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Tackling the Stigma Related to Mental Illnesses in South Asian Communities

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Most of us have heard the well publicised statistic that one in four people experience a mental illness at some point during their life. Even more alarming are figures which reflect that mental disorders account for 22.8% of total disease burden, compared with 15.9% for cancer and 16.2% for cardiovascular disease, (WHO 2008).

Mental illnesses are common. It is likely that you know someone who has suffered or who is currently suffering from one of the most commonly diagnosed illnesses which include depression, anxiety, obsessive compulsive disorder, schizophrenia, personality, addiction and eating disorders.

Despite this prevalence, some ethnic minority groups including Black and South Asian communities consider mental illness taboo. Something to be ashamed of and hidden from friends, family and communities.

Within these communities, adherence to social norms - norms such as doing well academically, being married, having children - is key to achieving and maintaining respect. Mental illness tends to fall outside of these norms.

There is often an intrinsic misunderstanding in Black and South Asian communities regarding the cause of mental illnesses with assumptions that illnesses are the 'will of god,' karmic retribution, evil eye or genetic for example.

Often the thinking is so ingrained that a complete shift in attitude is required to make the illness acceptable, much as cancer used to be. Up to the 1980's people spoke about cancer with hushed tones. As more celebrities 'came out,' the acknowledgement turned into a public fight for survival. This shift in attitude was partly due to better understanding, better treatments becoming available and survival rates improving.

Needless to say that the ultimate end-result of stigma can be a reinforcement of the initial illness resulting in a negative downward spiral for the individual suffering.

Patients from all ethnic backgrounds talk about how stigma from colleagues, friends and families produces a further sense of alienation. Nearly nine in ten people with mental health problems say that discrimination has had a negative effect on their lives, (MIND). Isolation, loneliness, loss of confidence, unemployment and a breakdown in relationships are all common negative effects.

The other major obstacle which stigma creates is that often it causes individuals to disengage from mainstream mental health therapies, of which there are many varied effective options from counseling and medication to supported social engagement programmes.

Taking this into account, the provision of services for these groups should be tailored.

Research has demonstrated that although middle aged Punjabi women understand what depression is, they also see it as a result of life's ups and downs. They would rather go to the temple, gurudwara or mosque than the doctor for treatment or advice because these are less stigmatising places.

Those in leadership positions in religious establishments and community groups are well respected - seen as figures of help, support and advice.

Taking these factors into account, services must be flexible to educate community leaders on for example types and prevalence of mental illness, treatments, the effects of stigma and safe places to seek support. Anecdotal evidence suggests that many religious leaders are aware of, and can suggest referrals depending upon the severity of illness. This is great progress but there is no reason why services shouldn't provide help at the location where it is needed.

Community and spiritual leaders should engage with service providers to discuss service planning and delivery, research agendas and how the landscape for interventions should be shaped. In addition, communities can set up helplines, hold forums where issues related to mental health are explored and also perhaps nominate mental health champions.

It is small steps such as these, which bring mental health issues into open, reduce stigma and ultimately increase diagnosis and treatment within minority groups.

On Thursday 25th April, the City Hindus Network, (CHN) in conjunction with the City of London Police explored the shame and secrecy surrounding mental health problems in South Asian Communities at a free event.

The City Hindus Network (CHN) is a non-profit-organisation created to promote networking, personal development and charity amongst Hindu professionals in London.

Dinesh Bhugra is Professor of Mental Health and Cultural Diversity at Institute of Psychiatry (King's College) London and was President of the Royal College of Psychiatrists from 2008-2011. He is President-elect of the World Psychiatric Association. He has published extensively and has written on mental illness in Bollywood cinema.