The Aspiring Psychologist Podcast - Understanding South Asian Mental Health

Starting point is 00:00:00 Hi there, it's Marianne here. Before we dive into today's episode, I want to quickly let you know about something exciting that's happening right now. If you've ever wondered how to create income that works for you, rather than constantly trading your time for money, then you'll love the Race to Recurring Revenue Challenge with my business mentor, Lisa Johnson. This challenge is designed to help you build sustainable income streams. And whether you're an aspiring psychologist, a mental health professional, or in a completely different field,

Starting point is 00:00:32 the principles can work for you. There are also wonderful prizes to be won directly by Lisa herself. And if you join the challenge by my link, you can be in with a chance of winning a one-to-one hours coaching with me, Dr. Marianne Trent. Do you want to know more? Of course you do. Head to my link tree, Dr. Marianne Trent, or check out my social media channels, or send me a quick DM and I'll get you all the details. Right, let's get on with today's episode. Why might people from South Asian heritage feel overlooked in mental health or for that

Starting point is 00:01:07 matter physical health care? My guest Zainab Khan and I are looking at the unique social, cultural and familial factors that shape the health needs of people from South Asian backgrounds. We're also covering what we can do as healthcare providers to provide better, more effective support. Hope you find this so useful. Hi, welcome along. I am Dr. Marianne and it's lovely to have you here. One of the things I have loved best about this podcast is the kind of learning stuff that I didn't know before and that is useful for me in being a provider of the podcast but also useful for me when I'm thinking about client work that I do because I'm still a practicing clinical psychologist. I still see clients. Every day

Starting point is 00:01:59 is a school day and it's really important that we stay curious. You might be watching this episode because you're a health provider. You might be watching this episode because you are of South Asian descent yourself and you would like to kind of feel seen, feel heard. And this is really one of the reasons that we are doing this podcast episode because Zainab herself recognised that she didn't really have that experience herself. So I hope you will find it so useful. And if you do, please do drop me a like, do drop me a comment. If you're on Spotify, please do rate the episode. If you're listening on Apple podcast, please do rate and review. I'll look forward to catching up with you on the other side.

Starting point is 00:02:39 I just want to welcome along our guest for today, Zainab Khan. Hi, Zainab. Hi. Thank you so much for being here and for reaching out to me via LinkedIn. Very much. I'm really excited to be here. Oh, that's really nice for you to say. Just before we were speaking on camera and in the preparation for this episode, we were thinking about how represented you felt when you were studying at university could you tell us a little bit more about what you mean about by that? Yeah so it never really occurred to me as a thought until I reached sort of the final year I think it was mainly prompted because I'd sort of narrowed down an interest into doing research in psychology and one of my clinical

Starting point is 00:03:26 psychology lecturers was talking a lot about culturally appropriate care from a black and Afro-Caribbean perspective being that was her ethnicity herself. I think it sort of just made me think that I hadn't seen anyone that looked like me throughout my degree in regards to like staff, lecturers, researchers and I also did a placement year while I me throughout my degree in regards to like staff lecturers researchers and I also did a placement year while I was doing my degree and again within the staff that I liaised with there was no one that looked like me I think it just made me think that it would be given that culturally there's a lot of stigma that comes from South Asians around not talking about mental health and psychology isn't even a word that we use in our everyday language very taboo topic and I think one of the big things in breaking that

Starting point is 00:04:10 down is to see representation of people that look like me and are South Asian in the space of psychology especially within the UK obviously I'm not speaking about internationally because when you go abroad there's obviously lots of different um south asian representation but specifically within the uk i just haven't seen any and even with my own experience of engaging with any mental health services i have genuinely never seen anyone that's of a south asian heritage yeah thank you that's really really important and before we hit record you were saying that often in terms of demographics and monitoring forms, there won't be an option that feels like it represents you and your heritage. It will be just Asian. And that's kind of enormous, isn't it? Because that takes in India, that takes in

Starting point is 00:04:58 Pakistan, that takes in China. That's enormous. So what areas are we thinking about specifically when we say South Asia? For me when I was doing my own dissertation and my target population was South Asian women I sort of in my head the kind of three large ones that come to mind obviously even within South Asia there's so many different places you've got Tamil people you you've got indian pakistani for me the kind of three main ones i was considering were indian pakistani and bangladeshi because for me they're the three biggest ones i encounter within my everyday but also i think statistically they are also the biggest ones within the uk too lovely thank you and you know the people watching or listening to this episode might be doing so because they are of this heritage or because they're wanting to learn more about how to understand talking about feelings and kind of troubles and things that are concerning them?

