MENTAL hEALTH AND THE iNTERCULTURAL COMMUNITY IN FINLAND: AN INTERN'S TAKE
Every year on September 10th, the world unites to acknowledge Suicide Prevention Day. With Mental Health Awareness month approaching as well, it seems fitting to address the mental health and well-being among the population with a foreign background here in Finland.
This side of wellbeing and its connection to Familia’s work among intercultural families is not always clear to everyone. Nevertheless, considering the post pandemic era we are embarking on as a society (Laine, Nissinen, Nurminen, 2020; Kekäläinen et al., 2021), as well as the escalation of the racially discriminatory conversation in the United States (McCoy, 2020), which later made its way around the globe to Europe, including Finland (Non-Discrimination Ombudsman’s Report, 2020; YLE News, 2020; Familia ry, 2020. Survey on Discrimination and Racism among Intercultural Couples and Families), mental health should be on the top of the list of conversation topics concerning this demographic in the 2020’s.
Mental Health is defined by the World Health Organization as: “a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community” (WHO, 2018). Skills for maintaining one’s mental health can be strengthened and include both internal as well as external protective factors (Mieli Mental Health Finland, 2021). The internal strengthening methods are factors such as social support, physical health, positive early relationships in childhood, adequate self-esteem, being accepted, problem solving ability, capacity to deal with conflict, interpersonal skills, ability to form and maintain relationships, and the possibility to self-fulfillment. External strengthening methods, on the other hand, are factors such as: opportunity for education, employment or another source of income, support from the work community and manager, feeling of being heard and ability to influence, safety and a public support system that is nearby and easily accessible (Mieli Mental Health Finland, 2021). Many of these resources, especially external protective factors, are often lacking or even limited among the population with a foreign background in Finland, as I will come to show more in depth later in the text.
Suicidal thoughts are often caused by feelings found as unbearable (WHO, 2018). A negative feeling, such as fear, shame, disappointment or grief can function as the motivator of the thought process. As a result, the inner thoughts of the person become too heavy to handle. This is followed by looking for a way out of the situation.
“Often self-destructive thoughts are about the desire to lose the unbearable feeling, and not so much about wanting to die”
-Mieli, Mental Health Finland, 2021
According to the International Association for Suicide Prevention (2021) one in every 100 deaths worldwide is the result of suicide. This is a matter that can affect us all. Each occurrence of suicide is damaging and impacts the people around the person committing it. Therefore, raising awareness is important and needs to be addressed more in different communities. This can help reduce stigma and equip people with useful information on how to encounter and aid individuals with suicidal thoughts.
Though the number of suicides has been declining relatively evenly in Finland since 1990 (Statistics Finland, 2019, THL, 2021), the Finnish Institute of Health and Welfare (THL) together with the Ministry of Social Affairs and Health are acknowledging changes and developments required in mental health services in Finland in the 2020’s. This is done by establishing goals such as included in the National Mental Health Strategy and Programme for Suicide Prevention 2020–2030 (Ministry of Social Affairs and Health, 2020). Some of the main focuses for the start of the strategy in the years 2020-2022 are to increase suicide prevention efforts, and to expand preventative mental health services. This is encouraging to hear, especially as the strategy for prevention mentions the need for widening phone crisis help services for other language groups beyond Finnish and Swedish (Ministry of Social Affairs and Health, 2020 p.53).
By doing a quick internet search one can see that in Finland, majority of the low threshold mental health services provided by the third sector, as well as public health care, still consist only of Finnish or Swedish speaking crisis work, counseling appointments and hotlines. Fortunately, in the latter half of the 2000’s, more and more service outlets were established in other languages as well. These include Finland’s Mental Health Association, Mieli ry’s Crisis Helpline in Arabic and English established in 2008 (Mieli Mental Health Finland, 2021) as well as the substance abuse and mental health association SAMHA’s SOS WhatsApp service which was established in 2009 and is available in Arabic, Finnish, Somali, English, Italian, Spanish, French, Greek and Chinese (SAMHA, 2021). Services in multiple languages lower the chance of exclusion and marginalization among the foreign language population with questions or concerns about mental health (THL, 2020; SAMHA, 2021).
They also bring to the light the statistical and general societal lack of knowledge regarding the need for further policy development (Nussbaum, 2011), in which different communities and their specific needs here in Finland are considered. Lastly, they offer professionals a chance to practice cultural sensitivity (FinFami, 2021: THL, 2021) in mental health work.
As for mental health service use, research shows that people with a foreign background are known to utilize Finnish mental health services less than natives (Koponen et al. 2015b, Markkula et al. 2017; THL, 2020). However, this contradicts with the results of the 2020 FinMonik survey, carried out by the Finnish Institute of Health and Welfare (THL, 2020), which showed higher levels of mental stress among both men and women of foreign backgrounds (17%), when compared to the native population (13%), (THL, 2020 p. 121).
