Addressing mental health issues is crucial for achieving the larger community’s holistic health outcomes

BY SIMONE J. SMITH

In the pursuit of equitable health and healthcare within Caribbean communities, more than ever, research is showing how imperative it is to prioritize mental health. Historically, mental health has often been overshadowed by physical health concerns, and this has led to stigmatization and neglect of our mental well-being. However, studies are being done that acknowledge and address the fact that addressing mental health issues is crucial for achieving the larger community’s holistic health outcomes.

I recently read a review about children and young people in the English-speaking Caribbean. The English-speaking Caribbean is made up of about 18 countries, or territories, of which the majority are classed as low and middle income or developing status. Population statistics suggest that this region consists mainly of families of: African, mixed-race, Indian, or indigenous origins.

International evidence suggests that at least 1 in 10 children and young people in the Caribbean experience symptoms of a mental health problem with 50% of these occurring by age 14 years, and 75% by age 24 years. This might be experienced as: anxiety, depression and conduct or behaviour problems with high rates of comorbidities (The prefix “co” means together, and the word “morbidity” is the medical term for a health condition).

Studies conducted in the English-speaking Caribbean region also reported high rates of mental health problems and a limited number of evidence-based interventions. A recent report also highlighted a scarcity of appropriate mental health policies and funding. Due to the complexity of mental health and the great need for services, not all children and young people locally, or regionally are able to receive professional mental health services. Interestingly enough, even though we are supposed to live in a first world country, with access to superb healthcare, Caribbean children and youth in Canada are faced with the same issues.

Peel Region of Toronto, Canada is home to over a third of the province’s South Asian population. A research study titled, “South Asian youth mental health in Peel Region, Canada: Service provider perspectives (2023)” found that youth are at a vulnerable time period in terms of their mental health. South Asian youth populations face additional challenges to their mental health (acculturative stress, intergenerational conflict, and racism and discrimination). According to mental health service providers, South Asian youth navigate a number of unique stressors related to the domains of culture, religion, and family dynamics, experiences of discrimination, the impact of migration, beliefs around mental illness and help-seeking, help-seeking trajectories and therapy recommendations, and lastly, sex differences.

Yet, despite the growing South Asian youth population in Peel Region, the vulnerability of youth in terms of mental health, and the considerable mental health service access barriers experienced by South Asian populations, there is very little research exploring the mental health concerns and service access barriers of South Asian youth populations. The Mental Health Commission of Canada (2015) has suggested that improved services for: immigrant, refugee, ethnocultural, and racialized communities need to be built across Canada, services supported by significant research and data.

Where would the research start? How far back do we have to go to really get to the root of our current mental health dilemma?

Social inequality and racial prejudices have had a lasting impact on the attitudes of people of African, Caribbean or similar Ethnicity (ACE) towards mental health and help-seeking. Reasons for this social inequality? It is likely to have come from the history of European colonial rule first of Africa, and then of the Caribbean islands. It is why it is so important that models of mental illness address social adversity arising from such historical oppression due to the European colonial legacy.

Studies have also found that compared to White Canadians, Chinese, other Asian, African-Caribbeans, and ethnic minority populations are less likely to report: depression, or major depressive episode, mental distress, suicidal thoughts, and mental health service use, but are more likely to report: poorer self-rated mental health, and a weaker sense of belonging to one’s local community, which has been associated with higher levels of depression and poorer mental health.

A follow up study, “Ethnic Differences in Mental Health Status and Service Utilization: A Population-Based Study in Ontario, Canada (2018),” found that self-reported physician-diagnosed mood and anxiety disorders and mental health service use were generally lower among South Asian, Chinese, and African Caribbean respondents compared to White respondents.

There is also limited evidence around how unmet needs for mental health care varies across major ethnic groups in Ontario, which is particularly important given that previous literature has identified unmet needs as a persisting problem.

We are now very aware that Caribbean communities face unique socio-economic and cultural challenges that can significantly impact mental health. By placing mental health at the forefront of the agenda, communities can: promote greater understanding, access to resources, and support systems for individuals facing mental health challenges. This not only enhances individual well-being but also strengthens community resilience and fosters a more inclusive and equitable healthcare system that caters to the diverse needs of all its members.

Efforts are needed to better understand and address cultural and system-level barriers surrounding high unmet mental health needs in the Caribbean communities across the diaspora. We as a community need to identify ethnically tailored and culturally appropriate clinical supports and practices to ensure equitable and timely mental health care and insist that our governments put our tax paying dollars to supporting programs that will provide long term assistance.

Given recent investments made by the Ontario government to increase funding towards mental health and addictions services, a unique opportunity exists to uncover potential differences in the mental health status and experiences among the major ethnic minority groups in Ontario (i.e., those of South Asian, Chinese, and African-Caribbean descent).