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Outreach volunteers for a student-led drug overdose prevention group host harm-reduction training sessions at a community gathering site. Photo: Students Overcoming Opioid Use Disorder & Addictions

B.C. groups work to reduce mental health stigma in South Asian community

Grassroots organizations are using language and culturally-specific strategies to close mental health and addiction use gaps.

By Eleni Vlahiotis and Ashishvangh Contractor , in City Health , on April 16, 2021

Dupinder Kaur Saran was attending a protest in support of Indian farmers outside the country’s Vancouver consulate during the early hours of March 1 when she saw a young man off to the side overdosing. The registered nurse sprung into action.

“It almost got to a point where he was showing no sign of hope,” Saran said. “I quickly ran back to the vehicle, grabbed my naloxone kit, and we injected naloxone, and immediately it started to take effect. Had we not done that, he may not have survived.”

While she was treating the man, a small crowd of curious onlookers gathered around her. Saran saw the opportunity to share her knowledge and trained three of them to use a naloxone kit to save someone’s life.

“At the end of the day, it became more of a beneficial situation,” she said. “Those same individuals then contacted me at a later date and went and actually got training and now carry naloxone kits on hand with them as well.”

Saran is a volunteer with Students Overcoming Opioid Use Disorder & Addictions, a grassroots outreach initiative that was started in 2019 by volunteers of the South Asian Mental Health Alliance.

The student-led organization provides outreach and training on opioid-overdose response and prevention to the South Asian communities in Surrey and Delta, which have been hit hard by the opioid crisis.

This is one of a new cluster of groups working to tackle drug overdose in the South Asian community.

SOOUDA outreach team doing a naloxone kit demonstration at the Guru Nanak Sikh Gurdwara in Surrey, B.C. Photo: SOOUDA

Fraser Health, a region that is 75 per cent South Asian, has observed a steady increase in overdoses, with 2020 seeing a 74-per-cent increase in drug overdose deaths compared to the previous year.

According to Fraser Health’s 2019 chief medical health officer’s report, drug-toxicity deaths among South Asian people increased by 255 per cent between 2015 and 2018. In comparison, there was a 138-per-cent increase in deaths among other residents.

Allysha Ram, one of the directors of a local collective that helps connect South Asian people to health and social services, has witnessed this first-hand.

“Unfortunately, what we’ve seen in the Fraser region is an over-representation of the South Asian community in the overdose deaths.”

Cultural and language-specific programs are the key

The collective that Ram belongs to, the South Asian Community Hub, was created in 2019 to address the gap that she and other members of the organization saw in the lack of culturally appropriate health services for the South Asian community.

People in the South Asian community struggle to access mental-health services for a number of reasons, including lack of services in their language, lack of culturally appropriate care, and stigma.

“There’s a lack of culturally appropriate services and support for this population,” Ram said. “And with the existing services and supports available, we see low engagement in them by the South Asian community which suggests some barriers to accessing these supports.”

This is a sentiment echoed by others.

“There is a lot of taboo in the South Asian community, on topics such as mental health, substance abuse,” said Tajdeep Sandhu, co-director of Students Overcoming Opioid Use Disorder & Addictions. “And because of this, many of them do not go and reach out to professionals, or do not seek rehabilitation facilities.”

Language barriers mean that certain words or phrases don’t translate well.

“Many of these terms — like opioid — can’t be easily translated into, for example, Punjabi, or Hindi,” Sandhu said. “So our focus has been trying to find relevant terms in Punjabi or Hindi or other languages that these people can easily understand.”

SOOUDA volunteer holding opioid overdose awareness sheets in translated in Punjabi and English. Photo: SOOUDA

In response, both the student group and the South Asian hub have sprung up to create culturally and language-appropriate mental-health and addiction-use support services.

One culturally specific way that both organizations work is by sending outreach volunteers to community spaces, such as parks, gurdwaras, temples, or mosques, to set up booths and talk about the challenges of substance use.

