Bridging Culture and Care in Mental Health
Understanding barriers and building inclusive, accessible services for ethnic minorities
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How do ethnic minorities experience the mental health system, and what obstacles hinder their access to care? How do we adapt our approach to better support these communities?
Recognizing how ethnic minorities experience the mental health system is essential to creating fair and effective care. A 2025 study by Stepanova and colleagues explored the experiences of ethnic minorities in England, focusing on their engagement with mental health services and the support they received for their concerns.
The study used a semi-structured interview design, meaning that the researchers asked “guiding” questions followed by more probing questions. This approach strikes a balance between fully open-ended and strictly closed-ended questioning, allowing for both structure and flexibility in gathering insights.
Participants were recruited through community organizations, healthcare settings, and social media, with translated materials used to ensure accessibility. The interviews, conducted remotely or in person, were guided by a topic list co-developed with people from ethnic minority communities, caretakers, and clinicians to ensure cultural relevance.
What barriers to mental health care were found?
1. Cultural Stigma and Ignorance: Mental health is frequently seen as a sensitive and taboo topic within many cultures, leading to significant "stigma and silence." This often means the concept of mental health is not recognized within certain communities, making it hard for individuals to acknowledge their issues and leading to prolonged, silent suffering.
“Back in [South Asian country] we didn’t know…I never knew anything like mental health. Back over there, if you suffer something like that, she’s gone mad.”
Lack of Understanding and Support: Mental health is often described as invisible and poorly understood by others, making it difficult for individuals to open up and ask for help. This is often worsened by the stigma of being non-native, along with language and cultural barriers that limit management strategies and delay help-seeking.
“When I explain it [mental health problems] to them, they're like, “You seem to get up every day”, but most days I struggle.”
Fear of Negative Consequences: A significant concern, especially for parents, is that disclosing mental health struggles might be seen as an inability to care for their children, potentially triggering interventions from child protection services.
“I would never admit it [postpartum depression]… I felt like if I admit that I don’t feel good, they’re going to take my baby away from me. I just suffered in silence.”
Language Barriers & Navigational Challenges: Even English-fluent individuals can struggle to describe symptoms using medical or English terminology, leading to confusion or misinterpretation by clinicians. Non-native speakers face even greater difficulty, causing frustration and feelings of being misunderstood. Language barriers also hinder the discovery and access of support options. People also reported uncertainty over how the system works and how to navigate the system.
“Language barriers or perceptions, that’s one part, but also think about the system, it’s a totally different system, medical system here… we don’t know what type of support we can get from the NHS so that’s an issue.”
“I was having pins and needles in my head, I went to my GP, I didn’t know how to explain it so I just explained it the way I thought people knew and I said, ‘oh I feel like ants walking in my head.’ The first thing that the doctor did was check my head. I was like no, no, no….”
“I wish there were maybe more instructions or more information for minority groups on what type of support you can get from the NHS and where, and any other further signposting information for them.”
Not Seen as a Priority: Many feel their mental health isn't prioritized, facing long waiting lists and delays in care, which often worsens their condition. Consultations can feel rushed, with only immediate concerns addressed and underlying issues overlooked.
“The sense of rush. When I've been in a virtual session. We always seeming to be in a hurry and quickly get done with the meeting.”
“It was more rushed, you were distanced… there was that not that closeness that we started off with, so I would say I didn’t get the best benefit from the [online] sessions really.”
Staying Away from Services: Past negative experiences, like involuntary hospitalization or child removal, can create a deep fear of engaging with services, leading individuals to pretend to be "normal" and avoid seeking help. Experiences of racism from other patients in inpatient care can also foster mistrust and fear during treatment.
“I would never admit it [post-natal depression]… I felt like if I admit that I don’t feel good, they’re going to take my baby away from me. I just suffered in silence.”
7. Lack of Cultural Sensitivity: Many feel their cultural, religious, and social contexts are inadequately addressed in treatment, eroding trust and reducing the likelihood of seeking future support. This lack of culturally responsive care is particularly harmful during severe mental health crises, as it discourages engagement.“Stuff consider the different cultural beliefs and ways of life instead of just following procedure that you are doing… maybe your culture doesn’t allow you to talk to men if they are a woman, all of this consideration should be in place.”
8. Avoiding Professionals with Similar Ethnic Backgrounds: Due to cultural stigma, some express concerns about seeking help from professionals who share their ethnic or cultural backgrounds, fearing exposure of their struggles within their community, leading to judgment or breaches of confidentiality.
“Because I was African and he [GP] was African, he was saying basically you're imagining stuff, or something like that.”
9. Sense of Belonging: Connections with local, diverse community groups provide safe spaces for sharing and receiving support. These informal networks foster connection and belonging, often guiding individuals to formal services and serving as essential coping mechanisms. People also expressed a preference for multicultural communities as these are seen as more accessible and non-judgmental.“So at times they bring something for us to practice, like knitting something, like some games and books for us to read… Regular meetings, handcrafts, at times we have in the garden planting some seed, cutting the grass, cooking in the kitchen. All of us, we just sit down and have a meal together and they talk to us, we joke, then everybody will go home.”
