From silence to strength: unravelling mental health stigma in my community

Temane magaj bagrigay che (તેમણે મગજ બગરીગાય છે) translates into Gujarati as ‘they are mentally disturbed’. 

This is a phrase that may resonate with Gujarati South Asians if they’ve ever tried to speak about mental health with friends, family members, or loved ones. It’s certainly one that I’ve come to be increasingly familiar with in my own life. I’ve set out to unpack this sentiment, down to its profoundly ingrained foundations in sharam (shame).

Though this culture of shame is starting to be deconstructed in some pockets of the South Asian community, it is still fairly common, especially in many Gujarati households. Speaking up about mental health struggles can bring about judgement and, in some extreme cases, ostracisation, from our community.  

Speaking with health professionals and other South Asian individuals about their experiences, I embarked on a journey that revealed the complexity of this culture of shame, which exists in a tangled web of intergenerational struggles, cultural differences and a profound lack of understanding about mental health itself. 

Unravelling the stigma

Growing up in the vibrant embrace of the Gujarati community in Leicestershire, I have seen first-hand how traditional values like familial reputation and avoiding sharam-fueled mental health stigma. 

As a child, I was taught that we must paint our lives in a landscape of perfection, in fear of the ‘gossip monsters’ (the South Asian aunties in my community) and their ugly retaliation upon us. Openly having a mental health condition doesn’t exactly fit into this. Instead, I found that people perceived it as a weakness.

In fact, I would argue that this decades-old gossip culture in the South Asian community is one of the core reasons why mental health stigma is so widespread in this community. “Fear of gossip about children’s ‘madness’” was actually proven to dissuade British South Asian families from accessing mental health services – making the detrimental nature of this mentality starkly apparent.

The causes of this stigma in the South Asian community exist in a complex tapestry woven from deep-seated taboos, a lack of education, intergenerational trauma, and miscommunication.

Generation makes a difference

I spoke to Jayden, a 26 year-old third-generation Gujarati man, about his experiences of mental health and community support. In our conversation Jayden explains that he believes this lack of education is a core reason for the absence of empathy towards mental health from older generations. 

“I think [stigma] comes from the generations above us because they don’t quite understand mental health as it was never taught to them, so they’ll choose to ignore it as if it doesn’t exist” he tells me.

Counsellor and psychotherapist Ruxana Patel attributes this lack of understanding in part to “the oversimplification of complex family dynamics” as they can make it difficult to understand specific lived experiences. This overlooks the collectivist values and intergenerational expectations that exist in South Asian communities. 

She explains that many South Asian households consist of multiple generations where filial piety – the value system that holds the respect, obedience and views of elders at the utmost importance – is commonly practised. This concept plays a huge role in our understanding of where mental health issues and stigma originate as the very discussion of mental health issues may be seen as a challenge to family reputation by older generations and a sign of failing filial duties. 

Jayden adds that the traditional gender roles in older generations also play a role in this dynamic, pushing ideas of toxic masculinity which are then fed down into our generation. “They come from a generation which pushes the idea that we must man up,” he says. “Older people that I talk to do not believe mental health issues even exist until it happens to them and even then, they try to deny it.” 

Many men in our communities are suffering in silence. South Asian mental health professionals and psychotherapists have even noted that men from ethnic minority communities access mental health ‘on average 13 years later and in a more severely ill state than their white counterparts’. This is a frightening statistic that shows just how detrimental mental health silence and stigma can be.

Breaking the silence and seeking support 

One of the most important steps towards destigmatising mental health is facilitating open and honest conversations about the topic. 

According to a 2021 Sky News report, Asians access NHS secondary mental health services about half as much as their white counterparts. I spoke to Sima, a 50-year-old who first contacted her GP about her mental health five years ago. 

“Initially, I felt embarrassed and ashamed,” she tells me. “I didn’t want to go because I didn’t know what to expect or what the outcome would be.” The unknown can often be scary for those who haven’t contacted professionals about their mental health before. 

Not knowing what a prognosis may be or having no previous experience going to mental healthcare professionals can be an overwhelming and daunting experience. So Sima’s fears of the unknown are a common fear many in the community will have when it comes to sharing their experiences and seeking support.

And vocalising her mental health concerns had an overwhelmingly positive effect. “When I spoke about it to my family and contacted my GP, it felt like a weight off my shoulders,” she says. 

Sima’s hesitance to seek support from her GP and loved ones is a common experience for many South Asians. However, creating safer spaces for honest discussions can normalise seeking help. “I was overwhelmed with the amount of support I did get when speaking out and contacting my GP as they were so compassionate and knew how to help me whilst also understanding my cultural background,” Sima recounts. “Having a South Asian GP provided me with a level of comfort, as I didn’t have to explain why community stigma was something that stressed me out.” Often having a medical professional who comes from the same cultural background is key in creating a safe and understanding environment. 

However, not all experiences seeking support are the same. 