Starting point is 00:06:15 Yeah, so speaking from even personal experience, but also just my kind of toe dip into psychological research with this target population one thing that's so different about South Asian culture specifically I mean I'm Pakistani with my heritage so Pakistan and India quite similar in terms of their cultural practices but naturally I mean like back in our our young countries a lot of the time women take on more domestic roles they're almost a lot more submissive in comparison which is not necessarily seen as a bad thing in those cultures I think often when you come to western cultures there's so much talk about like gender disparity and sort of bridging the gap between gender roles that it's almost seen like it's very negative but sometimes within our culture that's

Starting point is 00:07:00 not actually a negative thing to take on those sort of domestic roles within the house and the gender roles and things it's not to say that women shouldn't be empowered it's just traditionally that's how we're sort of brought up I guess and even one thing I found myself from doing my own dissertation is that where we get our news and our sources of information and our influences are sometimes slightly different so there's a huge play on family influence passing down knowledge through generations and I think that was something that I thought of massively when I was doing my dissertation of to target this population sometimes the mainstream way of passing through psychological knowledge doesn't work we don't naturally pick up leaflets we don't

Starting point is 00:07:40 naturally pick up and things that you see maybe in doctor surgeries but when it's coming from say religious influences or an elder in the family they're often especially ones that don't come from England that have migrated here from other countries that can be their like primary influence for sources of information and if it's coming through there that you know psychological knowledge isn't that important or like mental health isn't that important then that's going to be what stemmed sort of through generation to generation yeah and it's um it's making me kind of think back to when I was working in a heart of Birmingham CAMHS service and I was working with lots of families who were of Bangladeshi heritage and

Starting point is 00:08:19 some of the young women that I was working with there were really finding it problematic because often their parents didn't speak English or didn't speak English well enough to kind of be able to really get on board with their education, with where they were at, with the kind of things they were struggling with, but also how to translate the concepts that were coming up for them. And we were almost kind of trying to help them bridge two quite separate lives, it felt like. That at home, with that which their parents would approve of or understand, whilst also trying to slot into a really Western, modern, and modern Asian British culture as well. It was just not an easy fit for them. And it actually did lead to lots of mental health struggles and kind of wondering who the real them is. Perhaps

Starting point is 00:09:15 they feel most vibrantly alive when they are with their friends and they're feeling understood and they're able to be perhaps more exuberant or you know more carefree and then you know perhaps also really enjoying aspects of their culture and their family but finding that that's much more limited and that their I don't know their limitless potential that they feel within them is not necessarily embraced yeah I mean off the back of, I think from a research perspective, the one thing that I thought of a lot during my final year was when it comes to, I think one of the reasons why South Asians are quite underrepresented in literature is because they're just hard to reach. And it's not necessarily anyone's fault. It's more so they already have a lot of stigma and it's a taboo topic to talk about anything to do with psychology and mental health but then also to be approached by a western or a white caucasian researcher you're less likely to assimilate with each other so I think one of the things I mentioned to my supervisor was

Starting point is 00:10:13 if I was to for example go into a mosque or a community center and say that I'm doing research I'd probably get a slightly different reaction and response than if a white Caucasian counterpart was to go in and say I'm doing research it's almost been very much shy away from that I mean that's why I'm very very like passionate about trying to get South Asian representation in the psychology field whether that's through like clinical services or even through research because you just you're not going to get to those participants through social media you're not going to get to the ones well a fair representation anyway because a lot of the south asians i mean i grew up in an area in manchester called long sight and that was very very heavily south asian dominant and most of those community members aren't on social media they've got no idea how

Starting point is 00:10:59 they would never find research call outs recruitment callouts they're not going to respond to them but if someone was to hold classes within like a community center or a mosque or a gurdwara or any place of worship or place of gathering it's more likely to be believed as a credible source of information or a credible thing to participate in yeah it's definitely food for thought isn't it to think about how we're kind of putting together our research teams actually and not to discredit or disparage any of the skills of anybody with any background but thinking about actually authenticity and respect and you know the chance of actually successfully recruiting to research studies might be dramatically improved if we try to obviously make sure that we've got some representation

