Saz Vora

Talking of mental health does not come easily to anyone, but it is worse in the South Asian community. An issue that demands to be kept in check, never talked of, a stigma that harms the family’s reputation.

My first engagement with psychiatric services goes back to the early nineties. The hospital referred both my spouse and I to child bereavement counselling after losing our profoundly disabled son. I pressed on and my husband, who came to England as part of the Ugandan Asian expulsion, declined by claiming, ‘Why would I need to talk to strangers about family matters?’ 

Being British South Asian brings an abundance of support. Our families help with our basic needs in times of trouble, physical comfort, cooking, washing and shopping. But displays of mental illness bring out the usual cliches, madness, possession, weak mindedness, and embarrassment. I persevered with my counselling sessions, but the absence of cultural sensitivity made me quit and find my own solution. In my case, I buried my feelings, got on with life, accepted that some days, weeks and months were bleaker than others.

The pandemic has forced mental health awareness to the fore in the South Asian community. When cricketer Monty Panesar and Bollywood star Deepika Padukone spoke candidly of their struggles with mental health, it became easier for second and third generation British South Asians to seek help for their mental illness. 

Dr Tina Mistry, Clinical Psychologist, co-founder of Another Mother Story and founder of Brown Therapy Network, highlights that the mental health care provided via the National Health Service (NHS) works for second and third generation migrants but does not support the older South Asian community. This group brings with them discrimination and trauma of displacement, whether it was India’s partition or the East African exodus and they use the service differently.

A recent report has revealed problems with accessibility, with a lack of awareness, stigma, trust in the counsellor, and lack of cultural identity. Individualist practices in clinician rooms create a barrier. When the idea of wellness is community centric, individualism of the service doesn’t appeal to them. Dr Mistry is all for decolonising mental health, an understanding of the ethnic culture, a holistic approach through community. She believes that the training needs of new professionals should examine this diversity and adequate time should be given to understanding this in psychiatry. Dr Dinesh Bhugra, Emeritus Professor of Mental Health and Cultural Diversity at the Institute of Psychiatry, King’s College, London, believes this is changing, but his onus is on the professional, who should gather information about the community they serve.

Dr Bhugra stresses an increase in South Asian doctors and medical students joining the profession will create more awareness of cultural identity with practitioners, but also with the community. However, he worries for the older members in the South Asian community, especially as they face challenging health issues with diabetes, hypertension, arthritis and the normal aging process that leads to dementia. He points out that the anxiety and stress of Covid and restrictions in meeting up has prevented the community from accessing spiritual clinics. Something widely used throughout South Asia and other low-income countries, these clinic use complementary medicines and consultations with traditional healers from India. This holistic approach of using Ayurveda, foods, and meditation treatments is another aspect that Eurocentric practices have not considered.

Both agree that to tackle mental health issues, especially in the older South Asian community, an outreach programme would be beneficial. Dr Bhugra believes that connecting with leaders, communities, and religious organisations will eventually break the barrier of stigma. He wants the NHS to use cultural brokers as a bridge to provide services in the community and not in clinician rooms. He suggests visits to the temple, gurdwara, mosque, and church as spaces for not only spiritual practice but also for mental health counselling. Whereas Dr Mistry states that pockets in the community are not the only answer- she wants more Black, Asian, and ethnic minority members on boards as decision-makers and the use of activism to de-stigmatise mental illness.

My recent experience was nothing like the session in the nineties. However, as Dr Mistry points out, in areas of deprivation and poverty, the local health service provider would not allow the poor cousin of the NHS any such funding. As many South Asians are from lower socioeconomic areas expensive talk therapy is not available when one pill is so much cheaper. She emphasises that in an already stretched NHS, provision for South Asian and other ethnic minority communities is an afterthought. 

There are multiple barriers for South Asians from seeking help with mental health; Lack of information and effective communication, stigma, the shame of using such a service and a ruin to reputation, mistrust of White and Asian professionals, cultural safety, inadequate interpretative support, and limited collaboration in the decision-making process. However, as more and more practitioners in the psychiatric community speak and build trust with wider cultural humility and an anti-racist lens, more people like me would have a better experience.

When I look back at my first consultation, I left because the advice given did not fit with my identity. The fragile nature of my constructed self, a bit of Britishness, a bit of Indianness. This time they recognised my hybrid identity, and I felt supported.

Saz Vora is an author, before she started writing South Asian women’s fiction, Saz had a successful career in Television Production and Teaching.