Consider the impact of culture

Recognizing and appropriately treating mental health problems and illnesses require awareness of the impact of clients' cultural backgrounds throughout the process of working with them, and gradually learning from them if they choose to share. Cultural considerations or factors affect how people view mental health and mental illnesses, how and when they seek care, and how they respond to care. Awareness of how culture can interact in these ways allows service providers to provide more effective care and support.

Although service providers bring their own personal and practice-based cultures, which influence their interactions with clients, for the purposes of this discussion, the focus is on clients' cultural backgrounds as they relate to the provision of mental health care and support. We provide information about the related topics of cultural humility and service providers' influence on interactions with clients in Module 7.

The impact of culture on mental health problems and illnesses

Culture can be a factor in newcomers' use of mental health services. Immigrants and refugees access, or are referred to, mental health services at a lower rate than Canadian-born individuals; this can be partly attributed to cultural barriers (Kirmayer et al., 2011). Clients may be concerned that they will not be understood by service providers due to cultural differences, which can prevent them from seeking help (Kirmayer et al., 2011). Culture can also influence whether or how people seek help. Among newcomers, it is common to use multiple sources of support, such as traditional healing in conjunction with biomedical treatment (Kirmayer et al., 2011).

Cultural concepts, values and beliefs influence the meaning people impart to mental illness. Some clients, for example, may believe that mental health problems are caused by supernatural forces, sin, evil spirits or violation of sacred beliefs (Paniagua, 2014; Racin & Dein, 2020). Due to culturally-specific explanations of illness, mental disorders may be highly stigmatized and clients may be reluctant to attribute symptoms to a mental illness (Kirmayer et al., 2011). Stigma can be a powerful deterrent as it can also affect clients' family members.

Culture can also influence how people describe their symptoms. Individuals in some cultures may be more likely to express emotional distress through somatization. In primary care, many clients present physical complaints, resulting in under-recognition and treatment of mental health problems (Kirmayer et al., 2011). People experiencing distress may express it indirectly through metaphors or somatic complaints such as heaviness in the heart, for example (Hassan et al., 2015). There may also be degrees of socially-sanctioned expressions of emotions. For instance, among some groups it may be more acceptable for women than men to express emotions. The way clients present symptoms can also be affected by the situational context. A refugee client may conceal symptoms out of fear of deportation, for example, or may describe more heightened symptoms of stress before a refugee hearing.