Starting point is 00:11:46 of that of that background within our research team yeah yeah exactly i think one of the in regards to say psychological interventions one of the like points of interest that i remember brought up this was in response to black and afro-caribbean individuals mainly men it was to do with implementing psychological interventions within barbershops this was in america and that was part of the research that she had done but it was to obviously kind of again mask that stigma that's so often heavily held within different cultures but it was about going into their places of comfort as opposed to trying to bring them into you know like clinical environments and where people don't feel that comfortable and that again made me think

Starting point is 00:12:30 that the same really should be applied to South Asians I think especially when you look at a lot of the statistics around like South Asian mental health difficulties I know that Black and African Caribbean and also South Asians have two usually of the highest rates but I think one of the reasons why also there aren't actually very many accurate statistics around South Asians is because they're not seen as an entity by itself I think when you're trying to combine the whole of Asia especially a continent like Asia the cultural differences between literally every country is so stark that it's almost next to impossible to kind of assimilate them all into one and to get an accurate representation so i think if the statistics were really done represented to each

Starting point is 00:13:10 population within angia i think the statistics you'd get would be largely different than what's seen in all the different reports nowadays yeah very very interesting stuff and if we're thinking about kind of clinical issues and running a service and trying to get better engagement of, you know, less DNAs and more show ups and more useful clinical interventions, I'm kind of remembering that actually it would be a bad idea to necessarily invite someone on a Friday afternoon if they knew you would go to Friday prayers because they are not going to necessarily want to come they're not going to be able to necessarily swing that to to come by could you tell us a little bit more about that Zainab? Yes I think if sort of healthcare providers are more trained to be more culturally attentive and almost be invited to soak up knowledge from the participants and from the clients that they're dealing with it would just make for a more balanced relationship because even something as simple as if you're given appointments on a Friday afternoon just the act of then having to ring up cancel it rearrange

Starting point is 00:14:15 I know a lot of people even myself sometimes just making that phone call is such a headache so again it's just putting like another barrier in between that if healthcare providers already knew okay for this client who's muslim let's say friday afternoon they're not going to be available don't even bother making an appointment for them on that day you're just making one less barrier and one less thing that they need to to do it and you would definitely have a lot less dna's than they probably already do at the moment it almost feels like there should be a section on a on a form doesn't that when you're filling it in are there times that you definitely aren't available and then you just kind of put that in the system so that you you kind of get it right first time every time yeah and even just things like i mean it's such a largely spoken about topic now with

Starting point is 00:15:01 regards to how say psychological disorders or mental health difficulties present in different cultures but even things like obviously for me personally religion plays a huge part and I know a lot of my like immediate community members religion is such a huge influence and I actually found through my dissertation work that really should be sort of almost used as a tool so So just really briefly speaking, I know that obviously the WHO recommends women to breastfeed for a certain amount of time. It just so happens that that recommendation

Starting point is 00:15:32 is worded exactly in the Quran as a recommendation when it talks about breastfeeding. And it made me think that, for example, for someone that's not born in England, that hasn't been brought up maybe through Western education or isn't even familiar with the word the organization who to see it to note for a health care provider to then say well you know culturally if you look at your religious book the quran it says word for word what's written there's more influence coming from that source as opposed to who for certain people absolutely

Starting point is 00:16:05 it's really important and actually you know what we know with who is that breastfeeding is supposed to give the child the best chance to to kind of thrive because it optimally meets their needs we're going to have a separate episode where you and i talk about um specifically kind of breastfeeding um and your research in breastfeeding for South Asian women. So if people are wanting to listen to that, please do listen out for probably the next episode of this podcast that's coming soon. But this is, you know, mental health care is more than just breastfeeding and kind of the issues related to that. Could you kind of give us any more insights into how if we're trying to better serve the needs of the people that we are working with,

Starting point is 00:16:54 what we might begin to think about, Zainab? One thing that came up for me when I was just talking about this particular interest of mine with friends and family and things is where you actually do these interventions or where you do where you promote the messages about you know looking after your mental health I think one of my friends was talking about say for their mother-in-law who's probably a couple of generations older of Sikh religion one thing that my friend was saying is that things like trauma-informed classes or like group interventions or even just educational content in regards to what services to go to when you need support and things like that I remember my friend saying was that if that was done in a good way where she goes every single Friday or every single day of the week anyway

