Breaking the Silence: Cultural Stigma Around Mental Health in Minority Communities

Written by: Misha Syed and Isheen Thakur

Edited by: Allyssa Chan and Lydia Su

INTRODUCTION

Culture cannot be ignored when discussing mental health. After all, it can play an important role in aspects like an individual’s coping styles and the method in which they choose to seek help. Moreover, mental health conditions are more prevalent in certain minority populations. For example, PTSD is found at a high degree in Asian American and Hispanic American communities prior to immigration to America (Office of the Surgeon General (US) et al., 2001). 

  Despite this concerning information, one of the biggest issues with seeking out psychological help is the stigma attached to mental disorders, and it can be especially worse for racial and ethnic minorities (Eylem et al., 2020). Health professionals working with clients who are people of colour should be mindful of cultural pressures, expectations, and different perspectives when seeking out mental health support. 

MENTAL HEALTH STIGMA

Mental illness stigma fosters negative public opinions and discriminatory behaviours against people with mental illnesses (Eylem et al., 2020). This can prevent them from getting psychological treatment. 

To further examine how mental health stigma works, one can examine the mechanisms and classifications of stigma. There are three key mechanisms of mental health stigma (Eylem et al., 2020). Cognitive mechanisms involve stereotypes and negative ideas held by society, such as beliefs that individuals with mental illness are dangerous or weak. Affective mechanisms involve prejudices driven by emotional reactions caused by stereotypes, such as fear or pity. Behavioural mechanisms refer to discriminatory actions taken by others such as purposely avoiding individuals suffering from mental illness.

According to Eylem et al. (2020), mental health stigma can be further classified into three different types of stigma. Experienced stigma refers to the regular experiences that are caused by preconceived notions about mental health from the public. Additionally, anticipated stigma is one's expectation to be targeted by these stereotypes. Lastly, internalized stigma occurs when individuals apply negative stereotypes and beliefs to themselves.  For instance, an individual might believe that they must be dangerous to others as a result of their mental illness. 

CAUSES OF STIGMA

An individual’s culture can play a critical role in how mental health is viewed. For instance, according to Eylem et al. (2020), collectivistic cultures value group harmony and cohesion, and suffering from common mental health disorders is seen to be in opposition to these concepts. This can lead to feelings of shame being associated with these issues. 

Various minority communities may hold different perspectives on mental health issues. These perspectives can shape an individual’s beliefs about whether a certain illness is “real”, whether it involves the body or mind, and what its causes and treatments are (Kleinman, 1998). This can prevent someone from choosing to seek out treatment, or affect the manner in which they look for support (i.e., choices of which people to discuss their mental health with). After making the decision to seek out mental health treatment, these attitudes can have significant impacts on the reaction and level of support received from their family and community.

Stigma can further impact the family members of those suffering from mental illnesses, which can weaken the individual's self-esteem and relationships. In some Asian cultures, mental illness is thought to reflect poorly on the family. This could potentially harm marriage and economic prospects for other family members (Sue & Morishima, 1982, as cited in Office of the Surgeon General (US) et al., 2001; Ng, 1997).

COPING STYLES, CLINICIAN MISTRUST AND BIAS, AND SEEKING HELP

Culture can play a role in the coping styles of an individual. For instance, Asian Americans are likely to avoid dwelling and expressing upsetting thoughts (Hsu, 1971), and African Americans are more likely to take active action to face issues, as well as focus on spirituality as a form of support (Broman, 1996, as cited in Office of the Surgeon General (US) et al., 2001; Cooper-Patrick et al., 1997). 

Mistrust is also a significant barrier for racial or ethnic minorities when seeking mental health treatment. Mistrust of clinicians is a result of historical oppression and maltreatment as well as existing issues with racism, discrimination and abuse from practitioners (Neal-Barnett & Smith, 1997, as cited in Office of the Surgeon General (US) et al., 2001; Office of the Surgeon General (US) et al., 2001). The combination of negative attitudes towards those with mental illnesses and minorities further exacerbates mental health stigma. Upon seeking treatment, there continue to be concerns regarding clinician bias. For instance, a study from 1988 notes that at the time, African American youth were four times more likely to be physically restrained for similar aggression levels to white youth (Bond et al., 1998).

In general, research shows that minority communities are less likely to seek mental health treatment for mental health compared to white communities (Office of the Surgeon General (US) et al., 2001). A cross-cultural study on Asian Americans living in Los Angeles found that 12% of Asian Americans would talk to a friend or relative about their mental health issues compared to 25% of white people. This study further reported that 4% of Asian Americans sought help from a psychiatrist or specialist compared to 26% of white people, and only 3% of Asian Americans sought help from a physician compared to 13% of white people (Zhang et al., 1998).

When seeking out treatment, minorities are more likely to approach primary care, as well as non-medical community members, such as family and friends, or religious leaders like traditional healers and clergy (Neighbours & Jackson, 1984; Peifer et al., 2000). For instance, Indigenous Americans and those who are native to Alaska often utilize the services of traditional healers (Kim & Kwok, 1998). 

Difficulties associated with minority communities getting psychological treatments are not limited to barriers prior to seeking out treatment; studies have shown that there are significant obstacles for improving one’s mental health in regards to adherence to treatment and the treatment process. Cultural backgrounds can also impact how individuals communicate their symptoms and seek help. For instance, Asian patients are more likely to report physical symptoms, and acknowledge emotional symptoms only upon additional questioning (Lin & Cheung, 1999). 

CULTURALLY-SENSITIVE MENTAL HEALTH TREATMENT

It would be beneficial for mental health providers to increase their cultural competence — that is, understand and respect cultural differences, and considering them when providing care (Sue & Sue, 1999). Culturally sensitive psychotherapy is a form of psychotherapy that involves adjusting treatment to account for one’s cultural background, and their specific needs and characteristics that may be unique to their culture (La Roche & Christopher, 1999). This type of treatment could be crucial for better outcomes for minority communities. For instance, a review conducted by Huang & Zane (2016) notes that culture can play a role in the relationship between clients and therapists, particularly in relation to the amount of client disclosure, as well as the strength of the working alliance between the two. This review highlights that, according to Cabral & Smith (2011), Meyer et al. (2011), and Meyer & Zane (2013), ethnic minorities are more confident in the skills of their therapist if they are of the same race or ethnicity, and they prefer therapists of the same culture. Additionally, clients generally find therapists to be more supportive and credible if they believe they share similar life experiences, values, and mindsets. For instance, Hispanic outpatient clients in which clients were matched with therapists with the same place of birth and acculturation level were more likely to participate in treatment (Suarez-Morales et al., 2010). As such, cultural considerations are crucial for better treatment choices.

CONCLUSION

Mental health stigma serves as a significant barrier to seeking out help for psychological struggles, particularly in minority communities. It is paramount to consider the impact it has on a community’s perspectives on mental health, choice of preferred coping styles, and behaviour when seeking out help. It has been observed that there are improved outcomes when culture is considered in treatment plans for individuals, whether it be through culturally sensitive psychotherapy or through matching clients and therapists by their culture. Thus, increased cultural sensitivity in the treatment of mental illness should be encouraged.

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