Considering the increase in immigration and persons with a foreign background residing in Finland (THL, 2020), it becomes even more critical to address the gap in mental health wellbeing between the population groups. The solution lays partly in developing public conversation and awareness of mental health and the challenges it can present to a person of foreign background and intercultural communities and families. This is needed in order to fight stigmatization and exclusion within the population. Furthermore, there needs to be dialogue among different parts of society about discrimination and racism that the aforementioned groups often experience and how that affects mental wellbeing (effects of racial discrimination on mental health) (Carter et al. 2017; Tuomaala, 2021). The actual needs of the demographic based on research, such as the results of the FinMonik survey (THL, 2020), are also significant for theoretical framework to be developed beyond the current understanding of the diverse needs and differences among the persons with a foreign background as members of our society (THL, 2020). It is needed to understand the nuanced mental health factors of culturally and ethnically diverse population groups before addressing intercultural families, where more than one culture prevails simultaneously within the family.
We humans, just like any other topic, also view the concept of mental health and solutions to it through our cultural lenses (Mielenterveystalo, 2021; THL, 2021). Therefore, we must take note of the fact that mental health, along with the symptoms of any challenges, can be perceived differently from our own views (THL, 2021) whether those views are Finnish, Western, or whichever. This diversity in conceptualizing mental health presents challenges when the topic is addressed among people from diverse backgrounds. On the other hand, this offers us a place to challenge ourselves by listening, striving to understand others and their manner to formulate the world. We can suddenly understand why a situation that could be considered as “treatable” in a certain way or with a certain medicine within the Finnish cultural standards for instance, suddenly raises such a different reaction in a person from another cultural background. Once we hear others and possibly get to share our own understanding and interpretation of different sub concepts such as certain symptoms (of trauma, for instance), we have taken the first step towards removing shame and raising awareness on the communality of the different mental challenges such as depression or post-traumatic stress disorder (PTSD) beyond culture, gender, ethnicity, socio-economic status or nationality.
Now, as for intercultural families, similarly to any other population groups, mental health also forms part of intercultural families’ lives by linking to overall wellbeing (THL, 2020). Wellbeing entails emotional, psychological and social wellbeing along with the absence of ill-being (Keyes 2005; Kokko et al. 2015). Through everyday activities, challenges and interactions, people reinforce their mental wellbeing by applying resilience where the challenges faced are viewed mentally as possible to overcome (Hofgaard,Nes & Røysamb Espen 2021). Nevertheless, every now and then, events take place in one’s life where mental resilience is challenged to its maximum capacity and a person starts feeling a decrease in their wellbeing (THL, 2021). The type of event varies among individuals and their circumstances (e.g., war, divorce, moving to a new city or country etc.) but the common factor is stress. If not dealt with, stress can affect a person’s ability to function, (Mieli Mental Health Finland, 2021).
Mental wellbeing is also one of the factors in the adaptation process of a person moving to Finland (THL, 2021). Cultural adaptation process presents a differing factor in mental wellbeing from the rest of the population among those who have immigrated to Finland (THL, 2021). Adaptation is a process that usually involves three stages (THL, 2021). In the arrival phase, external conditions of one’s life change. These include things such as language, friends, home, and surroundings. This can motivate fear, confusion, unfamiliarity or helplessness. In the engagement phase, the environment of the new nation is viewed and compared with one’s original country. Lastly, in the hindsight phase, the person adapting can combine the characteristics of the new and old culture in a manner that suits them (THL, 2021). It is to say, in the process of adaptation, one mentally releases their past cultural and therefore, conceptual way of formulating the world around them, letting go of the old -and familiar- environment and culture, whilst embracing the new -and unknown- nation along with its language, people and norms (FinFami, 2020; THL, 2021). Adaptation can also happen collectively when a whole family experiences changes and adjustments during the first months and years of life in a new country.
On this smaller societal unit called family, the adaptation process in intercultural context occurs reciprocally in the form of acculturation. It entails individuals clashing and finding their place within the family and its inner culture (Väestöliitto, 2012). Factors such as, partners’ employment status, internalized gender roles (among other cultural norms), possible child upbringing methods, ethnicity, and inner family values form part of the process (Silva, Campbell, & Wright,2012 Väestöliitto, 2012; Familia ry: Intercultural Communication Online Course, 2021). Eventually the aforementioned actors weave into a unique yet mutually agreed combination of both partners’ personalities and backgrounds. Still, amid the process the clashing and forming can cause additional demands on mental health and is therefore important to consider when addressing intercultural families in this context.