Starting point is 00:17:40 and has done for the last however many years more she's more likely to listen and to see as a credible source of information and to actually take notice of what's being said than if she is visiting say a GP surgery for a general appointment and there's leaflets or the GP themselves hands over a leaflet or brings it up during a during a consultation it's even though we all know that the GP has qualifications and is educated and qualified enough to make those recommendations but having it done in a place where they see as their sort of almost place of comfort and they've just been going there for years and years and years there's just more credibility for those sorts of individuals

Starting point is 00:18:21 than there is for those going to the GP surgery I think it's about for me the one thing that I'm keen to know and obviously it would just require the research to be done but is to take the clinical interventions into more culturally safe spaces I'd probably call it like community centers, mosques, other places of worship and I think one thing I read was kind of similar to this is I think there should be widely looked into and widely tested as to whether changing who's actually delivering the intervention or delivering the message would help. Yeah it's almost like we need some culturally representative outreach to really look at the demographics of the populations that we serve you know so I know that my children

Starting point is 00:19:25 go to a school that has kind of 50% ESOL and so how are we trying to for example in that school look at communicating in a way that represents that and when we're delivering health services how are we looking at people's heritage their their culture, their background? And we can't just expect people to come to us where we are. We can't necessarily just deliver a one-size-fits-all service. And I've spoken on the podcast before that I know in Birmingham, there was actually quite a high Chinese population. And yet, I had never in my almost four years of working in Birmingham ever seen somebody of Chinese heritage and so is that the service just not attracting people from that background is this a culture thing that they're not aware of the service or that there's kind of stigma against them entering the service and I think it's it's I guess that's where research comes in

Starting point is 00:20:25 that it lets us look better at what we're doing and who we're serving and who we are not serving yeah I think it's a culmination of everything that you've said I think services need to do more to engage with the what's always considered as hard to reach I actually don't think they're hard to reach I just think the approach to reach isn't always correct. So then always going to be classified as hard to reach. But then there's also from the other side, the actual service users or the research participants, there is such a disconnect in what they even think psychological research is, what they think the impact is is I think often with different ethnic groups when they're seen as such a minority I think sometimes there's a risk of when it's words

Starting point is 00:21:13 like research and we're exploring what's going on with your mental health it can almost be seen as oh they're like a spectacle it's seen as such a negative thing when I think again if like more information was given in a more accepted way to that population group they'll they themselves would understand more what perspective you're coming from I think it is just about different perspectives aren't almost aligning up so you're always kind of butting heads and I think one thing I think about a lot is that with obviously the day and age we're in we move so much to all social media and online and making everything online because it's more convenient but I think by doing that you're also icing a group that has no concept of being online has no interest in being online especially

Starting point is 00:21:56 ones that don't come from England originally when within their own cultures back home you know when electricity isn't so convenient um i know for example in pasadena when you go to villages and things you know like electricity isn't a thing they've got power outages all the time so for them being online just isn't the same as it is for say myself and so where i'm likely to see digestible content on social media and i'm likely to i know how to use google to find out information I need you've got a whole host of people that have absolutely no idea so I think there's almost a I think there's almost too much of a reliance on moving towards this online life and making

Starting point is 00:22:36 everything digital that's almost putting a lot of people at risk of being completely isolated from a lot of psychological services and a lot of just healthcare services in general. That's a really good point, isn't it? As we try and move everybody towards attend-anywhere appointments, whether that actually is ideal for everybody. And of course, if there doesn't feel like there's a safe space or if actually the home environment is part of the problem, it might not feel like it's appropriate to be talking about those issues from a remote setting. I traveled quite extensively in India

Starting point is 00:23:10 in 2008. And actually, it looked like to me anyway, that anybody with mental health problems was just kind of left to fend for themselves. I don't know if that's actually the case, but kind of culturally there may be a stigma towards people with mental health problems could you kind of illuminate that aspect a little bit for us yeah so certainly I mean for generations and generations mental health isn't a topic spoken about within a lot of South Asian cultures being that I'm not Indian I can't certainly say for Indian culture but I know for Pakistani culture although we share a lot of similarities it is the same it's just not spoken about speaking about women in particular when it comes to things like postnatal depression or postnatal psychosis

