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Cultural Responsiveness in Youth Mental Health

What is culture? It would take volumes to unpack this question comprehensively, or with any degree of effectiveness or accuracy. Cultural identity has formed the subject matter of art, research, social discourse, and even policy. Our understanding of culture and identity is evolving the more that we recognize its importance. But for the purposes of this brief article, how can we understand what we mean when we refer to culture?  Race, ethnicity and culture are sometimes mistakenly used synonymously. However, while race refers to identification based on physical characteristics, and ethnicity relates to ancestral heritage, culture can often be more intangible.  Although clearly related to race and ethnicity, one’s culture is more about how one perceives, experiences and engages with the world. Dr. Janet Walker, of the Research and Training Center on Family Support and Children’s Mental Health, states that “culture is a set of ideas, behaviors, beliefs and values that are shared by a group of people….Children learn cultural values and beliefs from the people around them as they grow up — family members, community members, people from the same region or the same country of origin, people with a similar heritage, people who speak the same language” (2000).  

For many youth, culture is a complex and dynamic issue. Adolescence is a time of identity formation, as youth explore who they are in terms of (among other things) age, sex, gender, race, ethnicity, and socio-economic status. For many first generation Canadian youth, there is a further layer of complexity, as they may adopt practices and values that are incongruent with those of their family, and find their cultural identity straddling two worlds. 

The intersection of Mental Health and Culture

In Canada (and the “western world” more generally) mental health is still largely approached through a medical model. We look at symptoms, we diagnose an illness, and we treat it.  This can sometimes be an effective approach. Conceptualizing mental illness as a health issue – rather than as a result of laziness, defiance, or poor parenting – can help to decrease shame and stigma associated with mental health disorders. However many cultures have different understandings of wellness, and may have varying degrees of acceptance in their attitudes towards mental health.  Increasingly, our schools are diverse, and we work with youth and families from a wide range of racial, ethnic, cultural and religious backgrounds. Mental health can be a sensitive topic for many, and must be approached with respect and open dialogue, while also recognizing some barriers that exist in supporting diverse youth. 

Different generations, different perspectives

Joshua Chin, MSW, a Child and Family Therapist working with Child and Youth Mental Health in Richmond, BC, identified differences in cultural practices between parents and youth as a significant issue in addressing mental health challenges among teenagers. We know that, when supporting youth in the area of mental health, it is important to collaborate as much as possible with the youth’s family. However, “often youth and parents are not on the same page, or following the same cultures and traditions”. This can lead to disagreement regarding what it means to be mentally healthy, different interpretations of symptoms, an unwillingness to acknowledge symptoms, a hesitancy in engaging supports and services, and different beliefs about how to respond (Ferris, Hane & Wager, 2014). 

Stigma

The fear of stigma can act as a barrier to mental health work with youth. While this can be true for anyone, there are some cultures that do not acknowledge the existence of mental health issues, or that continue to see them as shameful. If a youth comes from a cultural background where they believe their parents will be ashamed of them for their mental health symptoms, or where their parents may simply deny the existence of a problem, it will be much harder for that youth to seek help. Likewise, it will be more difficult to engage the family in a therapeutic process. 

Ability to relate

While the population of youth with which we work has become increasingly diverse, it is unfortunately still the case in many places that the majority of helping professionals are of the dominant culture (Caucasian/Western European). While it should be acknowledged that this is changing, we must nonetheless recognize the impact this dynamic can have on a youth (or family) from a minority culture, and on our ability as counsellors to adequately relate to, and engage with, youth and their families on a sensitive topic such as mental health. On a similar note, for many recent immigrants, language barriers may also lead to a hindered understanding of the mental health issues facing their child. 

The impact of immigration itself

Finally, in the case of new or recent immigrants, we cannot ignore the impact of the migration and resettlement process itself on a youth’s mental health (Seah, E., et al., 2002). A youth and their family may be leaving a traumatic situation in their home country, may experience a traumatic migration, may experience shock and anxiety at arriving in a new and unknown culture, and may be mourning the loss of their home. All of these could manifest as mental health symptoms and must be taken into account as part of the holistic picture of a youth’s functioning. 

How can we be Culturally Responsive?

In the past, when working with culturally diverse clients, efforts have been made to gear our responses or interventions to what we believe a given culture needs. This culturally-targeted approach is well-meaning, and certainly it can be helpful to understand in general terms how a given culture responds to mental health. However, “knowing about” a culture, is not the same as living it. Most of us have not lived the experiences of our diverse youth, and we cannot therefore presume to know how they – or their family – understand their mental health symptoms, based simply on their cultural background. A study by Sundar, et. al (2012) found that assumptions and close-mindedness were the most common barriers for youth in establishing safe and supportive relationships when seeking help for mental health issues. The belief that you already know what someone is going through can prevent you from actually getting to know what someone is going through.

The Kelty Mental Health Resource Centre, based in British Columbia, is one of many healthcare resources that encourage an approach of “cultural humility” when dealing with diversity. Specifically with regard to mental health, this means placing ourselves not as authorities when it comes to mental health, but as those who want to learn about the youth’s experience. “A cultural humility approach is interactive: we approach another person with openness to learn; we ask questions rather than make assumptions; and we strive to understand rather than to inform.” (Kelty Mental Health – Culturally Connected).  Sundar, et. al. (2012) also found that the qualities of curiosity, flexibility, openness, mutual learning and empowerment were identified by youth as being helpful factors in establishing a positive and supportive relationship in a mental health context. In explaining his approach to working with diverse youth and families, Joshua Chin echoed this framework: “Spend the extra time to build trust with families… ask cultural questions and be curious… I want to understand how the youth and their family understand the mental health issues.”

Practical strategies

Starting from an approach of cultural humility, we can learn about the experiences and perspectives of diverse youth, gain insight into how culture is influencing their experience of mental health, and take a more collaborative approach to responding to the mental health symptoms. But beyond this framework, there are some practical strategies that school professionals can take to better engage culturally diverse youth and their families when it comes to mental health:

  • Provide translated mental health information. Regional and provincial health/mental health bodies will often have handouts on mental health that have already been translated.  Many of these are available online. While they may not be a substitute for dialogue and conversation, providing families with basic information about their child’s difficulties – in their own language – can show a degree of respect for their experience and a desire to engage.
  • Draw on cultural supports that already exist, even if they are not mental health specific. If there are cross-cultural workers in your school or school district, these can be valuable supports in engaging families as they may more easily establish trust and alliance. 
  • Explore and show openness to alternative approaches to mental wellness, or alternative treatment/healing methods which may resonate more with a youth and their family.

Culture is complex and affects our work with youth on many levels. By adopting a stance of cultural humility and a willingness to learn, we can more effectively support youth from all backgrounds towards greater health and wellness.

By: Laura Hamilton, M.Ed 


References
Ferris, M., Hane, A., & Wagner, B. (2014). Engaging youth and families in mental health services: Lessons learned for creating a culturally-responsive system of care in Ramsey County. St. Paul, MN: Wilder Research.
Seah, E., (2001). Cultural Awareness Tool: Understanding Cultural Diversity in Mental Health. Multicultural Mental Health Australia.
Sundar, P., Todd. S., Danseco, E., Kelly, L. & Cunning, S. (2012). Toward a culturally responsive approach to child and youth mental health practice: Integrating the perspectives of service users and providers. Canadian Journal of Community Mental Health, 31, 99-113.
Walker, J. (2000). Caregivers speak about the cultural appropriateness of services for children with emotional and behavioral disabilities. Portland, OR: Portland State University, Research and Training Center on Family Support and Children’s Mental Health.

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