Mental Health in Ethnic Minorities and Immigrants
By Anitha Iyer, PhD, Chief Clinical Officer and Vice President, Crisis and Behavioral Health Technologies at Vibrant Emotional Health
The decision to seek mental health care requires one to overcome various internal barriers. For ethnic minorities and/or immigrants, additional systemic barriers may further complicate care-seeking and connection. Systemic barriers that impact minority and immigrant communities can range from lack of confidence in the system’s cultural competency compounded by the lack of diversity among providers, lack of trust, and lack of awareness of tailored services that may be available. Additionally, insurance related barriers and financial strain can also complicate matters. Limited service availability for undocumented individuals can be an added concern for some.
While the concerns outlined above are reasonably well documented and understood, less discussion has focused on an area where individual/internal, familial, and systemic pressures intersect with care-seeking. Specifically, in ethnic minority and immigrant communities, especially those who trace their roots to South Asia, there is a significant expectation that one must put their family before themselves. An individual’s behavior in the world is often seen first as a reflection of their family. In South Asian communities in particular, as relationships as inherently seen as “other-generated” (Venkataramani-Kothari, 2007), the individual is generally perceived as a part of a whole. In this vein, one’s actions are never just about one alone. Three intersecting factors combine to inform the dynamics at play in this area:
- Decision-making—is derived from the family collective whereby one rarely chooses for oneself alone. For example, it is quite common for a young adult to consider family expectations when she/he chooses college and area of study; in some families this may be more an explicit demand from the family rather than a voluntary consideration by the individual. In South Asian families, it is fairly common for individuals to reject partners for potentially poor cultural and religious fit with their family, even if individual and personality factors are perceived to be a great match. Again, in some families, this is more an explicit demand, and may even extend to include conflict and punishment when the family’s expectations are not adhered to.
- Family reputation—is paramount. Consideration of family reputation is often central to the decision-making process outlined above. Particularly in the realm of one’s choice of partner, it is common for individuals to consider whether the family reputation would be placed at risk through marriages outside prescribed options. Honor killings, common in South Asia, frequently involve strong feelings of reputational damage to the family because of inter-religion or inter-caste relationships (2016, BBC News). This reputational risk or damage is often concretely defined as impacting other members of the family, particularly younger siblings (especially female) whose own marriage prospects may be seen as negatively impacted by one individual’s “poor choice.”
- Boundaries—between the family and the rest of the world are also clearly defined and expected to be strictly observed. The distinction between insiders and outsiders is emphasized and expectations for keeping family secrets within the boundary is clearly conveyed and understood (Dasgupta and Warrier, 1996).
The factors outlined above, compounded with the expectations of ‘model minority’ behavior, may intersect to impact individual decisions around care-seeking for mental health needs. Mental illness, in particular, may be seen first and foremost as a problem for/about the family. For example, an individual who is visibly seeking or needing mental health services (as evidenced through entering and leaving local mental health facilities) may be placing the family’s reputation as risk, including marriage prospects for siblings who may be perceived as “less attractive.” Along the vein of family-oriented decisions noted above, an individual’s expressed need for self-care may be seen as a selfish-decision that does not consider the damage this action brings to the family reputation. The act of seeking supportive conversations with an individual outside the family unit (such as a clinical provider or peer support specialist) may be seen as a breach of the family’s boundaries and a betrayal of cultural norms and expectations.
Technology-enabled, confidential emotional health solutions such as NYC Well provide a vital access point to individuals from minority communities who are seeking care, and looking for a way to maintain themselves in focus through their care-seeking behavior and process. From the privacy of their phone, whether through a phone call or text/chat, an individual can address their needs, receive culturally-appropriate validation and support, without worrying about who else will know, and what it will mean for their family.
While NYC Well and other services like it are increasingly available, awareness campaigns and efforts to engage stakeholders within minority communities are lagging. Such efforts, aimed at shifting perspectives and increasing care-seeking, are vital to improved mental health outcomes across minorities at large, including and especially, those who are suffering in silence.
Dasgupta, S. D., and Warrier, S. (1996). In the footsteps of “Arundhati”: Asian Indian women’s experience of domestic violence in the United States. Violence Against Women, 2, 238-259.
Pakistan honor killings on the rise, report reveals (2016). Retrieved from: https://www.bbc.com/news/world-asia-35943732
Venkataramani-Kothari, A. (2007). Understanding South Asian immigrant women’s experiences of violence. In S.D. Dasgupta (Ed.). Body evidence: Intimate violence against South Asian women in America. (pp 20-45).