Abstract
The cultural stigma of mental illness and substance abuse creates silence and barriers for some South Asian communities. While little is known about mental health challenges and substance use in South Asian (SA) females, it is especially important to understand the challenges and various obstacles that prevent formal treatment enrollment and retention. These include cultural stigma and patriarchal traditions whereby women’s agency is removed, making treatment seeking and retention significantly harder. Treatment is often the “last resort,” therefore social workers and clinicians have a small window of opportunity to engage SA female clients. The overarching framework of feminist therapy coupled with cultural humility are approaches that allow clinicians to be genuine and examine power and powerlessness with clients. These interventions build trust in the therapeutic relationship and empower the client to move toward liberatory change. Practitioners must also value the cultural traditions of collectivism, the influence of patriarchy, and the weight of cultural stigma. This article discusses interventions to engage and build therapeutic relationships with South Asian female clients and their unique challenges.
Similar content being viewed by others
References
Arora, P. G., Metz, K., & Carlson, C. I. (2016). Attitudes Toward professional psychological help seeking in South Asian Students: Role Of stigma and gender. Journal of Multicultural Counseling and Development, 44(4), 263–284. https://doi.org/10.1002/jmcd.12053
Augsberger, A., Yeung, A., Dougher, M., & Hahm, H. C. (2015). Factors influencing the underutilization of mental health services among Asian American women with a history of depression and suicide. BMC Health Services Research, 15(1), 542–542. https://doi.org/10.1186/s12913-015-1191-7
Bauer, A., Jenkins, T., Bazan, C., Howard, L., Swarbrick, M., & Ji, M. (2022). Building bridges: Resources to center cultural humility. Retrieved October 7, 2022 from http://www.reachalliancegroup.org/uploads/1/2/7/0/127063386/building_bridges_cultural_humility_toolkit.pdf
Baxter, P., & Jack, S. (2008). Qualitative Case study methodology: Study design and implementation for novice researchers. The Qualitative Report, 13(4), 544–559. https://doi.org/10.46743/2160-3715/2008.1573
Berry, J. W. (1997). Immigration, acculturation and adaptation. Applied Psychology, 46(1), 5–34. https://doi.org/10.1080/026999497378467
Brown, L. S. (2018). Theory. In J. Carlson & M. Englar-Carlson (Eds.), Feminist therapy (2nd ed., pp. 37–95). American Psychological Association.
Budiman, A., & Ruiz, N. (2021). Key Facts About Asian Americans, A Diverse And Growing Population. Pew Research Center. Retrieved October 21, 2021 from https://www.pewresearch.org/fact-tank/2021/04/29/key-facts-about-asian-americans/
Center for Health Journalism (2013). Suicide Amongst Indian Americans: We’re Stressed, Depressed, But Who’s Listening? University of Southern California Publications. Retrieved from https://centerforhealthjournalism.org/fellowships/projects/suicide-amongst-indian-americans-we’re-stressed-depressed-who’s-listening-read
Chaudhry, T., & Chen, S. (2019). Mental illness stigmas In South Asian Americans. Asian American Journal of Psychology, 10(2), 154–165. https://doi.org/10.1037/aap0000141
Duffy, M. (2010). Writing about clients: Developing composite case material and its rationale. Counseling and Values, 54(2), 135–153. https://doi.org/10.1002/j.2161-007x.2010.tb00011.x
Fikree, F. F., & Pasha, O. (2004). Role of gender in health disparity: The South Asian context. British Medical Journal, 328(7443), 823–826. https://doi.org/10.1136/bmj.328.7443.823
Fisher-Borne, M., Cain, J. M., & Martin, S. L. (2015). From mastery to accountability: Cultural humility as an alternative to cultural competence. Social Work Education, 34(2), 165–181. https://doi.org/10.1080/02615479.2014.977244
Gottlieb, M. (2020). The Case for a cultural humility framework in social work practice. Journal of Ethnic & Cultural Diversity in Social Work. https://doi.org/10.1080/15313204.2020.1753615
