Experiences with Counselling for Individuals Within the South Asian Community I: Rationale and Literature
by Alisha Mann, MPsy
This series was originally completed as a Major Research Project in partial fulfillment of Adler Graduate Professional School’s Master of Psychology degree.
Research supports that the experience of stigma is a front-line barrier for South Asian individuals who want to actively seek counselling. Hess and Tracey (2013) found that stigma (in the form of a subjective norm) was the strongest predictor for help-seeking behaviour in that higher stigma led to less help seeking. It can also lead to underreporting of mental diagnoses (Islam et al., 2014).
It must be noted that a distinction exists between actively seeking counselling and receiving counselling due to a crisis situation. A qualitative study of UK women from four focus groups showed a heightened tendency to use self-harm techniques to cope with distress and mental health concerns as opposed to a tendency to actively seek counselling (Chew-Graham et al., 2002). When these women were provided emergency mental health support and questioned about actively seeking counselling, they turned down the notion, as they felt it would bring shame and disrespect to their families. This concept is known as izzat, which is the respect a family has within their cultural community and amongst extended family members. Another qualitative study, also conducted in the UK, showed that the stigma of mental illnesses affects not only the individual but also the family and is associated with a decrease in marriage proposals for other family members, the amount of dowry, and even the family’s status within their community (Johnson & Nadirshaw, 1993). Research by Gilbert et al., (2004) and Rehman (2010) has also demonstrated that a family’s izzat is closely tied to the behaviours of that family’s children, specifically their women.
A study conducted by Constantine, Okazaki, and Utsey (2004) found that stigma could be both personal and cultural. The researchers indicated that international students in the USA arrive expecting life to be different or even better than at home and may experience psychological crises or become socially dysfunctional when their expectations are not met. Due to feelings of personal failure, or not wanting to bring stress or shame to family at home, international students are less likely to seek counselling (Constantine et al., 2004). Also, those who believe they should be able to address their concerns on their own are less likely to seek help (Hess & Tracey, 2013), which may be related to not wanting to go through the hassle of seeking counselling. This notion may be explored further by comparing South Asian international students with Canadian-born or -raised SA students. Also, exploring the experience of what has allowed international students to seek counselling may help create programs based on those results.
Stigma exists not only through an individual’s or community’s negative attitudes and beliefs but also on a systemic level through organizational policies and procedures (Knaak & Patten, 2014) as well as the attitudes of health care providers (Bhui, 2003).
Similarly, Johnson & Nadirshaw (1993) found that health professionals hold the attitude that members of SA communities do not really suffer from mental health problems or that any concerns are contained within the families and communities.
Over the years, a number of campaigns have been launched to help understand and decrease the stigma associated with mental health illness in general and specifically for South Asian minorities. For example, a London-based campaign, Time To Change, has been educating and providing resources to their South Asian community as a means of eradicating stigma, ignorance, and discrimination for both the families and individuals seeking help (Time to Change, 2014).
The Mental Health Commission of Canada launched a similar campaign, Opening Minds (Knaak & Patten, 2014) as means of altering attitudes and behaviours related to mental illnesses in order to reduce the associated stigma and discrimination. They utilized a targeted approach to interact with health care providers and people in the workforce, as well as youth and the media, to evaluate the effectiveness of existing mental health programs. A major component of their campaign has been the “contact-based educational sessions,” which allow for personal stories of recovery and strength to be shared with the audiences (Knaak & Patten, 2014). Understanding the root(s) of stigma among health care providers was crucial to assess and create the antistigma programs.
The researchers found the following as possible roots:
- Pessimism about recovery/feel like what they do doesn’t matter;
- Seeing the illness and not the person/learning to cope with internal experiences/compassion fatigue;
- Lack of skills/confidence; and
- Lack of awareness of own prejudices. (Knaak & Patten, 2014)
If services are being underutilized, any increase in availability may not be fruitful. However, gaining an understanding of the basis of stigma from a South Asian perspective will help target specific areas for educational purposes. Future research should include a reevaluation of stigma after educational courses have been implemented. Further consideration leads to questions about cultural differences that are felt both by individuals and through systematic stereotypes.