Starting point is 00:23:52 anything like that not even a thought it's not even part of the aftercare it's not even considered a thing and if anything within our culture anyway there's so much emphasis put on being a good mother and being a mother within your community that almost if you sort of defer from that gold standard instead of looking at okay what's actually might be causing that how can we help bring you back up to this golden standard you're just outcasted it's it's like there's something wrong with you you're not fit to be a mother um and i know that for example a lot of i read research recently on um stillbirth women that have experienced stillbirth um and i think this research was done in rural areas of pakistan

Starting point is 00:24:32 and the women that had experienced stillbirth one of the things that they pointed out was that they were just seen as child killers that was literally the words that were used um and they were really really stigmatized by members of the community and I think again that can very easily although that research was done in rural areas of Pakistan it can so easily be seeped into the UK when you get people that come from those backgrounds that move here and build their families here that's just going to keep getting passed down generation that sort of that way of of thinking absolutely and how could we think that wouldn't affect somebody you know yeah it's making me think about when I was at school and one of my good friends was Hindu and for her and her mum when they were menstruating when they're on their period they weren't supposed to go in the kitchen because

Starting point is 00:25:20 it was seen as as being unclean and they shouldn't touch food. That was, for me, hard to get my head around. I did loads of cooking at that stage in my life for my family. It doesn't necessarily matter if we understand it or agree with it. We kind of just need to be aware of it and understand that for the person we're working with, that has importance. Is there anything else around, know menstruation or any wider issues for kind of cultures and faiths and beliefs that that perhaps somebody not of that heritage would not know about to actually come to mind the first one is actually in relation to menstruation so

Starting point is 00:25:58 whilst within my culture and religion that particular practice isn't a thing I have heard of it before but with regards to I'm a Muslim so obviously there's a period of time every year where we fast for 30 days and as a woman if you're menstruating at any point during those 30 days you're not supposed to fast you're given that time to have a break but I know and this has got nothing to do with the actual religion perpetuating it it's not mentioned anywhere in religious scriptures but it is perpetuated a lot by cultural beliefs that have just come from within families women within those families a lot of them are often almost made to feel like they have to hide the fact that they're menstruating from male relatives or male family members and friends and i've read stories before where women feel like they need to pretend that they are fasting

Starting point is 00:26:45 just for the sake of saving face and things I think stuff like that obviously for someone that doesn't come from that culture and even the the one that you mentioned would be so strange and I think sometimes if those experiences are discussed within a healthcare setting you always have the risk of the clinician or the healthcare provider almost seeing it as oppressive or using certain language like that which I think can really mess with the narrative that's actually being told because for your friend for example that may not be seen as oppressive or as strange or anything of the sort that's just normal for them but when they're then almost being fed by someone else who's not of the same ethnicity or heritage and no idea using you know words like well that's quite

Starting point is 00:27:29 oppressive controlling it can really start to mess the narrative in a really negative way and the second one that came to mind when you mentioned that question was um i actually think this is quite widely spoken about now in comparison to what it was before um but for people of my heritage or people of my same religion one of the things that we're invited to do from a religious perspective is almost make prayers under sort of like a whispered tongue so to the outside it might look like we're just talking to ourselves but it's almost making prayer but with moving them off at the same time and I know again from reading just stories online and from I've got family members that work in the healthcare settings and things one of the risks of that is when you have a patient or a service

Starting point is 00:28:17 user that is so strongly connected to their religion they might use expressions that are related to their their religious beliefs or they might be doing that practice of making a prayer under their tongue or under their breath but that also can be seen as talking to themselves which obviously then starts to weave into different psychological disorders and mental health problems and I think again similarly to religious practices or cultural practices that then start to be seen as oppressive and controlling you then also have the risk of just religious acts being seen as someone's talking to themselves or they're hearing voices and things like that so again I think from a

Starting point is 00:28:56 researcher's point of view a psychological practitioner's point of view there has to be such a strong knowledge or not even a knowledge but just an acceptance of that there are such stark differences across different cultures that it's not always such a negative thing or don't always jump to sort of the dsm and trying to match the things up i think if we if there's more time taken just to understand what is the whole picture what is their day-to-day life what is the practices that they engage in there'll be a lot more of a complete story I think sorry to keep rambling on but another thing that made me think just then is I remember that I have a friend that did a midwife course and one of her clients was again South