Different dynamics

When Jayden sought familial support, he faced several obstacles. “I remember being around 20 or 21 and explaining and reaching out about how low I felt to my mum. I told her about one time when I had a bad anxiety and panic attack, and she just could not understand it at all and just kept asking me ‘why’ – as if I could explain it.” 

The idea that mental health is something that can easily be explained or justified is an incredibly harmful viewpoint that oversimplifies the nuances of mental health struggles. This idea that mental health issues need to be justified or explained in order to be valid only adds to the stigma and additionally deters individuals away from seeking help rather than speaking out. 

Though it is incredibly important for us to break the silence and stigma around mental health, we must remember that not everyone’s experiences are linear. Where we choose to seek support may differ, and cultural and familial dynamics also play distinct roles in different individuals’ lives. 

Shaming around various mental health disorders is incredibly complex and layered as there are varying levels of stigma, education and support. How this presents in the community too, is also just as complex – with certain members of the community, such as LGBTQI+ people, often being neglected from mainstream attempts to address the gaps in our healthcare.

The intersectionality of identities within the South Asian community often goes overlooked, therefore some people might fail to receive the nuanced and adequate mental health care they need and their specific needs are then ignored. According to a 2021 study by the Trevor Project it was even found that 51% of Asian LGBTQ youth wanted mental health support but didn’t get it, whilst only 28% received it. This is a staggering statistic yet it illuminates how drastic this issue is. There is a dire lack of support systems or educational information that caters to the specific needs of this community. In our fight to destigmatise mental health in our community, we must include all spectrums of identity – or we will have failed.  

Language plays a massive role in creating safe and inclusive spaces. In the same vein, language barriers between patients and providers often lead to miscommunication and misdiagnosis in mental health settings. 

Former psychological research officer Sabrina Sudera tells me: “language barriers may hinder the accurate expression of emotions and thoughts.” People may struggle to articulate their emotions and therefore struggle to find the safe space they need. This can lead to frustration, miscommunication, and ultimately failure to receive the vital support they need. 

Therapy spaces, mental healthcare providers, and organisations must use inclusive language and offer translation services. Without this, they remain inaccessible. 

Mental health care inequities 

Unfortunately, it doesn’t end once you do seek help. The mental healthcare systems at our disposal are, without a doubt, rife with inequities. Discrimination, forced displacement, lack of culturally competent care, and structural violence are all inequities faced by minority groups. For instance for South Asian individuals they may be on the receiving end of unconscious bias when it comes to mental healthcare treatment which may lead to differential treatment. This is why destigmatising mental health and improving healthcare systems must go hand in hand. 

In addressing these inequities, it is at the hands of professionals to undertake unique and multi-faceted approaches as the experiences of these individuals are culturally unique. “To address these challenges, mental health professionals should undergo cultural competence training and engage in open dialogue with patients and their families. “Tailoring treatment plans that align with cultural beliefs and practices fosters trust and facilitates better therapeutic outcomes,” Sabrina suggests. 

Speaking to Sabrina makes me reflect on the importance of cultural competence in decolonising mental healthcare and increasing support and healthcare accessibility in the South Asian community. Culturally informed therapy in particular can foster trust and can create a stronger relationship between a therapist and patient which is key to shaping a safe and inclusive environment.

I asked Ruxana why catering to the specific mental healthcare needs of the South Asian community is so important in her profession. “Western assumptions and the Eurocentric belief system do not represent the shared practices and values of the diverse South Asian communities,” she says. 

As Ruxana aptly explains, it is pertinent to consider the nuances of South Asian mental health as the landscape of this community starkly differs from the white majority. 

Sabrina adds to this. “There’s a real need for further research and resources dedicated to understanding mental health issues in the South Asian community,” she says. “Focused studies can highlight cultural-specific factors that impact mental health and inform targeted interventions.” There needs to be a greater availability of resources and targeted support allowing us to understand and normalise South Asian mental health. 

Bridging the gap

Professionals like Ruxana and Sabrina – who are advocating for increasing cultural competence and destigmatising mental health in their own community – bring a sense of clarity. 

However, there is still work to be done. As Ruxana says: “the stigma of mental health is still prevalent however that may be due to fear and the unfamiliar nature of seeking help.” By dismantling stigma barriers that deter seeking help we can reshape attitudes and normalise mental health. 

A communal effort is needed. Increased education to dispel myths, and the creation of better support networks and safe spaces are key actions that need to take place within our ranks for us to move forward.

Safe spaces for people to express their mental health concerns are incredibly important and can be lifesaving – if only you know where to find them. Organisations such as Sikh your Mind, Taraki, and Cysters, are just a few examples of organisations and community spaces working to create a safe space and discuss South Asian mental health. 

Removing an engrained and intergenerational stigma also requires us to rewrite the narratives that equate weakness with mental health. By creating a better culture of understanding, empathy, and communal support, mental health no longer has to be a taboo topic. By celebrating the diversity of South Asian experiences, while making meaningful efforts to challenge harmful norms, I hope we can pave the way for a brighter, stigma-free future. 

Some names in this article are changed to preserve anonymity