A lack of diversity among mental health practitioners creates a cultural divide
Tiyana Maharaj started seeing a counsellor when she was 14 years old in the Greater Toronto Area. Now in her third year of the women’s studies program at the University of Ottawa, she continues therapy but notices things she hadn’t as a teenager.
“I’ve always had a white person treat me. I’ve never had a person of colour in treatment until last year,” she told the Fulcrum. “And even then (it was a psychiatrist)—they’re not there to provide therapy.”
Maharaj is a first-generation Canadian, with a West Indian background, and faced unique challenges that came with her identity.
“In my experience, I’ve never had a therapist that’s been able to understand the connection and the mentality of immigrant parents,” she said.
Finding mental health care providers of colour is a problem many students from diverse cultural backgrounds run into when seeking help.
“I think (white mental healthcare practitioners) do their best to understand, but I also think that a lot of times … it’s super difficult to have conversations with parents that are immigrants, because there’s a mentality that’s like ‘you’ve been through worse, it’s fine, this is just a phase.’” Maharaj explained.
“It’s difficult in the sense that (white mental healthcare practitioners) can’t really grasp the type of divide between you and your family. There are types of trauma that they can’t relate to.”
For Noella Kondo, a third-year Telfer School of Management student with Congolese parents, Maharaj’s struggle resonates.
Kondo first sought help in high school, with her guidance counsellor.
“Of course getting advice from someone that’s black versus someone that’s white when it comes to racial issues isn’t the same. I’ve never had the opportunity to have a guidance counsellor who was a person of colour,” she said.
“They didn’t always know what to do to help because they were never in that situation.”
While Kondo now sees a white therapist who she feels comfortable with, she says she often felt misunderstood by therapists in the past.
“You know when you go somewhere and you need help, you can see it in their eyes—you can see when someone can’t really understand or resonate with what you’re saying,” she said.
Still, the lack of diversity in the field hasn’t stopped Kondo from getting treatment.
“It’s just not allowing me to get the extent of help that I know I could receive if it was a person of colour (treating me),” she said.
The “littlest bit” of diversity
In an interview with Global News, psychologist and educator Dr. Jeffrey Ansloos of the University of Toronto explained the lack of diversity in the field stems from little representation of people of colour in graduate programs themselves.
Neha Sindhwani, a fourth-year psychology and music student at the U of O agrees, both with the lack of representation in her classes, and in the field.
“Aside from being a psych student, I’ve gone to therapists before. For a while my therapist was a woman of colour, however when I was in residence and I was seeing the residence therapist, I would agree with the fact that there wasn’t very much diversity,” she said.
For Kondo, the lack of diversity in the field has to do with cultural perceptions of mental health.
“I think it’s honestly the fact that’s it’s so frowned upon in our culture and that’s why there’s not many (people of colour) in the profession,” she said.
Sindhwani, a child of Indian immigrants, feels similarly, explaining psychology wasn’t something that was openly discussed in her household.
“I had a very good life,” she admits. “It’s just the way my parents would talk about mental health in the house wasn’t the best because of the way they were raised and where they were raised.”
“I find when I talk about certain things especially with therapists who aren’t of colour or even Indian, they don’t really understand it as well—they still act the way therapists should, and it’s really great that they know how to tackle these ideas—but it’s almost like they’re trying to give you solutions or talk about things that wouldn’t be solved in the same way.”
Like Maharaj and Kondo, Sindhwani feels that the cultural divide between herself and her therapists results in a stalemate when it comes to finding helpful solutions in her day to day life.
“A lot of times therapists will say ‘maybe you should talk to your parents about how you feel,’ when in a lot of these cultures if your parents were raised in a very strict manner, talking to them wouldn’t lead to very great results,” she explained.
Sindhwani said she also noticed just “the littlest bit” of diversity in her classes.
“It’s one of those things where when somebody says it, you realize it,” she said.
“I don’t see many people of colour in positions of psychologists and therapists very often, even in terms of psychology professors or teachers in that area. It could just be being in Ottawa, because I’ve noticed there’s a lack of diversity in Ottawa itself, but when I go to my classes that are in psychology I notice it is mainly Caucasian students.”
Ansloos told Global News that one way of solving that problem would be “more strategic recruitment.”
“That means when we have conversations about family, mental illness, identity, religion, spirituality or culture, people need to see their life more fully in what’s being taught.”
Sindhwani says she’s also noticed a lack of classes that focus on cultural sensitivity training. While she’s currently enrolled in a cross-cultural psychology course, she says the material depends on the professor and how they choose to teach it.
