Respecting cultural practices, avoiding stereotypes and recognising differing capacity to respond to trauma are key for practitioners working with people from a range of cultural groups.
It is well recognised that traumatic exposure is a strong and direct predictor of mental health issues such as posttraumatic stress disorder (PTSD), depression and anxiety. But how is mental health affected when culture is added to the mix – particularly if people are living with a mental health problem while adjusting to a new country with new cultural norms?
Dr Dzenana Kartal is a Research Fellow at Phoenix Australia who has more than 15 years’ experience working in public and university mental health research. She specialises in posttraumatic mental health problems among refugees and culturally and linguistically diverse communities.
Dzenana’s PhD investigated the influence of war-related traumatic exposure, acculturative stress and acculturation on the mental health of long-term settled refugees in Australia and Austria. Acculturation is generally described as the process of becoming part of a new culture while simultaneously maintaining one’s ethnic culture and identity.
“We know the experience of trauma among refugees is quite high – they can experience as many as 14 traumatic events pre-migration – and we know the consequences for mental health that that can have”, says Dzenana.
“But we didn’t know much about, when someone has experienced trauma and comes to a new country, how do they deal with integration into the new society, for example learning a new language, finding a house and a job, having to function in society and take on new social roles? That can be very challenging and research indicates that migration stressors and acculturation can contribute to negative mental health consequences over and above the impact of pre-migratory traumatic exposure.”
Dzenana’s research also sheds some light on supportive factors or enablers that can effectively help culturally and linguistically diverse people who’ve experienced trauma integrate into the society as they make a new life in Australia.
“My research found that there are a lot of things that can help people from culturally and linguistically diverse populations overcome those traumatic events, and one significant factor is language. Language is the biggest barrier to accessing treatment for mental health problems, and hence when we see people from culturally and linguistically diverse populations present for services, they present with more severe problems. Hence, learning the language of the host country enables them to integrate better into society, to find a job, to work through mental health issues by talking about them and going for treatment, and they are able to express and name those traumatic experiences and consequences,” explains Dzenana.
“If we help culturally and linguistically diverse populations learn the language of the host country, it helps them not only to become more independent and functioning members in society, it can also help overcome traumas experienced prior to migration.”
Sometimes though, being given a chance to establish a new life is not enough, and refugees may need professional psychological support to overcome the difficulties and mental health problems that are related to their pre-migration traumas. In those circumstances, practitioners have to be informed about, and need to respect, the cultural beliefs and practices of the person.
“As practitioners, it is valuable to be informed and open to different cultural perspectives and values, and to understand that cultural beliefs influence an individual’s meaning of trauma and can either assist or hinder the processing of trauma. Hence, practitioners need to know how to tailor their treatment to each patient, their cultural and individual beliefs, and their presenting psychopathology.”
Dzenana says it is also key to not put all cultures in the ‘same bag’, as cultural differences should be taken into account. Some cultures have strong religious foundations that underpin the presentation or interpretation of mental health problems. Some may also be reticent to talk about certain traumatic experiences and mental health issues because of stigma or taboos. This is particularly relevant for sexual and gender-based violence.
On the other hand, social networks are an important source of strength and practitioners need to recognise and utilise this. “In different cultures, a person may bring to an appointment an aunt, an elder, a support person or a religious leader. Obtaining support from respected or trusted members of the same community can be very helpful to the individual dealing with traumatic experiences”, says Dzenana. “This is an important factor because it can support the establishment of trustworthiness and the therapeutic relationship which does not happen as easily when different cultures meet.”
Finally, Dzenana wants to remind us that “We also see a lot of resilience in different cultures. Despite horrific exposure, many refugees, migrants and people of culturally and linguistically diverse communities demonstrate resilience in their mental health and wellbeing and in their capacity to integrate and function well in society when they are given some support, or on their own.”
“As practitioners, it’s important to see these cultural differences from a respectful point of view and to be open-minded to create the best chance to offer support.”