World Mental Health Day: Expert Perspectives Coming Your Way

In recognition of World Mental Health Day, we’re privileged to share a thoughtful piece from Dr. Janis Jenkins, a psychological/medical anthropologist and the Director of the Center for Global Mental Health at UCSD. In this video, she examines how culture plays into mental health and awareness, and discusses ways we can help erase the stigma and discrimination around mental illness.

For those of you who’d rather read through the content (or you’re in a quiet place not conducive to video-watching) we’ve got you covered:

Aya Healthcare is committed to bringing you expert perspectives on issues related to diversity, mental health, equity and more.

Thanks to the generosity of spirit of our employees, our company culture has always been rooted in giving back. We believe access to healthcare, food security, safe shelter, education and equity are basic human rights. Our goal is simple. Equality for all.

But social issues are complex, challenging to solve and require long-term investment. They require study. That’s why we’re partnering with UC San Diego to bring you engaging and insightful thought pieces.

Today we’ll hear from Dr. Janis Jenkins, the Director of the Center for Global Mental Health at UCSD. As Dr. Jenkins and her colleagues believe, there can be no health without mental health.

She examines the meaning of culture and how it plays into mental health and awareness. She’ll discuss the stigma and discrimination around mental illness and how by listening and learning, we can help erase that stigma. Let’s get started.

Greetings! I am Dr. Janis Jenkins, Professor of Anthropology and Psychiatry, and Director of the Center for Global Mental Health at UC San Diego. For over three decades now, my interdisciplinary teams and I have conducted NIH-sponsored research on culture, mental health and wellbeing among culturally diverse populations. Recently, it’s been exciting to see the growing momentum to make mental health a global priority for all persons, worldwide. 

This is important — since mental health — no different than physical health — is a fundamental human concern. Mental health affects us all — to greater or lesser degrees — at different points in time. Every healthcare provider — along with the general public — knows a patient, family member, friend or neighbor who has first-person experience with mental health challenges. A rallying cry for providers, researchers and advocates of the field of global mental health is: There can be “no health without mental health!”

And while this affects us all — there are geographic regions and populations that require specific attention — in relation to diverse cultural orientations and social-economic inequalities. Gaps in knowledge and awareness of these factors can contribute to disparities in healthcare outcomes and satisfaction. 

To make clinical interventions and research more efficacious, equitable and satisfying for patients and providers alike, we need to be knowledgeable about ways to integrate mental health into our practices. Often, there are implicit biases that impede these goals. There typically is a prioritizing of infectious or ‘physical’ health concerns over those of mental health.  In addition, there are two domains of influence that are particularly important for mental health. (1) First, there are usually presumptions about cultural orientations of patients and providers — as likely to be shared — or divergent; and (2) second, an inadvertent lack of awareness or knowledge that applies not only to cultural orientations — but also to the social contexts of patients’ lives. Both of these domains have profound effects on mental health and wellbeing. 

With respect to culture — what we know — is that typically — culture goes unrecognized. There’s a great deal of confusion about what culture IS — and what it’s NOT.  In terms of what it’s NOT: Culture isn’t reducible to a variable; culture isn’t an ethnic/racial designation, nor is it a place, a nation-state, or a people. Culture isn’t a fixed and coherent set of values, beliefs or behaviors. What, then, IS Culture? Culture … is an orientation to the World — that’s actively created and recreated in the process of social interaction. Culture encompasses meanings that are taken for granted. While there CAN be cultural patterning, there’s ALSO significant individual variation. Perhaps most important of all — culture translates into what we pay attention to; what matters … and … who matters.  

We now have several decades of empirical studies that have demonstrated the profound role of CULTURE in SHAPING nearly every aspect of mental health and illness. This includes: risk and vulnerability factors; the content and form of symptom presentation; the clinical diagnostic process; the subjective experience and meaning of the problem from the perspectives of patients and families; and, the valuation of cultural worth in relation to gender: Why DO we typically see a 2:1 ratio of girls and women with depression compared to males? Other key cultural issues include healthcare utilization — and, perhaps most important of all —  the course and outcome of mental illness. We have robust longitudinal data to show that outcomes vary widely, transnationally and cross-culturally.  

In addition to culture, the second set of issues that contributes to disparities in healthcare outcomes are social, economic and structural inequalities. Often, there’s an inadvertent lack of awareness or knowledge about the social and economic contexts of patients’ everyday lives. This includes household income and household composition, food security, neighborhood safety, transportation and access to local healthcare. Finally, we need a working understanding of the local community in relation to ethnic/racial composition and climate with respect to social harmony or social tensions.

Also, as a matter of combined cultural and social structural features, we have the pernicious effects of social stigma and discrimination surrounding mental illness. Stigma is as commonplace as it is harmful to mental health and wellbeing. 

We can only know about the interlocking sets of cultural, social, and economic features through approaches to healthcare that are grounded in both clinical and “real world” settings.  

In closing, I’ll invoke Margaret Mead’s vision for scientific and medical knowledge, when informed by anthropology. She said, “Anthropology demands the open-mindedness with which one must look and listen, record in astonishment, and wonder that which one would not have been able to guess.”  Moving forward here’s to engaged listening and learning — to growing our shared kinship to improve healthcare practices and patient outcomes in light of substantial cultural diversity and as matters of equity and social justice.  

Thank you for reading (or watching!) and stay tuned for more insightful content related to healthcare, equity and inclusion.