Mental Health and International Schools: Towards a greater understanding of cultural and contextual factors

In a recent article for another publication, I put forward the argument for the need for a more ‘internationalised’ PSHE (Personal, Social, Health, and Economic education) curriculum framework which better serves our international study body and takes into account the national context of the school. In particular the article called for the need to discuss and understand mental health problems not just through a western lens (which arguably makes up a significant part of the teaching body of international schools).

In my personal experience, I recognise that by default I view social-emotional difficulties and mental health problems through a western lens, and in doing this I often feel that I miss the opportunity to better understand the cultural complexities that accompany these issues in the students I work with. The aim of the blog post you are reading here is to delve into this topic a little more deeply in an attempt to better illustrate why it is important to better understand cultural views of mental health problems, which may in turn help us to better understand the difficulties that some of our students may face. As I am currently based in Thailand, this article will focus on the nuances found within different Asian cultures.

When researching this topic, an interesting paper that I came across was by Gopalkrishnan (2018) and is entitled ‘Cultural Diversity and Mental Health: Considerations for Policy and Practice’. This paper sought to explore some of the key considerations that lie at the intersection between mental health and cultural diversity. In this regard, the author sought to highlight that cultural differences can have a range of implications on how mental health problems are viewed and understood, how and when people seek help, and the nature of the therapeutic relationship.

Gopalkrishnan (2018) begins his paper by defining culture to help frame this discussion a little more, and he defines culture (in relation to ethnic identity) as ‘the multidimensional set of ascriptive group identities to which religion, language, and race (as a social construct) belong and all of which contribute to a person’s view of themselves’. Culture (and cultural diversity) is an important part of discussions around mental health, and feels particularly relevant to the multicultural makeup of international schools, as ‘culture influences what gets defined as a problem, how the problem is understood and which solutions to the problem are acceptable.’ (Hernandez et al., 2009).

Hechanova and Waeldle (2017) provide a useful way of understanding the different ways in which cultural differences can impact on understandings of mental health treatment. These authors highlight five key components of diverse cultures that have implications for mental health treatment:

  1. Emotional expression – some cultures believe that an imbalance in expression can lead to disease, and talking about painful feelings can lead to further painful feelings. This in turn could lend itself to a reluctance to engage in talking therapies.
  1. Shame (and stigma) – Hechanova and Waeldle (2017) argue that shame and the significant role of the family within Asian culture is why Asian individuals with mental health problems can be slow to seek help.
  1. The ‘power distance’ – the power differential between the therapist and the patient in Asian culture can lead to a lack of autonomy on behalf of the client.
  1. Collectivism – the collectivist culture in Asian countries can positively impact with resiliency and coping.
  1. Spirituality and religion – this can influence what are seen to be the causes of mental health problems as well as how these problems are treated. For example some cultures view the onset of disease as caused by the possession of spirits and as such may ascribe to the use of traditional healers or elders. 

It is important to note that much of the work in terms of theory and practice within the fields of mental health, psychiatry and mainstream psychology has emerged from western understandings of the human condition, in particular the dualistic understanding of the body and mind interconnection and reductionism. As such western cultural approaches to health are often ‘predicated on a model that focuses on individual intrapsychic experience or individual pathology, while other traditions may be based more on community or familial processes.’ (Tribe, 2005). Therein lies some of the tension when applying Western understandings of mental health to the context of non-western cultures. 

To bring back our students into this discussion, a paper by Inman et al. (2009) discussed some of the critical issues and challenges facing school counselors in international schools. Whilst we can understand (to some degree) the many mental health and wellbeing challenges facing young people in terms of navigating relationships, keeping safe online, and addiction amongst many other topics, our international student body experience some unique challenges by virtue of attending an international school. Namely the difficulties experienced as a result of the ‘transient and unfamiliar nature of their educational and geographical experiences’ (Rifenbary, 1997, as cited in Inman et al., 2009). 

If we take these vast differences in cultural understandings of mental health problems within the host nations that we are situated in, take into account the often westernised views of mental health and counselling support, and couple that with the complex identities of our students (Danau Tanu’s book ‘Growing Up in Transit: The Politics of Belonging at an International School’ provides an excellent insight into these complexities of being a student in transit), it feels that imposing a purely westernised understanding onto our students without first appreciating the context may inhibit our abilities to individualise our support to students when necessary. 

I appreciate that the complex way in which I have discussed how we can help students with mental health problems provides no answers, and instead highlights gaps. However, if we can better understand the cultural complexities of mental health and our student body then ultimately we will also be able to find better ways to support our students and their needs.

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