Structural Determinants of Mental Health Vulnerabilities and Access to Services Among Asian Immigrant Men in Toronto, Canada

Background and Purpose

Racial disparities in access to mental health care is well documented in Canada. People who self-identified as East, Southeast and South Asian are less likely to seek treatment or services than people who self-identified as White. When admitted to treatment, however, studies have shown that patients of Asian descent often present much severer symptoms of mental disorders. Further the lack of gender-based and intergroup research impedes the development of culturally inclusive programs and services for Asian populations in Canada. Drawing on the findings of the first large-scale Canadian study on Asian men’s perspectives on mental illness stigma and access to mental health services, this presentation focuses on the interplay of multiple ‘minority stressors’ associated with racialization, migration, and masculine subordination in shaping the mental health of Asian men in Toronto.

Methods

Toronto-Strength In Unity was an intervention study to reduce mental illness stigma. It was underpinned by a socio-ecological health equity framework and informed by critical race and masculinity theories. Participation criteria were: self-identified as men, aged 17 or older, from the East, Southeast or South Asian communities in Toronto, Canada. Asian men living with and/or affected by mental illness were also included. Recruitment strategies included: media, e-flyer, in-person information sessions, and stakeholder referrals. Over 600 Asian men participated in the study. Seventeen focus groups were conducted with 138 participants. Thematic analysis using inductive and deductive approaches were used to analyze the data.  

Findings

In this study, we found that Asian immigrant men’s mental health and their access to services are greatly influenced by the processes and outcomes of their journeys of migration and settlement. Specifically, we identified five major themes: (1) decline in social status and economic resources post-migration contributed to participants’ mental stress; (2) experiences of psychological stress as participants renegotiated their racialized gender identities; (3) emergence of post-migration relationship tension at home as participants attempted to reestablish their pre-migration social and economic status; (4) stigma of mental illness intersected with the structural inequalities in deterring participants from seeking mental health services.

Conclusion and Implications 

Our findings have revealed the prominent role of structural determinants in influencing the mental health and access to services among Asian immigrant men. Structural inequalities, associated with racism, hegemonic heterosexist masculine norms and socioeconomic marginalization, interact with one another to shape how Asian immigrant men experience and perceive mental health challenges and their hesitation to seek services. Implications for social work in addressing the mental health needs of racialized immigrant men include: (1) deconstructing mental illness, not merely as a disease, but the bio-psycho-social outcomes of structural inequalities; (2) applying an intersectional lens of critical race and critical gender analysis in designing and delivering inclusive and structurally competent mental health services; and (3) promoting structural interventions to reduce mental health disparities.