The Current

'The unspoken ones': How race and culture complicate Asian-Canadians' access to mental health care

Language stands at the forefront of mental health barriers for Asian Canadians — both in what is said, and what is not said.
The Current's Piya Chattopadhyay speaks with guests (left to right) Sally Lin, Queenie Choo and Dr. Hiram Mok. (Wendy D. Photo)
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No matter who you are, it's never easy to talk openly about mental health. But Sally Lin says her cultural identity has made it that much harder. 

In her Chinese-Canadian household, mental health was not really spoken about. When issues arose, her parents had a go-to mantra: "bitterness first, sweetness later." Work-hard and persevere. 

It wasn't until Lin took a Psychology 101 course at McGill that she was introduced to the concepts of depression and anxiety.
Author Sally Lin discusses the intersection of race, culture and mental illness at The Current's Facing Race town hall in Vancouver. (Wendy D. Photo)

"I thought, 'I think these things resonate with me. But I've never heard of them before,'" she told The Current's  Piya Chattopadhyay, as part of our town hall series Facing Race.

Lin eventually sought help in the mental health system, but there she found a whole new set of challenges tied to her ethnicity.  

"My dream is to walk into a room for a therapist to really see me and not to avoid the issue of race," she said.

'Feeling perpetually seen as a foreigner impacts my mental health': Sally Lin 1:48

Writing about the intersection of mental health and race, Lin discovered she was far from alone.

In Vancouver, 25 per cent of households speak Chinese at home.

People of Asian descent make up almost 50 per cent of Canada's visible minorities, thanks in part to a huge shift in demographics that began in the 1970s. There are currently over five million people of Asian descent living in Canada.

But as ethnic and racial demographics change in Canada, is the mental health system keeping up?

When it comes the wide-ranging Canadian-Asian experience, how do race and culture serve as barriers to mental health?

Redefining health

For Lin's parents, the idea of  "eating your bitterness" had two implications. It communicated the importance of perseverance, but it also privileged physical health over mental health.

She says it's common for Chinese-Canadians to disregard mental health concerns given the life threatening stakes for many living in China in the 20th century. 

"If you look at Chinese history in the last century just basic survival was so important — physical survival," she told Chattopadhyay.

"Being able to talk about mental health in this forum I feel very, very privileged."

Queenie Choo is the CEO of SUCCESS, a multicultural immigrant settlement organization. (Wendy D. Photo)

The cost of counselling also contributed to Lin's anxiety about pursuing help.

Familial obligations were at the forefront of her thinking.

"Is this valuable? Is spending this money on myself, as opposed to you know the values of saving your money or supporting your parents or extended family."

Confronting stigma and denial 

Dr. Hiram Mok, a clinical professor at the University of British Columbia's department of psychiatry, says cultural values like those Lin learned when she was young may impede access to mental health support.

By example, he said cultural traits like stoicism and tolerance generally see help as "a weakness" which can deter individuals in need from reaching out.

"In China we talk about 'Ming yun' — destiny. You've got to rely on your destiny," he told The Current

Queenie Choo on 'denial' and mental health in Asian communities 1:14

According to Queenie Choo, CEO of the multicultural immigrant settlement organization SUCCESS, Asian-Canadian communities are not only fighting the denial of mental health needs, but also overt stigmatization.

This is often reflected in the language a community uses to talk about these issues.

"In the Asian community you don't called it 'mental health' — mental health, at least is health. But rather in the Asian community we talk about 'mental illness.' So you change the whole connotation," she said.

Like Wok, Choo says this outward cultural stigma deters Asians from seeking help. But As Lin's experience testifies, those who do seek help often encounter more difficulties within the system itself.

"When this individual was having a crisis the only number he could reach out to was 911 because ambulances, mental health services, psychologists and all of this is not an essential service." 1:39


Barriers in the system 

When Lin would go see a therapist who was white, she said there was often "an elephant in the room" — race.

She found her therapists didn't want to address it directly, and failed to have a grasp on the role it might play in her mental health.

"As a patient I don't want to have to explain certain things to them ... [such as] feeling like I'm perpetually a foreigner, [or] perpetually seen as a foreigner."

She found the "colour-blind" treatment methods for her anxiety, which included recommendations of yoga and breathing exercises, were not well suited to her. 

Violet Campbell, left, helps Wu Xiao Yun during a weekly group meeting to help people practice their English skills and combat social isolation in Vancouver. (THE CANADIAN PRESS)


"I can't go to a yoga class without thinking about cultural appropriation," she joked.

"I'd rather come to Vancouver, go to Richmond go for dim sum, [and] eat some congee, because that's actually what makes me feel comfortable."

Tailored care

Lin believes therapists should be better equipped to address cultural difference in their practice, and that training should be provided to that end.

Choo adds that language barriers can further impede access to mental health care.

Queenie Choo on language barriers facing immigrants and refugees 1:05

"The language barrier is so amazingly important. I would stress that. These are the unspoken ones. They are not able to communicate whatever they think, what they have in mind, never mind having some interaction with the therapist," she said.

Choo's organization fundraises money to offer counselling services to those who can't afford it, and that are culturally specific.

For example, SUCCESS is experimenting with familial group therapy, given the fact that it is customary to have two or three generations of one family living together in an Asian household. 

A huge shift in demographics has Asians making up almost 50 per cent of Canada's visible minorities. (Statistics Canada/CBC)

But both Choo and Mok say it's important not to fall into stereotypical thinking when pursuing mental health care that is more culturally informed.

They believe an embrace of multiculturalism in health services would hedge against reductive thinking.

"I've seen some stereotyping going on [in the emergency room] but not in my own practice because I do a lot of cross cultural work," says Wok.

"As an organization we are also very multicultural. We have multilingual staff to make sure the language barriers are overcome," adds Choo. 

"No one wants to come to this country and not be welcome."

Listen to the full conversation at the top of this page, where you can also share this article across email, Facebook, Twitter and other platforms.


The Vancouver town hall event on race relations in Canada was produced by The Current's Yamri Taddese, Pacinthe Mattar and Ruby Buiza.

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