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Our communities are culturally diverse. Mental health and substance use problems affect everyone, regardless of where they live or their cultural background, but current mental health and substance use services may not always respond to the diverse needs of our community members.
Culture includes sharing a set of values, beliefs, traditions and sense of belonging. Culture is larger than one person, but people interact with culture or place in their own ways. Culture is also not a monolith—differences within a culture may be just as great as differences between cultures.
Understanding relationships between culture, mental health, and substance use is vital for care providers and supporters.
Culture, mental health, and substance use
Culture and place play a big part in the way we think about and understand health and wellness. Here's a very simple example. If you grew up in Canada, you may have heard that salads and raw vegetables are a very important part of a healthy diet. But in some places and cultures, warm foods and cooked vegetables are considered healthier and more beneficial than raw. Neither perspective is wrong, and each group can explain why their perspective promotes health. But when health care systems fail to understand diverse perspectives and experiences, people are invalidated and misunderstood, and may receive poorer support as a result.
Mental illnesses and substance use problems are diagnosed based on Western assumptions like what a typical family looks like, community dynamics, roles, and priorities. While mental illnesses occur everywhere in the world, how you understand symptoms, concerns, causes, and treatments is shaped by culture and place. Some people understand mental illnesses in terms of physical symptoms or effects on community relationships. Some people recognize mental illnesses from religious or spiritual perspectives. What is considered normal substance use in one place may be considered a serious problem in other places. When only one perspective out of all of the possibilities in the world is considered "right," it means that people are left out, ignored, or simply not even recognized by systems and institutions.
In Canada, some people assume that you seek help for a mental health or substance use problem by talking to a doctor and then following a treatment plan like taking medication and talking one-on-one with a psychologist or counsellor. These assumptions mean that people from different places, cultures, or religions may be labelled "non-compliant" or "refuses treatment" because their way of managing a problem isn’t the same as dominant public health messaging in Canada. Some people manage their mental health through informal systems, like talking with family or community members or talking with a faith leader. Some people don’t feel safe or understood in mainstream health systems and seek help in informal systems because that is the best support available to them.
Isolation
One of the greatest harms to well-being is isolation. Stigma, discrimination, lack of access to supportive communities (whether cultural or based on other identities), inadequate wages or income supports, and lack of access to safe mental health or substance use supports are some of the factors that increase isolation. Building social connections or expanding networks can have a significant benefit not just on mental health but also physical health.
Stigma and discrimination
The stress of stigma and discrimination in all areas of life affect well-being. Racialized Canadians may experience stigma and discrimination in education, employment, housing, health care and justice, just to name a few. Culture in Canada holds stigma around mental health and substance use, and stigmas around mental health or substance use may be present in other cultures. Due to stigma around mental health and substance use in many cultures, people may feel ashamed or hesitate to share their experiences with friends, loved ones, or healthcare providers.
Language
Languages have different ways to talk about mental health experiences. Direct translations from English to another language may not be meaningful to others or may not reflect everyday language used to talk about mental health problems. Health care providers may miss symptoms or the severity of symptoms when they don’t understand idioms or health-related terms in a particular language or culture. Communication styles and expectations vary among cultures, places, and people even when everyone is speaking the same language. Fluency in English doesn’t guarantee that people understand medical terminologies or health systems navigation, which is a barrier even among people who learned English as their first language.
Acculturation
For people who move to Canada, adapting to Canadian norms and expectations can be a stressful process. That process—called acculturation—can pressure people to adapt faster or let go of their culture in order to fit in. Acculturation can also cause stress within a family or community, as there may be generational differences in how people move through the acculturation process. Even people born in Canada may feel caught between Canadian norms and their family's culture. Everyone navigates acculturation differently, but research shows that family support and community support play an important role in lessening the effects of this stress.
Resilience
Resilience is the ability to overcome difficult situations. It includes your personal ability to overcome problems on our own, but it also includes support from groups like family or community. The way you overcome difficult situations, including the way you help ourselves and seek help from others, is linked to cultural factors like values and beliefs. Even the way you view different situations is based on your values and beliefs. Culture is a very important part of well-being, and the values and beliefs you learn through your culture can help guide you to wellness.
