Referring to a state of emotional, psychological, and social wellbeing, “mental health” is a fundamental aspect of human existence (World Health Organisation, 2022). It dictates an individual’s capacity to handle stress, make sound decisions, and establish meaningful connections with others (World Health Organisation, 2022). It is important during all stages of life, as it profoundly influences one’s overall quality of life and capacity to contribute positively to society (World Health Organisation, 2022). Unfortunately, accessing adequate mental health care can be a complex journey fraught with barriers that must be addressed to ensure everyone has an equal opportunity to improve their quality of life (Fauk, et al., 2021).
Australia is celebrated for its diverse population, with people from all corners of the world calling it home (Phillips & Klapdor, 2014). These immigrants often hail from culturally and linguistically diverse (CALD) communities, and each brings with them their own languages, traditions, and beliefs (Phillips & Klapdor, 2014). Despite this rich tapestry of diversity, there is a disheartening reality. CALD women often find themselves at the short end of the stick when it comes to accessing mental health care (Fauk, et al., 2021). The challenges they face stem from the interface between their unique cultural backgrounds and experiences (Wohler & Dantas, 2016). This means CALD women are more likely to receive mental health support at a crisis stage rather than early intervention service (Radhamony, et al., 2023). When coupled with a lack of data and reporting, the persistent disparities these communities face in the quality, and access to care are exacerbated (Radhamony, et al., 2023). In this blog post, we hope to shed light on the critical need for a more inclusive and culturally sensitive mental healthcare system in Australia.
Cultural Stigma
Cultural stigma surrounding mental illness is a pervasive issue within CALD communities, although the degree of stigma varies among cultural groups. In general, discussing mental health challenges is a taboo subject, shrouded in secrecy (Radhamony, et al., 2023). Struggles with mental health are perceived as personal shortcomings caused by a lack of resilience and must be kept within the confines of the family (Radhamony, et al., 2023). Acknowledging emotional distress or seeking professional support is seen as an embarrassment to the community (Fauk, et al., 2021). For CALD women, grappling with these cultural attitudes can create a paralysing dilemma where the fear of judgment and ostracism looms large, where a disclosure carries the risk of ruining one’s reputation or losing employment (Radhamony, et al., 2023). When coupled with the pressure CALD women may feel to follow stringent gender roles within their families, their mental health is impacted in profound ways as they need to bear the weight of these unrealistic expectations (Wohler & Dantas, 2016). For example, the role of a caregiver and nurturer is frequently thrust upon CALD women. They are expected to prioritise the well-being of their families, often at the expense of their own needs and desires. In these communities, the image of a selfless mother, wife, and daughter-in-law is idealised, leaving little room for CALD women to express their own vulnerabilities and seek help when they need it. This is evident in a study by Radhamony et al., (2023) where a participant of Indian origin stated that “people are definitely [going to] look down upon you” if “you [have] to go and see a psychiatrist or psychologist” (Radhamony, et al., 2023). They, and many other like individuals are concerned that “people might think that you are crazy” (Radhamony, et al., 2023). Because of this, CALD women may find themselves caught in a perpetual cycle of self-sacrifice, where their emotional struggles are buried beneath the weight of familial expectations (Wohler & Dantas, 2016). The result is that seeking mental health care becomes not only a personal challenge but a cultural one as well and in some cases they may need to seek their husband’s permission (Fauk, et al., 2021). Consequently, CALD women may delay or entirely avoid seeking the help they require. They may endure in silence, trying to manage their mental health challenges on their own (Wohler & Dantas, 2016). This delay in seeking care can amplify their mental health conditions, sometimes with severe consequences.
Cultural and Language Barriers
Language, being one of the most immediate and formidable hurdles for CALD women seeking mental health care, shapes their entire experience within the healthcare system (Yeasmeen, et al., 2023). This challenge is accentuated by the varying degrees of English proficiency among CALD individuals, particularly recent immigrants who may not yet be fluent in English (Yeasmeen, et al., 2023). For CALD women, the language barrier goes beyond mere vocabulary; it extends to the nuanced expression of their thoughts, emotions, and innermost struggles (Said, et al., 2021). In mental health consultations, the ability to accurately convey one’s feelings and experiences is vital (Said, et al., 2021). However, when CALD women struggle to communicate effectively due to language limitations, the very essence of their mental health concerns can be lost in translation. Moreover, the limited availability of mental health services in languages other than English exacerbates the issue. CALD women may be confronted with a stark reality: the very services designed to support their mental well-being are often delivered in a language they may not fully comprehend (Yeasmeen, et al., 2023). This linguistic disconnect can breed frustration and anxiety, creating a substantial barrier to accessing care (Wohler & Dantas, 2016). Even when interpreters are available, a complex interplay of emotions and cultural factors can come into play. CALD women may feel uncomfortable discussing deeply personal and sensitive topics through an intermediary (Radhamony, et al., 2023). The presence of an interpreter can feel like an intrusion into the privacy of their thoughts and emotions, potentially leading to underreporting or misunderstanding of symptoms. This is supported by a patient who asserted that they feel “scared” of the interpreter “because [they] know you from the community” and may violate confidentiality (Radhamony, et al., 2023). Likewise, interpreters were unable to clearly convey culture-specific terms or daily emotional stressors related to acculturation that could not be clearly articulated by patients (Radhamony, et al., 2023). For example, South American women use the term “loss of soul” to express distress, and it possesses no English equivalent, whereas some African women have no words for anxiety or depression in their language (Wohler & Dantas, 2016). In fact, some women felt as if doctors were hesitant to use interpreters, and that they viewed refugee women as “a source of money rather than people” (Radhamony, et al., 2023). Furthermore, many women exposed the culturally insensitive practices that could not provide sufficient care. For example, medical practitioners “did not really hear what was being said” and rushed through the consultation with CALD women, making their issues feel insignificant and appearing “inflexible and insensitive to their needs” (Wohler & Dantas, 2016). This intricate dance of language and cultural sensitivity underscores the need for a more holistic approach to addressing language barriers in mental healthcare for CALD women.