Social psychologist Gerard Hofsteede (2001) came up with a framework on cross cultural communication differences in the methodology of different nations and cultures way of communicating called, Cultural Dimensions Theory. According to this theory, Finland represents a low-context culture where there is more distance between relationships. Additionally, the individual is valued as an autonomous and self-reliant variable of society rather than a part whose value and status are determined by a group or a community. This can challenge a person used to culturally more communal way of interaction, such as sub-Saharan Africa or the Middle Eastern nations for instance. What is more, the North bound location of Finland with its cold temperatures and long, dark winters can cause seasonal depression as Grimaldi, Partonen, Haukka, Aromaa, & Lönnqvist (2009) found. All of this can defy mental wellbeing, especially for immigrants or persons with a foreign background in intercultural families who are already in the middle of an adaptation process due to being new to the country. Lastly, the legal and more formal aspects of the immigration and adaptation process, one may be presented with stressors affecting mental health in response to dealing with government officials such as during the residence permit process (Familia ry, 2021. Kuljen Rinnallasi project 2018-2020), employment challenges due to discrimination (Ahmad, 2019), socio-economic instability or language learning (FinFami, 2021). When accumulated, these stressors can create uneasy mental situations eventually weakening one’s mental state and overall well being in ways such as disease related physiological changes as Cohen et al. (2015) suggest.
The beginning pages of the FinMonik survey (THL, 2020) includes a summary, in which the writers conclude the following: “Promoting integration and taking into account welfare and health issues as part of the integration process contribute to improving the quality of life of the population with foreign background.”, (THL, 2020 p.4). When looking at mental health and the ways it forms part of everyday life through the elements mentioned previously, it is safe to say that Familia’s work and activities hold a greater significance towards mental health and wellbeing than one might assume at first glance. Especially the promotion of mental health as it is, in accordance with the World Health Organization, which establishes the emphasis on respecting and protecting the basic civil, political, socio-economic and cultural rights of human beings (WHO, 2018).
Furthermore, the activities organized by Familia highlight the socio-pedagogical framework (Freire, 2000; Nivala, Ryynänen, 2019), commonly applied by social work professionals in their work strengthening an individual using a more relational approach, viewing the client as a holistic being with potential. In activities using the participants’ own skill set and encouraging to take initiative we can see these socio-pedagogical methods such as, dialogue (Bohm, 1999) and participation at work. By creating the activities around methods, such as the previously mentioned, individuals’ mental health is being promoted through providing a space to practice skills similar to language learning, social relationship forming, physical, artistic manners of self-expression and learning. By creating positive experiences of learning and interaction participants' self-esteem and self-image are promoted (e.g., when learning to speak a new language, learning about other cultures or traditions, or teaching others how to acquire a skill already familiar to oneself). Also, creating close relationships supports one’s interpersonal skills (in peer group activities such as Familia’s Duo living rooms). By providing a safe and accessible system to meet the social and educational needs of a person, it also enhances the external strengthening factors (e.g., being heard, ability to influence, safety and a public support system that is nearby and easily accessible) of one’s mental health (Mieli Mental Health Finland, 2021).
What do I suggest now since on the topic of mental health awareness and suicide prevention? Well, after having worked with this demographic for only a short time and considering that my perspective originates from the field of social services, I would suggest the following: we need to be available to each other as a society and communicate our availability for the conversation on mental health louder than perhaps we have in the past. Now, I know what you must be thinking, “I am not a therapist.” and that is quite alright.
Availability can look like many things. It can be sitting down with someone and listening, it can be providing the answers to someone’s question on where to find the adequate help, it can even be not knowing but searching together. Through organizing and offering services as well as raising awareness on the mental health needs of intercultural families and community in Finland, we can prevent miscommunication. Overlooking someone as secondary or not possessing challenges important enough to ours or some other groups is a risk in the case, we stay silent. As mentioned in the beginning, Familia’s focus point in services is intercultural families, couples as well as their children. Though every family has their own unique challenges, intercultural families' needs in this area, as expressed in this text, often lead from cultural adaptation and unfamiliar service system as well as insufficient resources in social networks. The search for a community, of people who understand or have walked through the hard moments of immigration or language learning before, is more needed now than ever before in Finland. This is what makes low threshold peer group and other activities so crucial. To prevent and to facilitate a better way to deal with the questions, than having to deal with them alone.
Mental Health awareness month is an opportunity for us all to gain understanding of the importance of the overall subject as well as to start a conversation about some of the differences, fears and even misconceptions we may have related to mental health. We get to be the change in this society by being available. By addressing something this important in the middle of these changing times while beginning a new decade. Let us consider this a chance to open a new page in mental health conversation in grassroots level work and policy.
Text by Maria Amani, Familia's intern.
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