Conversations with the community also include handing out language-appropriate instructions about how to use the kit properly.

Gurkirat Nijjar, the founder of the student-led prevention group, has experienced first-hand the positive responses from the community.

“The response which we received was overwhelming — it was really, really positive,” Nijjar said. “The response from the general public was really, really uplifting. They were so happy that someone was doing this kind of work, so that actually motivated us to do more.”

There is history behind the numbers

In order to explain why South Asians are dying from overdoses more frequently than other people, Ravia Dhaliwal, a facilitator for the Punjabi Alcohol Resource, turns to history.

Ravia Dhaliwal, mental health advocate and facilitator for ASRA: the Punjabi Alcohol Resource. Photo: Ravia Dhalliwal

“You have to look at it historically,” Dhaliwal said. “In order to culturally understand the current crisis, it is important to be aware of the imperialistic circumstances under which opioids and other addictive substances were brought into Punjab.”

During the 1960s and 1970s in India, opioids were used frequently by workers after long, hard workdays to alleviate stress. As South Asians immigrated to the West, they continued to use opioids for pain and stress relief.

“When people move, they’re often not moving with a lot of capital and need to work very hard labour jobs,” Dhaliwal said. “When they do work those labour jobs, they end up using similar coping mechanisms that they’ve seen used before, or even used themselves.”

This pattern of substance use trickled down, generation after generation, and the impacts are still felt to this day.

Kulpreet Singh, founder of the South Asian Mental Health Alliance, says he can’t stress enough how important that context is to mental health and substance use support.

“The important thing, when you’re talking about any racialized community, is the impact of settlement, the impact of systemic racism, the impact of colonialism, the impact of intergenerational trauma,” said Singh, whose non-profit has been around since 2010.

“Not just ‘If you need help, please reach out’ — that’s great for Bell Let’s Talk day, but it’s not good for the other 364 days of the year.”

Dhaliwal says that the conversation that these organizations are starting in communities are especially important because of the direct link between faith and mental-health support training.

“Being religious and following the Sikh faith, a big part of it is doing Seva and helping others selflessly,” she said. Seva, also known as “selfless service,” is a core principle of Sikhism.

“Part of that is helping others to the best of your ability,” Dhaliwal said. “So if you are to do Seva, and you are able to administer naloxone to someone and save their life, why wouldn’t you, why wouldn’t you save someone else’s life?”

Looking to the future

Mental-health and substance-use services need more than just awareness-raising — Singh also wants to see better accessibility of these resources.

“Accessing mental health services is not just about stigma reduction,” Singh said. “It’s also about changing the service model. It’s not only enough to give people a business card or tell them a website, but it’s also important that when they reach that phone number, or when they reach out to a website, that they can get access to the service they need.”

SOOUDA founder Gurkirat Nijjar. Photo: Gurkirat Nijjar

In the meantime, SOOUDA is working to expand their services to as many people as possible.

“Our vision for the future is basically to train as many people as we can,” Nijjar said.

What motivates Singh and Nijjar to continue their outreach and harm reduction sessions are the individuals and family members that reach out for support.

Nijjar recalled a story of a community elder who approached SOOUDA last summer. The man, whose son was using opiates and was unwilling to undergo addiction treatment, felt helpless and desperate for support.

SOOUDA gave the man, who did not speak English and had no medical background, full naloxone training and a kit to take home.

“That uncle was fully trained, and he was good to go,” Nijjar said. “He practiced two or three times at our booth with all the supplies, and he was then able to follow all the steps.”

“That was one of the biggest, I would say, achievements we got,” he said. “The happiness which I can see in that person’s eyes — he was so much more confident.”

It’s stories like this that keep Nijjar motivated in the work he does.

“Seeing them adopting all the different ways they can save their loved ones’ lives is really uplifting,” he said. “It really motivates us to train more people like those who want to get help.”