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Mental Health

Double Stigma, Double Duty

Supporting Asian men to become mental health ambassadors and activists 

Rodrick Lal, MPA, MA, RCC, CCPC, CCC, PhD (Cand.)

Visions Journal, 2017, 13 (1), p. 33

Evidence suggests that the mental health needs for racialized communities are seldom met, especially for men. In particular, men from Asian communities (such as the Chinese, Filipino, Korean, South Asian and Vietnamese communities) are among those least likely to seek help for mental health problems in Canada. This avoidance is frequently attributed to stigma, the individuals' sense of shame and his perceived need to "save face."1

While mental health stigma cuts across all cultures and ethnic backgrounds, research suggests that stigma takes different forms in different communities and is compounded by cultural stereotypes surrounding ideas of masculinity and an individual's experiences of racism and discrimination. This combination is sometimes referred to as "double stigma." The Strength in Unity (SIU) project (2013–2017), funded by the Movember Foundation, is the largest intervention study in Canada aimed at developing individual and community capacity to reduce the stigma of mental illness among Asian men and youth.

From my personal experience, as a counsellor and as an Asian male, I know that for many Asian families, especially for men, a diagnosis of a mental health problem such as depression can bring shame to the family, often leading to denial and a breakdown in communication between the mentally ill individual and other family members. In Asian cultures, having control over one’s emotions is considered to be very important. Men, particularly, are taught not to express their feelings. As a result, seeking help is sometimes equated with bringing shame on the family honour.2

In some Asian religious or spiritual traditions, families are taught to surrender to divine will, to accept their lot in life, to be thankful for what they have and to not feel downhearted about difficulties in their lives.3 For many Asian men in Canada, religion is a central part of family life. For immigrants, worship has taken on an additional role—that of sustaining cultural identity and social ties within the community. For men experiencing mental health difficulties, religious leaders are often the first source of help, and yet religious leaders are not always well trained to respond to mental health concerns.4,5

The Strength in Unity project

Strength in Unity involved numerous community partnerships with key settlement, mental health and immigrant-serving organizations. Through a community-engagement process, the SIU study was able to include 1600 men and youth from Asian communities in Toronto, Calgary and Vancouver, with the aim of encouraging and supporting them to become ambassadors and activists for mental health in their communities. In Vancouver, the study involved participants from a wide age range (16-70 years) and from diverse ethno-cultural backgrounds. The vast majority of the participants (90%) were born outside of Canada. Of those, 30% were newcomers to Canada. Twenty percent of study participants were living with mental illness and 25% of study participants were family members of people living with mental illness.

The central focus of the SIU study was to examine the effectiveness of two intervention workshops in addressing internalized and social stigma. Acceptance Commitment Training (ACT) provides a series of experiential workshops that encourage participants to re-examine and challenge their preconceived, culturally influenced notions about mental illness and mental health care. The program nurtures self-awareness, mindfulness, living according to one’s cultural values and compassion for oneself. Contact-Based Empowerment Education (CEE) is a program that deepens the readiness of people to engage in anti-stigma mental health advocacy. It provides education about mental health and mental illness, motivates people to speak out against stigma and discrimination, and teaches skills that will aid community engagement and encourage individuals and families to seek care and treatment.

Findings of the study

Prior to the study interventions, men exhibited stigmatizing beliefs and used stigmatizing language in relation to mental illness. For example, one focus group participant said, "It's shameful in not being able to handle [mental health problems] yourself, it's something that's really difficult to involve others. It's difficult to even admit it yourself. Just because the community has this kind of ideal, or this kind of belief that you can’t show that side of yourself, that weakness. That's internal, that's not for everybody else to see. It's hard for yourself to even, you know, admit or kind of own up to it."

Post-intervention, the study's preliminary findings from the Vancouver site suggest that a combination of ACT and CEE interventions is the most effective approach to reducing stigma among Asian men living with mental illness and their family members. The ACT workshops helped Asian men improve their capacity to face current and future mental health challenges. For example, some men in the study adopted mindfulness practices and were more accepting of their own mental health challenges or those of others. The CEE workshops helped many men become more active in their communities in reducing stigmatizing beliefs, often through the use of social media and discussion groups.

All participants, regardless of whether they were in the ACT, the CEE or a combined intervention group, reported improved attitudes, intentions and behaviours in relation to social justice and anti-stigma activities. These activities included talking to family members and communities for the first time about their mental health challenges, speaking in public forums about mental health issues, using social and traditional media as venues to discuss and de-stigmatize mental illness and, in some instances, volunteering for mental health organizations.

Reducing stigma and becoming empowered to make a positive social impact are gradual processes that require ongoing support. Together, the ACT and CEE programs provided participants with the individual and collective support to achieve these goals. Currently, participants are using their new knowledge, skills and networks to encourage their families, friends and communities to engage in dialogue about mental illness and mental wellness. Through this process, we hope to see Asian men in communities across Canada become more receptive to seeking mental health supports.

 
About the author

Rodrick is a Registered Clinical Counsellor/Educator. He is a co-investigator for the Strength in Unity project and is completing his PhD in the Faculty of Health at York University. Sepali Guruge is the lead and Nominated Principle Investigator for the Strength in Unity Project. For more information about the study and the team, see www.strength-in-unity.ca

Footnotes:
  1. Abe-Kim, J., Takeuchi, D. & Hwang, W.C. (2002). Predictors of help-seeking for emotional distress among Chinese Americans: Family matters. Journal of Consulting and Clinical Psychology, 70(5), 1186-1190; Chan-Yip, A. & Kirmayer, L.J. (1998). Health care utilization and child care practices among Chinese-Canadian women in a pediatric practice (Report No. 7). Montreal, QC: Culture & Mental Health Research Unit; Chen, A.W., Kazanjian, A. & Wong, H. (2008). Determinants of mental health consultations among recent Chinese immigrants in British Columbia, Canada: Implications for mental health risk and access to services. Journal of Immigrant Minority Health, 10(6), 529-540; Luu, T.D., Leung, P. & Nash, S.G. (2009). Help-seeking attitudes among Vietnamese Americans: The impact of acculturation, cultural barriers, and spiritual beliefs. Social Work in Mental Health, 7(5), 476-493.

  2. Ting, J.Y. & Hwang, W.C. (2009). Cultural influences on help-seeking attitudes in Asian American students. American Journal of Orthopsychiatry, 79(1), 125-132.

  3. Tudiver, F. & Talbot, Y. (1999). Why don’t men seek help? Family physicians’ perspectives on help-seeking behavior in men. Journal of Family Practice, 48(1), 47-52. 

  4. Moller-Leimkuhler, A. (2002). Barriers to help-seeking by men: A review of sociocultural literature with a particular reference to depression. Journal of Affective Disorders, 71(1-3), 1-9. 

  5. Yang, L.H., Phelan, J.C. & Link, B.G. (2008). Stigma and beliefs of efficacy towards traditional Chinese medicine and western psychiatric treatment among Chinese Americans. Cultural Diversity and Ethnic Minority Psychology, 14(1), 10-18.

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