Bhagwati Kumar, 58, has been suffering from depression since past three years. She is on medication but is reluctant to disclose her condition to others in her neighborhood, even though they perceive her as unfriendly. "The depression medications make me sleepy and I find it hard to keep my appointments," she admits. Also, she feels drowsy and tends to yawn during conversations, something that people find rude. "It was different back home with family around. Here I have few neighbors as friends and now even some of them don't talk to me. Even I don't feel like talking to anyone most days," she says. Bhagwati lives in Ontario with her son in a two-bedroom apartment and doesn't have much company throughout the day. "My son has his own life and work. After I complete the cooking I don't really have a lot to do," she reveals.
Unfortunately, Bhagwati is not alone in her misery. There are many South Asian immigrants who are fighting depression and other mental health problems silently. Many are not even aware that they can easily seek help and get better.
So recently, despite the temperature hovering around 14 degrees Celsius and chances of showers, 600 people, mostly South Asians, donned their running shoes to participate in the Lions 5K Walk on raising awareness about mental health in their community in Ontario.
"Mental illness costs the Canadian economy a staggering $51 billion a year in health care and lost productivity. Only one-third of those who need mental health services in Canada actually receive them," emphasizes Gobind Sharma, Co-Chair, Lions 5K Walk. The walk was organized by Milliken Mills Lions Club, a Markham-Ontario chapter of the international voluntary organization, Lions Club and Social Services Network, a not-for-profit agency.
The immigrant communities, especially from India and Pakistan, are one of the last to get help when it comes to mental health problems, including depression, schizophrenia, bipolar disorder, substance abuse disorder and obsessive compulsive disorder. And there is an urgent need to raise awareness about mental health issues, especially within the South Asian community that still tends to ignore them.
Together, the walkers circled boulevards near the brick and glass building of Markham Civic Centre and the city town hall of Markham, an Ontario suburb that has one of the highest concentrations of South Asians. "The $30,000 raised through the walk will be used to raise awareness about mental health," said Sharma.
The reasons for engaging South Asians in a walk on mental health are not hard to find. The town of Malton is a ready proof of the fact that South Asians in Canada shy away from getting help when it comes to mental health. Malton is a part of Mississauga, Canada's sixth largest and fastest growing city, and a showcase of multiculturalism constituting immigrants of different nationalities. Yet, in comparison, a homogenous Malton is a long-forgotten and best-ignored part of Mississauga. It is commonly referred to as Mississauga's "ugly little brother." It has a small population of 38,174 of which 52 per cent are South Asians and 16 per cent are black. Punjabi, Urdu, Gujarati and Hindi are some of the most common mother tongues spoken in the town after English.
In March 2009, various not-for-profit groups, government health agencies, and prominent mental health institutions came together at Malton to discuss some of existing lacunae in accessing mental health. Many grim realties were discussed at this meeting, including the fact that people who do not speak English are less likely to receive treatment for their mental health problems and more likely to have their mental health disorders go untreated. This is because when it comes to mental illness, immigrant communities lack information. They are confused about "what questions to ask, who to ask and what the services are." Also information on mental health issues is not available in the languages they speak.
Aside from language barriers, another reason cited by experts was that, even after migrating to Canada, people tend to hold on to the mindsets prevalent in their home countries. "There is stigma attached to mental health," agrees Dr Ravi Kakar, a consultant psychiatrist practicing in Scarborough, Ontario. He says that in his practice it is not uncommon to come across clients who avoid seeking medical help for as long as possible. "They will seek help when things begin to fall apart. For instance, wait until the very end when their marriage is at breaking point because of mental illness," he says. And before coming to a psychiatrist, people like to explore other options, including seeking those who advocate witchcraft or getting rid of the evil eye. "Or they keep on dealing with a mental health issue as a karma of sins done in the past life," elaborates Kakar.
Health care providers agree that they too have their own set of problems, which makes it hard to bring the relevant services to immigrant communities. Lack of data is the primary reason for the delay. This was what Kwsai Kafele, the Director of Corporate Diversity at the Center of Addiction and Mental Health, Canada's largest mental health and addiction teaching hospital, emphasized when he spoke at a workshop at Brampton Civic hospital recently. He pointed out that the health monitoring system does not keep statistics by race. This means that there is limited comprehensive data on how ethnic communities fare when it comes to mental health issues and illnesses.
As a result, people facing mental health issues are not under the radar of health care providers, even as experts agree that immigrant communities are among those most in need of accessing mental health services.
One big reason for this is the process of immigration itself. The "healthy immigrant effect" is a reality in Canada. Immigrants come with better health, which deteriorates as they try and adjust to their new surroundings. Here, health includes both their mental and physical health.
"Immigration is a stressful process. You uproot yourself and try and settle in a different culture. You have to find a new job, learn a new language and take on challenges. Many people have anxiety problems and require counselling for balanced mental health," said Kakar.
Some of these issues are not unique to South Asians. "Mental health is a big issue in the Caribbean community and there is a need to demystify it," said Kafele, speaking at the workshop "Building Awareness of the Caribbean Community's Health." He said he tried to get an article published in a local ethnic Caribbean newspapers on mental health but was not able to do so because of the "stigma." Like Kakar, he believes that immigrants have to deal with chronic stress problems that are exacerbated not only by the process of immigration but also the poverty and racism that often accompany it.
However, voices are now being raised within the communities to generate awareness about mental health issues. "Our walk got a tremendous response from politicians and support from mental health institutes and the public at large," said Sharma. He is hopeful that these "small steps" will result in creating greater awareness about mental health.