Han, M., & Pong, H. (2015). Mental health help-seeking behaviors among Asian American Community College Students: The effect of stigma, cultural barriers, and acculturation. Journal of College Student Development, 56(1), 1–14. https://doi.org/10.1353/csd.2015.0001
Inman, A. G., Devdas, L., Spektor, V., & Pendse, A. (2014). Psychological research on South Asian Americans: A three-decade content analysis. Asian American Journal of Psychology, 5(4), 364–372. https://doi.org/10.1037/a0035633
Kallivayalil, D. (2007). Feminist therapy: Its use and implications for South Asian immigrant survivors of domestic violence. Women & Therapy, 30(3–4), 109–127. https://doi.org/10.1300/J015v30n03_09
Karasz, A., Gany, F., Escobar, J., Flores, C., Prasad, L., Inman, A., Kalasapudi, V., Kosi, R., Murthy, M., Leng, J., & Diwan, S. (2019). Mental health and stress among South Asians. Journal of Immigrant and Minority Health, 21(Suppl 1), 7–14. https://doi.org/10.1007/s10903-016-0501-4
Kudva, K. G., El Hayek, S., Gupta, A. K., Kurokawa, S., Bangshan, L., Armas-Villavicencio, M. V. C., Oishi, K., Mishra, S., Tiensuntisook, S., & Sartorius, N. (2019). Stigma in mental illness: Perspective from eight Asian Nations. Asia-Pacific Psychiatry. https://doi.org/10.1111/appy.12380
Leong, F. T. L., & Kalibatseva, Z. (2011). Cross-Cultural barriers to mental health services in the United States. Cerebrum (new York, NY), 2011, 5–5.
Leung, P., Cheung, M., & Tsui, V. (2012). Asian Indians and depressive symptoms: Reframing mental health help-seeking behavior. International Social Work, 55(1), 53–70. https://doi.org/10.1177/0020872811407940
Loganathan, S., & Murthy, R. S. (2011). Living with schizophrenia in India: Gender perspectives. Transcultural Psychiatry, 48(5), 569–584. https://doi.org/10.1177/1363461511418872
Moller, N., Burgess, V., & Jogiyat, Z. (2016). Barriers to counselling experienced by British South Asian women: A thematic analysis exploration. Counselling and Psychotherapy Research, 16(3), 201–210. https://doi.org/10.1002/capr.12076
Nagaraj, N. C., Vyas, A. N., McDonnell, K. A., & DiPietro, L. (2017). Understanding health, violence, and acculturation among South Asian women in the US. Journal of Community Health, 43(3), 543–551. https://doi.org/10.1007/s10900-017-0450-4
Patel, M., Phillips-Caesar, E., & Boutin-Foster, C. (2011). Barriers to lifestyle behavioral change in migrant South Asian populations. Journal of Immigrant and Minority Health, 14(5), 774–785. https://doi.org/10.1007/s10903-011-9550-x
Peña-Sullivan, L. (2020). The “Wrong Kind” Of immigrants: Pre-migration trauma and acculturative stress among the undocumented Latinx community. Clinical Social Work Journal, 48(4), 351–359. https://doi.org/10.1007/s10615-019-00741-z
Puri, N., Allen, K., & Rieb, L. (2020). Treatment Of alcohol use disorder among people Of South Asian ancestry In Canada and The United States: A narrative review. Journal of Ethnicity in Substance Abuse, 19(3), 345–357. https://doi.org/10.1080/15332640.2018.1532855
Rai, A., & Choi, Y. J. (2018). Socio-cultural risk factors impacting domestic violence among South Asian immigrant women: A scoping review. Aggression and Violent Behavior, 38, 76–85. https://doi.org/10.1016/j.avb.2017.12.001
Rastogi, M. (2007). Coping with transitions in Asian Indian families: Systemic clinical interventions with immigrants. Journal of Systemic Therapies, 26(2), 55–67. https://doi.org/10.1521/jsyt.2007.26.2.55
Rastogi, M., & Wadhwa, S. (2006). Substance Abuse among asian indians in The United States: A Consideration of cultural factors in etiology and treatment. Substance Use & Misuse, 41(9), 1239–1249. https://doi.org/10.1080/10826080600754470
Rastogi, P., Khushalani, S., Dhawan, S., Goga, J., Hemanth, N., Kosi, R., Sharma, R. K., Black, B. S., Jayaram, G., & Rao, V. (2014). Understanding Clinical perception of common presentations In South Asians seeking mental health treatment and determining barriers and facilitators to treatment. Asian Journal of Psychiatry, 7(1), 15–21. https://doi.org/10.1016/j.ajp.2013.09.005