What can we do about it?
Adopt intersectional approaches. Everyone has different identity factors that influence who they are, how they are viewed or treated in systems and by institutions, and how they move through the world. These factors may include nationality, race, ethnicity, culture, language, religion, sexual orientation, gender identity, dis/ability, body shape, and others. Different sides to our identities may carry different stigmas, discriminations, or structural inequities, which stack up and increase the risk of mental health problems. Some factors of identity provide privileges.
An intersectional approach in mental health and substance use aims to understand the whole of a person—the unique combination of overlapping identities that each of us carries—to understand the bigger picture, understand different experiences or perspectives, and provide safe, effective, and well-informed care. For example, 2SLGBTQI+ people experience significant harm when communities reject, discriminate against, or threaten violence against 2SLGBTQI+ people. Someone who experiences racism or xenophobia in addition to homophobia or transphobia may experience greater harms, and failing to recognize all identities mean that person isn't receiving all of the help they may want. It can also be invalidating when individuals or systems make assumptions around how different identities "should" work without considering how identities are interconnected and affect each other.
Practice cultural humility. Cultural humility is the ongoing process of learning from others and reflecting on your own biases, assumptions, and privileges so you can build authentic partnerships and correct power imbalances. Cultural humility recognizes intersecting identities. In the context of mental health, cultural humility means understanding others as experts in their own experiences and needs, where care providers are partners motivated by curiosity to understand different perspectives, empathy even when they don't fully understand someone else's experiences, and a desire to understand how their own biases, assumptions, or actions may impact their interactions with others.
Alongside cultural humility is cultural competency. Cultural competency is the knowledge to interact effectively with people from different cultures and places and is generally achieved by learning about values, customs, beliefs, and other important factors. While learning about one specific culture may be useful, a goal of cultural competency is intercultural competence. Intercultural competence describes skills that allow an individual to build relationships and work well with many different people even when that individual isn’t an expert in any one culture while developing awareness privileges, dynamics, and their own biases.
Where do I go from here?
Check out the resources below for more information on cross-cultural mental health and substance use:
BC Partners for Mental Health and Substance Use Information
Visit www.heretohelp.bc.ca for information on mental health and substance use, screening self-tests for anxiety and depression in Traditional Chinese and French, and the Plainer Language Series of mental health booklets.
Moving Forward Family Services
Visit movingforward.help for accessible and affordable counselling. Moving Forward Family Services offers counselling in person, online, or by phone to people across Canada. Services are available in many different languages.
Fraser Health patient education catalog
Visit patienteduc.fraserhealth.ca for mental health and substance use resources in several different languages.
The Affiliation of Multicultural Service Providers (AMSSA)
Visit www.amssa.org for information, events and resources. You can find service providers across BC and search the Multicultural Health Resources database.
Multicultural Mental Health Resource Centre
Visit www.mmhrc.ca for resources, research and information. You’ll find a library of mental health and substance use information in many languages, a tool to find services and service providers, and information and educational opportunities for clinicians.
Cross-cultural mental health services
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Cross Cultural Psychiatry Clinic in Metro Vancouver: provides culturally-sensitive assessment and care in many languages through inpatient and outpatient facilities as well as a several community Mental Health Teams. Referrals are required through a family doctor, social worker, Mental Health Team, or school counsellor.
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Child & Youth Cross Cultural Mental Health Program in Vancouver: provides mental health services to children and families in Mandarin and Cantonese. Open to residents of Vancouver. No referral needed—you can walk in to refer yourself. Visit www.vch.ca/en/service/child-youth-cross-cultural-mental-health-program for more information.
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Interpretation services: The Provincial Language Services providers interpretation services for health authorities, doctors, specialists, and midwifes. Talk to your service provider to access an interpreter and visit www.phsa.ca/our-services/programs-services/provincial-language-services/ to learn more about interpretation services.
About the author
The Canadian Mental Health Association promotes the mental health of all and supports the resilience and recovery of people experiencing a mental illness through public education, community-based research, advocacy, and direct services. Visit www.cmha.bc.ca.