Logistical Barriers
Within the context of mental health care accessibility, socioeconomic factors weigh heavily on CALD women, adding another layer of complexity to their already challenging journey (Klebanov, et al., 1994). The financial strain of living in a new country, coupled with potential language barriers that may hinder employment opportunities, can contribute to a lower socioeconomic status (Klebanov, et al., 1994). This, in turn, often leads to limited access to health care, further exacerbated by a lack of health insurance (Wohler & Dantas, 2016). For CALD women living in poverty, the struggle to make ends meet may take precedence over their mental health needs. When faced with difficult choices between paying bills, putting food on the table, or seeking mental health care, many may reluctantly prioritise immediate financial concerns, neglecting their long-term mental well-being (Radhamony, et al., 2023).
Beyond the direct costs of mental health care, transportation, and childcare pose additional hurdles, many CALD women may not have access to private transportation, relying on public transit, which can be both time-consuming and costly (Wohler & Dantas, 2016). This can be particularly challenging for those living in suburban or rural areas where mental health care services may be located far from their residences. Moreover, the issue of childcare often looms large for CALD women (Wohler & Dantas, 2016). Attending mental health appointments may require arranging suitable childcare, which can be logistically complex and, again, expensive (Wohler & Dantas, 2016). For those without an extended family network to rely on, this can create yet another barrier to accessing care.
In conclusion, the journey to mental health care for CALD women in Australia is riddled with intricate challenges rooted in culture, language, and socioeconomic factors. These barriers can deter early intervention and exacerbate mental health issues, highlighting the pressing need for a more inclusive and culturally sensitive mental healthcare system. To bridge these gaps, Australia must prioritise culturally competent mental health services, subsidise care for those in need, expand telehealth options, and promote community engagement and support networks. By doing so, we empower CALD women to prioritise their mental well-being, promoting a healthier, more vibrant Australian community where every individual, regardless of their cultural background, has equitable access to the mental health care they require.
References
Fauk, K. et al., 2021. Migrants and Service Providers’ Perspectives of Barriers to Accessing Mental Health Services in South Australia: A Case of African Migrants with a Refugee Background in South Australia. International Journal of Environmental Research and Public Health, 18(17), p. 8906.
Klebanov, P., Brooks-Gunn, J. & Greg, D., 1994. Does neighborhood and family poverty affect mothers’ parenting, mental health, and social support? Journal of Marriage and the Family, 56(2), pp. 441-455.
Phillips, J. & Klapdor, M., 2014. Migration to Australia: A guide to the statistics. Canberra: s.n.
Radhamony, R., Cross, W., Townsin, L. & Banik, B., 2023. Perspectives of culturally and linguistically diverse (CALD) community members regarding mental health services: A qualitative analysis. Journal of Psychiatric and Mental Health Nursing, 30(4), pp. 850-864.
Said, M., Boardman, G. & Kidd, S., 2021. Barriers to accessing mental health services in Somali‐Australian women: a qualitative study. International journal of mental health nursing, 30(4).
Wohler, Y. & Dantas, J., 2016. Barriers Accessing Mental Health Services Among Culturally and Linguistically Diverse (CALD) Immigrant Women in Australia: Policy Implications. Journal of Immigrant and Minority Health, 19(1), pp. 697-701.
World Health Organisation, 2022. Mental Health. [Online]
Available at: https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response [Accessed 25 August 2023].
Yeasmeen, T., Kelaher, M. & Brotherton, J., 2023. Understanding the types of racism and its effect on mental health among Muslim women in Victoria. Ethnicity & Health, 28(2), pp. 200-216.
Love and Respect
Pushpa Vaghela, CEO
Women’s Mentoring Foundation Ltd
Article written by: Sona Jerry
