World Mental Health Day is observed on 10 October every year, with the overall objective of raising awareness of mental health issues around the world and mobilizing efforts in support of mental health. The Day provides an opportunity for all stakeholders working on mental health issues to talk about their work, and what more needs to be done to make mental health care a reality for people worldwide.
Ghanaian-born Swiss-based Analytical Psychologist and Psychotherapist Esther Abena Keller calls attention to the increasing psychological and mental health risks of Africans in the Diaspora, who are challenged in specific ways, socially, economically and politically. Dr Keller identifies the specific reasons why diaspora Africans are especially susceptible to mental health challenges and what could be done to address these challenges
Migration is not a new phenomenon, early hunting and gathering societies migrated constantly. Nomadic herdsmen in many parts of the world still move routinely. The Bible story of Exodus is about movement of people in search of greener pastures.
Migration, both voluntary and forced, is increasing all over the world. People are moving in larger numbers faster and further than at any other time in history. Today, as many as 190 million people are thought to cross borders every year, as migration becomes an integral and inevitable part of the global social and economic development.
The process of migration, even under the best of conditions, involves a series of events that can be highly traumatizing. Migration involves uprooting, breaking with family, friends and established social networks.
It is a departure from traditional routines, value systems, accepted ways of behaving, and having to adapt, and at best, integrate into new social and psychosocial environments. This process involves a series of mental, physical, psychological as well as spiritual adjustments, which takes a toll on the migrating individual and their families.
Accept it or leave it
Few immigrants are adequately prepared to effectively deal with the changing dynamics that awaits them. There is the expectation from the Host Countries that the newcomers assimilate, acculturate and at best, integrate into their newly-found homes. The adage “When in Rome do as the Romans do” is, in most instances, cited as a simple answer, which means, accept it or leave it!
To exacerbate the pressures, are also the wishes and expectations from their original homeland, as families and friends hope for their return mostly with riches, and yet still holding dear the original traditional values they left behind. Despite the potential magnitude of the challenges facing the African in the Diaspora, the psychosocial health of Africans remains poorly addressed.
“Neither fish nor fowl” – the ambivalence of living in two worlds
Migration can be a positive experience for the Host Country and the Immigrant, depending on how it is approached. The coming together of an array of cultures, ethnicities and the diversity it offers can be enriching, bringing global ideas, perspectives and productive contributions. However, where there are different cultures so, too, is the likelihood for misunderstandings and conflicts.
Unsuccessful cultural adjustments and conflicts are common serious problems in migration. It affects people in different ways, some more overtly than others. To what extent is cultural conflict or clash linked to mental health problems among migrants from Africa referred to as the “visible minority”, whose cultural heritage at first glance seems alien and is an easier target for racism and discrimination?
In earlier times, attempts on how to incorporate or mainstream immigrants centred on an emphasis on the need to assimilate them into the larger existing culture as soon as possible. Assimilation here is to be understood as a method of “integration” whereby minority groups are “absorbed” into a generally larger community. This process presumes and demands a loss of all original characteristics and idiosyncrasies, which made the newcomers different.
Upon the completion of this process, the individual is said to be acculturated and is totally adapted to the new culture and assimilates its values. A recent trend in Europe and Switzerland is the idea and movement towards the process of integration. The original meaning of integration (Latin “integratio”) means, bringing various parts of something together to form a whole. Integration is a reciprocal process, involving a comprehensive, multi-layered, interactive learn and exchange dynamism.
Underscoring this process is tolerance and a level of acceptance from the Host Country and the Immigrant. The more open or liberal the Host Country is, the easier the integrative process would be.
The question still remains for each individual to determine how, what, and to what extent they will acculturate, assimilate or integrate. The African is often caught between two worlds and lives a split existence. What sort of ramification does this exert on mental health of Africans in the Diaspora?
Mental health challenges facing Africans
Mental health can be defined as an individual’s overall emotional and psychological condition. It is a balance between all aspects of life: social, physical, spiritual and emotional.
Mental health is an integral part of our overall health, a wellspring of thinking, communication, learning, resilience and self-esteem. It impacts on how we manage our surroundings and make choices in our lives. Mental health is fundamental to overall health productivity throughout one’s lifespan, as it is the basis for a successful contribution to family, community and society. It is easy to dismiss the value of mental health until problems surface.
The strengths and resiliencies of Africans in the Diaspora are also to be mentioned and commended. In the Diaspora, Africans continue to strengthen their positions economically, socially and politically. In the face of changing immigration laws, there has been internal mobilisation among Africans to form Associations, Churches and Organizations with the aim of providing a sense of belonging and support for themselves.
The psychosocial function of such groups are however limited, especially when cases such as depression and other serious psychological issues arise. There are very few African mental health professionals in the Diaspora. The need for such services within the various African communities is not to be underestimated as isolation and stress continue to be a greater part of their daily existence.
Availability and access to culturally sensitive mental health services
Culture is broadly defined as a common heritage or set of beliefs, norms and values, referred to as the shared attributes of a group. Culture and society play a vital role in mental health and mental illness. Health professionals and institutions in which they train to practice are rooted in traditional Western school medicine. This means that clinicians view symptoms, diagnosis and treatments in ways that sometimes diverge from their clients’ cultural views, especially when the cultural backgrounds of the client and that of the health service provider is dissimilar.
The disparity in cultural values can influence many aspects of the health delivery care including diagnosis and treatment. It is well documented that cultural backgrounds can profoundly influence the way people experience illness especially mental illness. In many cultures, people experience depression for example, in bodily terms (headache, trouble sleeping, stomach ache, etc), and not by name.
Such a scenario can often lead to misdiagnosis. Finding culturally appropriate mental health care can be difficult for immigrants especially Africans coming from numerous unknown cultural backgrounds
Most Africans are unfamiliar with the idea of therapy, and are afraid of the stigma attached to psychology and psychotherapy. People coming from war-torn areas of Africa who may have even been tortured or witnessed atrocities of war may not even realise that they may have mental health problems that demand attention and treatment.
For them, mental illness is enormously embarrassing and stigmatising. There is a strong resistance and a sense of taboo built around the need to access mental health services. Untreated, simple cases can develop into major psychological problems and the individual is at a greater risk of severe depression, anxiety, post-traumatic stress disorder and substance abuse.
Migration, voluntary or forced, will continue to be a modern day reality. The numbers of Africans in the Diaspora continue to increase. They bring with them not only their unknown cultures, but also their know-how and willingness to contribute productively in their newly-found homes.
Africans face a special situation in view of their visibility and the increased cases of racism and discrimination. This places them in a daily stressful and psychologically risky situation. There is an increasing need for mental health services in the African communities and the provision of culturally sensitive approach.
A collaborative process should be created between immigrant-based organizations and the mainstream institutions especially the health-care delivery system to gain greater access to culturally sensitive mental health services. African students in the Diaspora can be of help and must be encouraged to study and enter the Mental Health sectors, to bridge the gap and be adequately represented.