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CM: Cultural Competency in Mental Health Services: Perspectives from the Africa Centre
By Amanda Labonte
Odion Welch, Mental Health Youth Program Coordinator and Yawa Idi, Program Coordinator Enhancing Gender Equity Program and Program Coordinator of the Counselling Clinic with Africa Centre, engaged in a deep discussion about cultural competence in mental health supports.
Africa Centre serves many people under their mental health programming, Welch and Idi stated the youngest participant currently is around the age of six and the oldest is 67. While Africa Centre’s mental health programming is delivered from a Black lens, their services are not solely limited to the African community or those who are of African descent, recognizing not all Black people identify as African, nor are they all of African descent. Since Black identities are diverse and multifaceted, there are a variety of backgrounds and worldviews that make up these communities. These programs are open to any race, age, or gender identity.
Power of Language
Welch and Idi stated that their approach to mental health and wellness is to work against mental health stigma and try to avoid the use of illness or health disorder language. The focus is to promote the emotional, psychological and social well-being of an individual so they can actively participate in society to their fullest.
Definitions of ‘mental health’ or ‘mental wellness’ are broad. Welch and Idi stated young clients, often want to have discussions about mental health and have an awareness of what depression and/or anxiety mean. For older folks, the language can be different and might focus more on the experience of how mental health support feels good. Welch stated that there are over 210 languages on the continent of Africa and only 32 of those languages have words for mental health, depression or anxiety.
Some newcomers or immigrants who come to Canada may not understand questions like “how is your depression/anxiety” because in their language mental health is not well defined. Instead, practitioners and service providers should use language like ‘what is stressing you out or what is your biggest burden?’ Welch and Idi stated the language used, when fueled by cultural competency, engages a dialogue that is going to improve their mental wellness situation. A conversation can be had with a person and not once mention mental health – yet still engage in a discussion about it.
At the Africa Centre, Idi stated multiple languages are available, removing a barrier of access. She stated something as simple as greeting someone in their language changes the whole therapeutic relationship. Removing the interpreter was also identified as important. This was because previously sometimes the interpreter was a family member. This can be difficult, especially when discussing difficult topics like living in a refugee camp or having experienced trauma. It can be difficult to share fully when you may not want to harm the family member present.
Reducing Stigma around Mental Health
According to Idi, the mental health issues they witness at their clinic affect a person’s ability to participate in society to their fullest. Mental wellness has impacts not only on our emotional selves but also on our physical selves.
Welch explained how using and engaging with organizations like Africa Centre, who are already doing the work is key. Promote programs like Africa Centre’s ArTeMo project, an action based mental health project, where intergenerational folks come together and connect art, mindfulness and mental wellness. A space where mental health and wellness can be discussed without it being obvious contributes to stigma reduction and cultural competency. Welsch and Idi explained that bringing folks into mental health spaces sometimes needs to be different and not a ‘Mental Health 101’. They explained how most people will not walk into a Mental Health 101 seminar/workshop but are going to engage in an activity they already enjoy with people they already know.
It’s about having empathy. How someone from one place is going to interpret and experience mental health and wellness is going to be different than an experience of someone from somewhere else. Many dynamics can come into play, what language and words are used, gender and family roles, and how that tension can play out when not meeting familial expectations. Welsch explained how rebelling against family expectations is not as common in some cultures.
Welch and Idi stated places that are supposed to be serving the community often have business hours of 9 to 5, but community doesn’t happen strictly within the 9 to 5 schedule. Kids are in school, people are at work, university students – Africa Centre offers counselling hours and programming evenings and weekends, and those spaces fill up quickly.
Welch and Idi stated for a lot of folks, it is about raising everyday awareness and providing accessible resources, it’s about breaking stigma and changing how mental health is implemented. In the end it is not so much about what people say when they leave a program, but more so what they are doing when they leave.
Cultural Intelligence and Cultural Competency
Welch and Idi agreed that one of the biggest and most important pieces of work the Africa Centre does is having cultural intelligence and cultural competency. This extends into the counselling and preventative programs. This ensures that the therapy room is a culturally safe place.
“It is very important to have rigorous cultural competency incorporated with these clinics. There are a lot of Muslims and Christians within the Black and African communities, and that cultural knowledge needs to be understood. Certain behaviours that might be perceived as schizophrenic from a Western perspective, for instance a belief in communicating with spirits or ancestors, are actually cultural or spiritual practices being exhibited. As a consequence, they might be wrongfully admitted to a hospital and prescribed medicine when in reality they are of sound mind.”
People do not recognize how hard it is to become a citizen and the cost is incredible. Between getting educational credentials recognized and English proficiency exams, can create frustration and can be isolating especially when people are here alone. Looking at and recognizing these additional challenges is important.
Africa Centre has a $10 per day daycare that is also culturally intelligent and culturally competent. As well as so many other programs, this helps reduce stressors that contribute to people’s mental wellness. A good mental wellness program looks at all aspects of mental wellness, and that includes providing resources that help reduce stress.
Welch and Idi explained how they and everyone is still learning because “we are not the experts because there is so much to know, you can’t be the expert of all cultures and experiences.” It is the willingness to unlearn every day.
Impacts
The Africa Centre’s program is growing. Idi shared how in the months of January and February there were about 38 appointments at the clinic serving about 10 to 12 people consistently. Now there are 111 appointments a month, and people are proactively reaching out to the clinic. There have been over 400 people through the clinic in 2 years. A clinic that started with part-time hours and is now full-time, where so many more people can be reached.
Welch and Idi shared that research is now being conducted about Black youth and mental health particularly in Alberta. Much of the available Canadian research on underrepresented communities was from eastern Canada, which does not represent the Alberta experience or resources. Seeing an increase in research will help inform policies and put policies in place such as having the clinic that will help improve the mental health and mental well-being of the community.
If we have saved one person’s life or kept one person in university who might change the world, it’s worth it. We are keeping kids in school, keeping the next generation of policymakers in school, we are saving lives, and creating safe spaces. Lives saved and hearts changed are way more important than any policy change we could ever make.
What Can You Do?
Welsch and Idi stated having organizations look at themselves holistically and bring in anti-racism training or multi-cultural training were paramount because at the end of the day every resource someone accesses impacts their mental health. They stated organizations need to ask themselves: How can we eliminate degrading experiences and how can we learn and do better? What are we doing to understand cultures? Because that saves lives. They stated organizations need to enhance their capacity internally.
They stated that people need to actively invest in mental health and wellness. Don’t just read the article, get involved in some way, in some capacity. See how you can support the work going on. How you can contribute. What leverage you can bring. If you can’t help maybe, you know someone who can. Investing in anything with mental health. Not only in the communities we serve but, in your communities, as well. As we normalize mental health it benefits everyone. Idi compared it to being like going to a doctor’s appointment, where someone can say “sorry I can’t I have therapy tonight” and that is completely valid and accepted.
Welsch and Idi stated that looking at our language, looking at operating hours, listening to what people are saying and challenging our own perception of what mental health is, and not being afraid to say whatever we are doing existed before us. The kemetic yoga classes were powerful because having folks recognize a form of yoga came from Egypt meant people felt they were connecting to their roots, and this became more meaningful. They stated, we know when discussing mental health that community connection, and culture are key factors in developing self-esteem, resiliency and perseverance. So how can we do that and how can we do that in a safe, kind loving way?
If you or someone you know is in need of mental health supports or if you would like to learn more about Africa Centre:
Mental Health Mentorship Program
Note: This is an excerpt from our December 2022 Community Matters, you can read the full publication here
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