Mental health in a changing world: The impact of culture and diversity

October 10, 2007 marks the 15th Anniversary of World Mental Health Day. This is a day when medical and non-medical organizations around the world put on events to raise public and professional awareness of a specific mental health issue, which the World Federation of Mental Health (WFMH) selects every year.

This year’s theme concerns the need to improve understanding of how cultural differences affect how people not only view mental health but also the challenges that people face as a result, and the factors that do or do not make those affected seek professional help.

The world is getting smaller

According to the WFMH more people than ever before are living in a country other than the one that they were born or raised in. The organization estimates that one in 35 people, or 3% of the global population, are an international migrant.

“We find dramatically different languages, religions, family relationships and values, as well as views on health care and treatment wherever we go, including in our own respective countries,” the WFMH states in its information pack to support World Mental Health Day. [1]

Living outside the country one was born in may not always be due to personal choice. And, as the information pack highlights, some people may have been displaced for reasons beyond their control such as civil war or natural disasters. They now find themselves in a culture that they do not fully understand or that does not fully understand them. It can be difficult enough to cope with the challenges that these situations produce without the added complication of mental illness.

A natural disaster can displace people

Your culture or mine?

Culture can influence many aspects of a person’s life and this can be reflected in their mental wellbeing. How people’s symptoms of ill health manifest and how they then deal with symptoms may vastly differ from one culture to another, with some viewing mental illness as a blessing rather than a curse.

Ellen Mercer, Deputy Executive Officer at the WFMH, tells Patient Health International: “In some cultures if you are talking about hearing voices then that might be seen as that person having schizophrenia. However, in others it may mean that the person is hearing the voices of their ancestors and that this is considered a positive thing and not due to a mental illness.”

She adds: “If a practitioner doesn’t understand the culture of the patient then it’s very hard to treat them in a way that is really effective.”

Cultural differences can affect how people perceive mental health care and providers, how they communicate and label their symptoms. It is therefore vital for those caring for people with mental health problems to have an understanding of the person’s culture. This could dramatically influence how they can or should be treated

Understand cultural differences

Culturally sensitive programming

One of the key things that mental health care providers can do is to learn as much as possible about the cultures of the people that they treat and tailor services to meet their specific needs.

So-called culturally sensitive programming is essentially about making people feel comfortable to talk about their worries in an environment that makes them feel welcome.

Providing information in multiple languages and offering interpretation services by a person of the same cultural background rather than using a family member as the intermediary can help put people at ease. But practitioners also need to be aware of how different cultures view body language, such as too much or too little eye contact or standing too close or too far away, and communicate in general.

“To be culturally sensitive, an individual must understand his/her own views and those of other cultures,” the WFMH information pack states.

Thoraya Ahmad Ohaid, Executive Director of the United Nations Population Fund, states in the pack: “We may not believe in what they do, we may not agree with them, but we need to have compassion and the commitment to understand them and to support them.”

The WFMH pack includes 24 tips on how to be more culturally sensitive, from investing time in understanding another culture and its values to how to avoid making stereotypical assumptions. It also provides a self-assessment checklist for people providing behavioral health services to those in need.

Time to raise awareness

Culturally sensitive programming is not a new concept in relation to mental health, but it is an important one that the WFMH feels is time to bring to the public’s and healthcare professionals’ attention.

Part of the impetus behind choosing this year’s theme was based on the establishment of the WFMH’s new centre of Transcultural Mental Health, which opened its doors in January 2007.

Ellen Mercer who is the Director of this new center comments on the format of World Mental Health Day: “It’s a day where many different organizations and individuals around the world organize activities to raise awareness. We provide the general theme and informational materials that are sent out in CD form or downloaded for free from our website. This year the pack is available in the following languages: English, Russian, Chinese, Japanese, French, and Spanish.”

Her colleague Deborah Maguire, who has been responsible for coordinating the event each year, adds that the chosen theme is “usually based on something that the WFMH is already involved in or a topic that we feel is very important.

“I think our biggest goal of the day is the educational aspect, and how many people we can reach with this information.”

World Mental Health Day will hopefully raise awareness of the importance of taking cultural diversity into account when caring for those with mental health issues and help build a lasting framework for improved mental health care throughout 2007 and beyond.

Reference

1. World Federation for Mental Health. World Mental Health Day 2007 Information Packet. Mental Health in a Changing World: The impact of culture and diversity.