Why does Culture Matter in Mental Health Therapy

‘Yes we all know culture is important in therapy. What is exactly a good cultural therapy? ’

When culture is rightly acknowledged in a mental health support, the benefits are significant. We write this article with our mind on those who want to get a brief and accurate snapshot about what we mean by culture, its current role in mental health support. We hope you will be encouraged to advocate, for yourself or the others, a culturally-aware support.

What’s the definition of Culture?

Cambridge dictionary gives an official definition of Culture: “Culture is the way of life, especially the general customs and beliefs, of a particular group of people at a particular time”.

Two things stands out here - “Way of life” & “a particular group of people at particular time”.

“Way of life“ can be see as a set of beliefs, values, practices, and norms. Culture influences on how we see things, how we act, and how we connect with other people. Culture is part of the lens we see through about ourselves and the world around us.

Does everyone see the world with the same lens ? Certainly no.

In the second part of the definition, “a particular group of people at a particular time” tells us that culture differs across different people and across time. Our culture(s) give us a specific lens to see the world. Even within the same ethno-cultural group, individuals can be culturally different from one another in regards to other influences such as religion, social class, education, gender, sexuality, age, career position, professional discipline.

A young looking at the world influenced by his culture

Each individual will see the world in a different way, because culture isn't only about ethnicity but can also include religion, social class, education, gender, sexuality, age, career position, professional discipline.

Culture plays a crucial role in our mental health. Our beliefs, values, and norms greatly influence our mental well-being. Culture can impact our comprehension and strategies in tackling mental illness; affect our attitudes towards seeking for assistance and support.

For instance, when you speak to your psychologist, some implicit situation or a consensus within your culture will be less difficult to explain if he/she shares a similar cultural background, or could relate well this experience with you.

How are cultures currently addressed by psychologists/psychiatrists in Mental health Treatments?

When we read the literature, there are two interesting facts which are worth noting:

1. since the 90’s / 00’s we are seeing an increase of Mental Health disorders,

2. UK has become an increasingly culturally diverse country with the ongoing immigration from other countries.

The UK Department of Health has since claimed its commitment to prioritise Mental Health service provisions to ensure equality in service utilisation. Despite these available therapies and community-based care, different studies still have reported individuals with ethnic minority backgrounds in the UK underutilise Mental health services, despite not being less affected by Mental Health disorders.

We need to ask this question radically,

‘Why are individuals of cultural minority less inclined to use Mental Health services in the UK, though this agenda has been addressed as a priority for almost 20 years?’

The ignored or not dealt parts about Culture

Culture can affect the structure of a Mental Health service. Whether the service is set up with culture on mind can significantly affect its service quality. This can be whether the service includes a culturally diverse group of employees as well as leadership, whether the service is developed with consideration and care for different groups of people, or how the service is mindful of people who speak different languages than English. This affects people’s perception of the service delivered and their willingness to use it.

Unfortunately the importance of these factors are often disregarded. Cultural aspects are quite often invisible for those who are not aware/not trained to become aware or pay attention to it. Only when you have experienced cultural difference first hand, you then become more open/ careful to knowing and become aware of it.

I have seen many psychologists, psychiatrist or therapists who expressed their views that culture is a secondary element to the primary and ‘bigger’ mental health problem, and even act on it. I remember a psychologist who once told me that learning about cultures is an individual preference. Imagine how disheartening it is for me as a non-white practitioner to hear, let alone the service users…

Secondly, different cultures have different beliefs and the commonly known understanding of the cause of mental health illness, as well as the common attitudes towards help seeking. For example, some individuals, after such difficult experiences with mental health will prefer to not think about, or pay attention to it. They might feel socially disapproved if they ever talk, or seek for help about it. The own beliefs about the cause and what mental illness really is, can hinder their use of Mental health services. There could be a problem as the service then is not adequately set up or operated in a way which understands or pay attention to those people who struggle with their own perception of mental health and stigma.

Therefore, it is important we involve as much as possible patients' families in mental health services, to increase their understanding and acceptance of mental health.

“I look at the long list of available support in the local area…funny thing is, I can’t find anything suitable for me.”

Finally it has been related that patient who suffered from cultural discrimination - such as attitudes of ignorance or insensitivity of cultural difference, will be unlikely to reuse Mental health services.

We saw that when culture is disregarded by Mental Health services, there are higher chances that the service users who access the service would feel ignored when they try to understand and address his mental illness.

Patient and her therapist discussing during mental health therapy.

You should look for a therapist who's is sensitive to your culture as it might ease the communication. Remember that culture is not only about ethnicity but can also be about language, religion, social class, education, gender, sexuality, age etc.

So how can you find better support ?

We compile a list of point that you should considered to take your culture in consideration while looking for Mental Health therapy.

1. Look for a therapist who is sensitive to your culture. It can be helpful if they share your cultural background, as they might understand you better. The main point is not just the fact that you two may share similarities, but more importantly, the therapist could relate to you.

2. Choose a therapist who speaks your native language. This helps you express your thoughts and feelings more accurately.

3. Find a therapist who can help you navigate the complexities of culture. They need to do more than just understanding that culture is important. The therapist should be skilled in helping clients explore and understand even their subconscious cultural influences.

4. Talk about it with your therapist when you begin therapy. Dealing with culture is not simple. It's vital that your therapist is there for you, especially when it's hard to speak up or overcome challenges.

5. Aside therapy which helps you overcome problems and challenges related to culture, you can also look for education which allows you to equip yourself with intercultural knowledge and skills.

If you would like to start your therapy journey with a chartered psychologist fluent in English, Mandarin and Cantonese - please book your session or contact us if you want to know more.

Author’s background: Tiffan y is a practitioner psychologist, clinical supervisor and honorary lecturer. She bases her therapy, supervision and teaching practices in Hong Kong and the UK. She teaches intercultural communication in University of Manchester. She has a unique perspective in her work with culture and mental health, highlighting that one’s development in cultural competence needs to be outside traditional knowledge acquisition (reading and classroom learning). She has a particular interest in experiential learning and facilitating active exchanges in groups.

(Chinese Translation completed by Louis Leung.)