“The support I’ve had from community organisations, that has been, I think, the most effective for me, thus far, in keeping me stable and on the path to getting better… There’s opportunities for workshops and things to give you confidence and just to support people with their mental health and things.”
10. Holistic Care: While medication is often necessary, many feel it's insufficient on its own, emphasizing the importance of multi-component care.“…only tablet and medication is not enough. They need to…how to call it, emotional support and like a therapy service. It’s very important.”
“I met the psychiatrist, we spoke briefly and then I was prescribed some medication and that was really the end of it. I think I had one or two follow-up appointments, but they weren't really interested.”
Clinical Takeaways
1. Prioritize Culturally Affirming Care
Action: Integrate culturally appropriate care in your clinical practice by actively seeking to understand and incorporate patients' cultural beliefs, religious influences, and family and community structures into your assessment and treatment planning.
Why it matters: Acknowledging and adapting to diverse values, beliefs, and practices promotes trust and reduces feelings of alienation. It also allows you to better grasp the whole picture when addressing someone’s concern and finding solutions that are more impactful and sustainable long term.
Resources:
Training: Seek out continuing education (CE) courses on cultural competence and humility. Look for programs accredited by professional organizations (e.g., APA, NASW, ACA).
Assessment Tools (with caution): While no single "cultural competence scale" perfectly captures individual needs, tools like the Cultural Formulation Interview (CFI) from the DSM-5 can guide conversations about cultural influences on presenting problems. Remember these are guides, not definitive measures.
2. Collaborate with Ethnic Minority Communities
Action: Proactively initiate and sustain partnerships between mental health services and ethnic minority communities.
Why it matters: This collaboration leads to better mutual understanding, helps to decrease mental health stigma in communities, and encourages people to seek help. It also helps shape services to be more culturally- and patient-centered.
Practical Steps:
Partnerships with Local Organizations: Work with cultural, faith-based, and grassroots organizations to build trust and expand mental health outreach.
Co-develop psychoeducational materials that are culturally appropriate, translated, and accessible.
Actively Address and Mitigate Language Barriers
Action: Patients, even those fluent in English for daily tasks, may struggle with complex medical or mental health terminology, leading to confusion or misinterpretation.
Why it matters: Limited access to therapy in a patient's primary language worsens challenges and can lead to frustration and feelings of being misunderstood.
Practical Steps:
Offer professional medical interpreters, even if the patient appears proficient in English. Avoid relying on family members, especially children.
Advocate for interpreter training that specifically covers mental health terminology and cultural nuances.
Provide translated materials for consent forms, psychoeducation, and resource lists.
Navigate Cultural Stigma and Fear of Consequences with Transparency
Action: Understand that in many cultures, mental health may not be recognized as a real health concern, leading to stigma and a reluctance to seek help. Be aware that patients, particularly parents, may fear negative consequences if they disclose struggles, such as concerns about child protection services intervention.
Why it matters: This fear can lead to prolonged suffering in silence and avoidance of the healthcare system.
Practical Steps:
Provide clear and explicit psychoeducation on informed consent, confidentiality, and the legal limits of confidentiality (e.g., duty to warn, child protection mandates).
Explain processes and procedures transparently to build trust.
Emphasize the goal of support and strengthening families, rather than intervention.
Lead with empathy and patience as it may take time for some communities to build trust. Especially those who have been disparaged by the system in the past.
Acknowledge and Bring In Community and Informal Supports
Action: Recognize that individuals from ethnic minority backgrounds often prefer and rely heavily on community support and informal networks for coping and socialization.
Why it matters: These settings frequently offer a sense of belonging, connection, and non-judgmental peer support, especially when formal services are inaccessible or challenging. They can also serve as crucial pathways for individuals to learn about and access formal mental health services.
Practical Steps:
Peer-Led Support Networks: Encourage programs where individuals from ethnic minority communities can support one another through shared experiences.
Connect clients with community organizations where they can meet others and provide resources to these organizations to make it easier for them to educate and refer people to care when necessary.
In conclusion, ensuring access to mental health care for ethnic minority communities takes effort, cultural awareness, and teamwork. By tackling language barriers, reducing stigma, and working with community groups, mental health services can build trust and make care more accessible. When people feel heard and supported, they’re more likely to seek help, leading to better mental health and stronger communities.
Attribution: This summary was created by the team at Psychvox and is based on the source:
“I am not a priority”: ethnic minority experiences of navigating mental health support and the need for culturally sensitive services during and beyond the pandemic
The article is licensed under CC BY 4.0. Changes were made to adapt the content for clarity, style, and length. No additional restrictions have been applied, and nothing in this summary should be taken to imply endorsement by the original authors.
In an effort to maximize accuracy and transparency, each article is sent to the original authors of the research and reviewed by at least one clinician and researcher when possible.
This article was written by: Manuel Stoilov, LCSW
And edited by: Farah Mahmoud, Graduate Research Assistant and Clinical Social Worker