersect. Rather than attempting to change the community to fit the healthcare system (by providing educational pamphlets for example), we are working to change the healthcare system to meet the needs of the diverse communities they should serve in a culturally-safe and acceptable way. In order to do so, we wish to rethink research methods to better hear, know and understand the voices that are not often taken seriously by academia or mainstream healthcare institutions.
Both this project and my PhD research are especially vital now. Both Britain and Canada are home to increasingly diverse populations, and the Covid-19 pandemic has led to a rise in both mental and physical ill-health in the UK, especially in ethnic minority populations. Understanding an individual’s beliefs regarding their own health is of the utmost importance, and making healthcare culturally safe and accessible is crucial.