“We talk a lot about (Indigenous) people but we don’t go into a mix of different cultures, there are very specific cultures that you can tell he created his lesson plan around rather than talking about a (variety) of cultures,” she shared.
Institutionally acknowledging a problem exists
The lack of diverse representation in the field is almost an abstract issue. It’s especially hard to put a number on the demographics since no research on the topic is widely accessible.
While the U of O collects data on program enrollment for each faculty, it only compiles data on students’ age and gender.
In 2011, the Canadian Psychological Association (CPA) published a report intended to examine the nature of health conditions faced by Canadians at a population level.
According to U of O psychology professor John Hunsley, who contributed to the report, there were three surveys conducted for the report: The first seeking demographic information of psychologists in Canada, the second using a subsample of those respondents and asking them to provide information about a randomly selected adult client they were seeing, and the third doing the same for a child or youth client.
While the second and third surveys both asked for information on the clients’ ethnicity, among other identifying characteristics, the first survey asked psychologists about their age, gender, degree, area of specialization in psychology and focused solely on practice characteristics such as practice setting, and types of services provided.
The CPA did not respond to a request from the Fulcrum asking why ethnicity was not a considered question for respondents in its 2011 survey, but Hunsley explained that learning about Canadian psychological service providers was not a primary goal of the CPA surveys.
“I don’t know why this was the case, but I can only assume that such a question was not included because (a) there were no national-level data on ethnicity of psychologists/psychological associates (i.e., this would not help in determining the representativeness of the survey sample), (b) prior surveys of psychological service providers had not included this question, and (c) the characteristics of the service providers were not the primary focus of the work to develop a sentinel surveillance system,” Hunsley told the Fulcrum in an email.
However, he explained that if he were currently involved in research focusing on the characteristics of psychological service providers, he would “most certainly want to obtain information on participants’ ethnic backgrounds as such information would be important for a multitude of reasons.”
While research is lacking, the Mental Health Commission of Canada acknowledges that there isn’t enough diversity in the field, and has sought to address the issue by means of “promising practices.”
These include cultural consultation services, international social work bridging programs at colleges and universities, and translation services, among other projects across the country. These projects aim to meet the unique challenges faced by racialized people seeking mental healthcare in each province.
For Maharaj and Kondo, this is the right idea, but it needs to be implemented more widely.
“I’m happy that there are services that are open, that are free, that are still excellent, I just wish they would do more research to be able to help a wider group of people, a wider demographic,” Kondo said.
“If you have time to get more knowledgeable in certain areas you don’t understand, you should have the time to do the same for people of colour, because we’re the same as everybody else,” she added.
While Kondo believes this can be done through training and workshops targeted towards white mental healthcare providers, Maharaj said she believes the onus is on individuals in the field.
“It’s a responsibility I think as healthcare providers to be able to understand and to be more sensitized to the different backgrounds your patients are coming from. I’m sitting here in your office, you’re my therapist, it’s not my job to be like ‘Well no, this is how immigrant parents think.’ You need to step up and educate yourself,” she said.
While workshops exist, and organizations like the Canadian Mental Health Association offer voluntary webinars to industry professionals for things like cultural competency, they are few and far between.
Ansloos held a similar view to Kondo and Maharaj, telling Global News that “trust doesn’t require sameness, but a relationship,” although he also provided an alternative solution.
Ansloos disagreed that mental health care doesn’t exist in different cultures, claiming that it did, but presented itself in more holistic forms.
“It may not all look like psychotherapy, but I think there are natural helping roles that exist within every culture,” he said, citing midwives as an example where Muslim women would find support for their mental health.
“We can do a lot even on the level of promoting mental health by really supporting diverse communities in elevating the value of these different roles that people hold.”
However, on campus, this may not be the best or the fastest approach for students seeking help within their university careers.
“I think especially on campus, this school has a role to play, and I understand that maybe it’s harder to find people of colour who are therapists and psychologists and so on, but I think … there needs to be some kind of training where they’re going to be more sensitized to the fact that they’re going to get so many people from so many backgrounds coming in for the first time, leaving home for the first time,” Maharaj explained.
She also explained the cultural differences that come with leaving home.
“I remember in first year seeing a counsellor and their tips for leaving home, or leaving your family were so basic, and (they) didn’t understand the culture of immigrant families of staying together,” she said. “It’s not just ‘oh, I’m homesick.’ It’s much more complex than that.”
“I think if it’s hard to find people of colour to provide the care then I think there’s definitely room for the services to still be diversified,” Maharaj said.