Starting point is 00:29:37 Asian didn't speak very good English and so their partner was the person that was in the room with them as their almost representative and spokesperson. However, you could tell that the partner wasn't really interested in any of the aftercare when it came to talking about psychological care. And obviously, I think my friend was trying to get across information about, you know, if you experience this, if you feel like this, you need to report to this service and things like that. And for obviously the lady, no understanding of what's this service and things like that and for obviously the lady no understanding of what's being said and also her partner decided to not go ahead with an interpreter and took on that role himself but obviously once again when you allow things like that to happen within healthcare you run the risk of they're not translating the right information across and I think again for that example it just made me think so for those two individuals mental health care just wasn't a I thought it

Starting point is 00:30:26 wasn't even something to consider so for the gentleman who was supposed to be that woman's advocate and taking on that information translating it in something that she could understand he wasn't doing that because it just and I don't think it was even in a malicious way I think it generally was because for him it just wasn't something of importance so again for me that just brings up the importance of we have to sort of approach different target populations in a way that suits them absolutely and i think as a service provision issue in the service i most recently worked in an adult mental health we didn't allow anyone to interpret other than our official interpreting service just so that we've got our best chance, hopefully, of engaging

Starting point is 00:31:06 someone and not perpetuating problems. Zainab, it's been absolutely fascinating speaking with you. Thank you so much for talking with us about this. And like I said, we are going to be doing another episode together where we talk more specifically about your research into breastfeeding with South Asian women. But thank you so much for your time today. It's been really illuminating and I hope this will be really, really helpful for people. If people wanted to come and connect or learn more about you or your research, where's the best place for them to do that? Is it LinkedIn? Yes, I would say LinkedIn. I do plan to have a Twitter account at some point down the line for research purposes,. That will come as

Starting point is 00:31:45 of when. But yeah, LinkedIn would probably be the best place to start with. Perfect. Thank you so much for your time, Zainab. Thank you. Oh, thank you so much for your time, Zainab. It's interesting that after we stopped recording and we're waiting for the uploads to happen, we were talking about imposter syndrome and how for Zainab and for myself as well, sometimes you have those moments of, oh, who am I to be doing this? And I definitely have that. I'm definitely on board with that. And that is something that I spoke about in episode 155 of this podcast, thinking about imposter syndrome and how we can win that battle. But Zainab was saying really from being quite a recent graduate to then suddenly being on this podcast and having you know a platform to explore these really key and important issues you know it just takes a

Starting point is 00:32:31 little moment to kind of catch your breath and and kind of see where you're at and I have that all the time as well you know I might be about to do some tv work or to go live on the radio and you're thinking it's just little old me but it's really important that we feel the fear and we do it anyway. So yeah, with that in mind, if you've got an interesting topic that you think would make a great episode, please do get in contact with me. I would love your thoughts around this episode. Please do like, comment, engage, share this with anyone you think might find it helpful. Perhaps your staff team, perhaps your family, perhaps friends, people that you think might find it helpful. Perhaps your staff team, perhaps your family, perhaps friends, people that you think might find it really useful or might feel seen,

Starting point is 00:33:11 might feel heard by this episode. If you are watching this as an aspiring psychologist, please do check out my books, The Aspiring Psychologist Collective and The Clinical Psychologist Collective. And if it's your time and you're ready for the next step, the Aspiring Psychologist Membership, we are doing beautiful things in there. We are helping people to up their game in research, in CBT skills and formulation, in interview skills, in application form skills, in self-belief. People often say to me that it feels like I hold the

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Starting point is 00:34:48 It's the Aspiring Psychologist Podcast with Dr. Marianne Trent. my name's Jana and I'm a trainee psychological well-being practitioner I read the clinical psychologist collective book I found it really interesting about all the different stories and how people got to become a clinical psychologist. It just amazed me how many different routes there are to get there and there's no perfect way to become one and this kind of filled me with confidence that no I'm not doing it wrong and put less pressure on myself. So if you're feeling a bit uneasy about becoming a clinical psychologist I'd definitely recommend this just to put yourself at ease and everything will be okay. But trust me you will not put the book down once you start.

The Aspiring Psychologist Podcast - Understanding South Asian Mental Health

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