Rovitto, T. L. (2020). (Cultural) Humility in practice: Engaging first-generation college students. Journal of College Student Psychotherapy. https://doi.org/10.1080/87568225.2020.1819924
Sam, D. L., & Berry, J. W. (2010). Acculturation: When individuals and groups of different cultural backgrounds meet. Perspectives on Psychological Science, 5(4), 472–481. https://doi.org/10.1177/1745691610373075
Sharma, A. (2001). Healing the wounds of domestic abuse: Improving the effectiveness of feminist therapeutic interventions with immigrant and racially visible women who have been abused. Violence against Women, 7(12), 1405–1428. https://doi.org/10.1177/10778010122183928
Sharma, N., Shaligram, D., & Yoon, G. H. (2020). Engaging south asian youth and families: A clinical review. International Journal of Social Psychiatry, 66(6), 584–592. https://doi.org/10.1177/0020764020922881
Shih, K. Y., Chang, T. F., & Chen, S. Y. (2019). Impacts of the model minority myth on asian american individuals and families: Social Justice and critical race feminist perspectives. Journal of Family Theory & Review, 11(3), 412–428. https://doi.org/10.1111/jftr.12342
Sohrabji, S. (2013). Suicide Amongst Indian Americans: We’re Stressed, Depressed, But Who’s Listening? Center for Health Journalism. Retrieved October 16, 2021 from https://centerforhealthjournalism.org/fellowships/projects/suicide-amongst-indian-americans-we’re-stressed-depressed-who’s-listening-read
South Asian Americans Leading Together (2019, April). Demographic Snapshot of South Asians In the United States. Retrieved September 9, 2021 from https://saalt.org/wp-content/uploads/2019/04/SAALT-Demographic-Snapshot-2019.pdf
Substance Abuse and Mental Health Services Administration. (2015) Racial/Ethnic Differences in Mental Health Service use Among Adults. HHS Publication No. SMA-1504906. Retrieved October 19, 2021 from https://www.samhsa.gov/data/sites/default/files/MHServicesUseAmongAdults/MHServicesUseAmongAdults.pdf
Substance Abuse and Mental Health Services Administration. (2020) 2019 National Survey on Drug Use and Health: Asians/Native Hawaiians And Other Pacific Islanders (NHOPI). Retrieved from https://www.samhsa.gov/data/sites/default/files/reports/rpt31100/2019NSDUH-NHOPI/Asian_NHOPI.pdf
Tervalon, M., & Murray-García, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2), 117–125. https://doi.org/10.1353/hpu.2010.0233
Tonsing, K. N. (2014). Acculturation And adaptation of first- and second-generation South Asians In Hong Kong. International Journal of Social Welfare, 23(4), 410–420. https://doi.org/10.1111/ijsw.12079
Tummala-Narra, P. (2013). Psychotherapy with south asian women: Dilemmas Of the immigrant and first generations. Women & Therapy, 36(3–4), 176–197. https://doi.org/10.1080/02703149.2013.797853
Wendt, S. (2008). Christianity and domestic violence feminist postructuralist perspectives. Affilia: Journal of Women and Social Work, 23(2), 144–155. https://doi.org/10.1177/0886109908314326
Wendt, S., & Boylan, J. (2008). Feminist social work research engaging with poststructural ideas. International Social Work, 51(5), 599–609.
Yi, V., Museus, S.D. (2015). Model Minority Myth. In Anthony D Smith, Xiaoshuo Hou, John Stone, Rutledge Dennis, Polly Rizova (Eds.), The Wiley Blackwell Encyclopedia of Race, Ethnicity, and Nationalism (pp. 1–2) Wiley.
Funding
The author did not receive support from any organization for the submitted work.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The author have no relevant financial or non-financial interest to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Reda, Q. Cultural Barriers for South Asian American Women in Substance Abuse and Mental Health Treatment Retention. Clin Soc Work J 51, 273–282 (2023). https://doi.org/10.1007/s10615-023-00869-z
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10615-023-00869-z