British Columbia

There isn't a word for depression: immigrants and mental health

Seeking mental health care can be extremely difficult for immigrants and minorities, as one Coquitlam, B.C., man found when he was diagnosed with bipolar disorder.

Immigrants are less than half as likely to get professional help for depression

Jay Peachy founded Sound Therapy Radio after struggling with his own mental health. (Steven Chua/CBC)

Jay Peachy leans against the studio doorway of CJSF Radio — the campus station of Simon Fraser University — as he listens to the station’s mental health program, Sound Therapy Radio.

Although the Coquitlam native no longer hosts it, Peachy keeps in close contact with the show he created in 2009 to foster awareness about mental illness through storytelling and art.

He usually sticks to the sidelines, but every now and then he comes on air to crack a joke or two, employing a soft-spoken brand of humour.

Peachy honed his comedic skills as a comic in Stand Up For Mental Health, a group that fosters empowerment among the mentally ill through comedy.

But more than eight years ago, when Peachy was first diagnosed with bipolar disorder, there was little humour to be found in his situation.

Distrust of the system

The disorder — a condition marked by alternating states of depression and extreme excitement — meant Peachy rarely got out of bed and could barely climb the stairs.

Over the course of 15 months in his parents’ home, his 5-foot-5 figure ballooned to 200 lbs.

Isolated and alone, Peachy’s only treatment came from his mother — an immigrant from the Philippines who didn’t trust the mental health system.

Instead of allowing Peachy to get medical help, she chalked his symptoms up to a spiritual crisis and adopted a regimen of daily prayer.

"My mother’s perception — feeling that I had a spiritual crisis — and my own tendency to reject that notion, it created conflict," says Peachy.

"It almost held me trapped hostage in there, but I wasn’t physically held hostage."

When Peachy’s mother ordered an exorcism, his friends and siblings stepped in and insisted he get professional help.

Lack of adjusted programs

The inability of Peachy’s mother to trust the mental health system illustrates a point many experts are making — that cultural barriers can prevent immigrants and minorities suffering with mental illness from getting proper diagnosis and treatment.

Tahany Gadalla, a University of Toronto researcher who carried out a nationwide study, measured the rate at which people use the mental health system.

She found immigrants are less than half as likely to get professional help for depression compared to self-identified Canadians.

Gadalla believes this is due to a lack of programs that have been adjusted to educate people from different cultures about mental health issues.

Combine this lack of education with the fact that mental health is a predominantly Western notion, and properly diagnosing a condition becomes an even greater challenge.

It’s a problem researcher Paola Ardiles is familiar with.

Ardiles chaired the provincial committee that authored "Towards Reducing Health Inequities," which describes barriers keeping immigrants and minorities from accessing mental health services in B.C.

"In many cultures, for example, mental health problems are not even acknowledged," she said.

"There isn’t a word for depression, for example, in some cultures, so there’s a lot of stigma to be dealt with as well.

"People often find themselves isolated."

While stigma around mental illness is definitely a big problem among the non-immigrant population, cultural differences can complicate matters.

Familial shame and stigma

One woman — who does not want her last name published because she does not want her family’s reputation to be tarnished — is especially aware of this fact.

Wai has hidden her 13-year battle against bipolar disorder from all her relatives.

She believes if people found out about her condition, the stigma directed towards those with mental illness would not be aimed just at her, but her entire family.

"Friends will think maybe [my family] has a mental illness too," Wai says.

"Not just the child — the whole family before and future [generations]."

Wai’s rationale is an example of what researchers call collectivism — the tendency for some cultures, typically non-Western societies, to identify as a group.

Unfortunately, experts agree collectivism can be a barrier preventing people from getting help for a mental illness.

Wai was lucky — one of her friends recognized her symptoms and suggested she get treated.

However, it’s likely the fear of familial shame is keeping many others from seeking help for mental health issues, she says.

Collectivism vs individualism

Colin Chow, a registered clinical counsellor in Burnaby, deals with patients from diverse backgrounds.

"The family unit is the basis for one’s identity," he says.

"Collectivists would be the opposite of individualistic, [which] is what we generally would see in Western cultures."

Chow says the biggest difference between the two types of cultures is that in individualist groups "who you are and what you do is a reflection of yourself, where in a collectivist culture it’s a reflection of your entire family."

According to Chow, if a person in a collectivist group gets a prestigious job, it is considered a success for the whole family.

On the other hand, if a person falls victim to a problem — like mental illness — his or her whole family is considered to blame.

Changing diagnosis methods

Those cultural differences have prompted a prominent local expert to call for changes in the methods used for diagnosing mental illness.

Dr. Soma Ganesan is the director of the cross-cultural psychiatry program at Vancouver Coastal Health, the first of its kind in Canada.

"The Western model of psychiatric interview needs to be modified," he says.

Ganesan says the interviews, in addition to other methods, need to go beyond simply offering services in different languages — they need to be reformed to become culturally sensitive.

In a psychiatric interview, clinicians ask their patients a series of standardized questions and then use the answers to determine if their patient has a mental health issue.

The problem with this approach, Ganesan says, is that many of the questions are fraught with topics many cultures consider taboo, such as suicide and sexuality.

"This is more or less threatening to a lot of people," he says.

In addition, when the patients are children, parents are often present during the interview, making it even harder for those patients to give a honest answer.

Ganesan says the result is that many people probably aren’t getting diagnosed accurately.

If the method of questioning is not done in a culturally sensitive manner, clients cannot be expected to give accurate answers, Ganesan says.

"We need to train our new generation of [healthcare providers] ... to be culturally aware of the differences."

While healthcare providers struggle to adapt the way they serve the mentally ill in Metro Vancouver, back at the CJSF studio, Sound Therapy Radio is wrapping up its show.

Peachy shakes hands and embraces the producers, hosts and guests as they exit the room.

"The radio is a mechanism to kind of reach out a bit and a bit of a lifeline," he said.

"When I was really depressed I was listening to a lot of radio."


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