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Strength-in-Unity

    Strength-in-Unity, completed in 2017, was the first comprehensive community-based action research that mobilizes men in the Asian Canadian communities to address mental illness stigma and promote mental wellbeing. It was an innovative study that combined the use of psychotherapeutic, collective empowerment, and critical health promotion approaches to meaningfully engage East, Southeast and South Asian men, and communities to advocate for system change to achieve mental health equity.

    Importance of the Study

    About one in five people in Canada and worldwide experience mental health challenges in their lifetime. Many people experiencing mental illness do not seek help or services due to the fear of stigma and discrimination. Racial minority groups, immigrants and refugees experience a disproportionate burden of mental health disparities associated with systemic barriers to social determinants of health, resulting in a lack of access to adequate income, employment, housing, and culturally inclusive health services. These challenges are further compounded by everyday experiences of racism and multiple forms of social exclusion. Asian communities, which make up of 15% of the Canadian population and represent the fastest growing ethnoracial population in Canada, encounter barriers to mental health care. Further, men in Asian communities are faced with additional access to care related to gendered expectations of being strong, successful and self-sufficient.

    The Strength-In-Unity Study

    Strength-In-Unity is a community-based action research funded by The Movember Foundation to build capacity among Asian men in Calgary, Toronto, and Vancouver, and to mobilize them to become Mental Health Ambassadors (MHAs). The objectives of study included: (1) raising awareness about the social determinants of mental health, misconceptions of mental illness, and knowledge of community mental health resources; and (2) building capacity among Asian men to identify their mental health needs, address mental illness stigma, and advocate for effective and inclusive mental health care for Asian men and communities.

    The Strength-In-Unity Interventions

    Strength-In-Unity applies two interventions to address mental illness stigma and mobilize Asian men:

    • Acceptance and Community Therapy (ACT) — an evidence-based behavioural therapy that promotes psychological flexibility through experiential learning activities of acceptance, mindfulness, value clarification, and committed action.
    • Contact-based Empowerment Education (CEE) – a community-based empowerment education that focuses on skills development and increased understanding of mental illness through the opportunity to interact with individuals living with or affected by mental illness.

    Study Participants

    Strength-in-Unity is a national project that engages Asian men in three sites – Calgary, Toronto and Vancouver. The project team is made up of academic researchers, mental health professionals, and community partners. Over 1200 Asian men of diverse ages (17 to 80), sexualities, and ethno-cultural backgrounds were randomized into four groups – control group with one 2-hour session of psychological education on mental health and mental illness, ACT only group, CEE only group, and a combo ACT+CEE group. Participants who completed the ACT and CEE training were mentored to become community mental health ambassadors (MHA)

    Results

    This study showed the following important findings:

    • The mental health of Asian men and communities are influenced by myriad of individual and structural factors that range from their pre-migration contexts to post-migration experiences of (un)settlement and (non)integration. 
    • Asian men’s understanding of and responses to mental illness stigma are complicated by their social identities and minority positions.
    • The ACT and CEE interventions are effective in addressing many psychological and social aspects of mental illness stigma.
    • Evidence of community action taken by trained MHAs to address mental illness stigma and promote mental wellbeing in Asian communities
    • Effective stigma interventions for racialized and immigrant men in Canada must consider the intersecting effects of social determinants such as racialization, ethnicity, gender, age, socioeconomic status, education and length in Canada.
    • Effective mental health programs and services must be coordinated and implemented at multiple levels to reduce the burden of stigma and access barriers.

    Principal Investigators: Dr. Sepali Guruge (NPI), Dr. Souraya Sidani (Co-PI), and Dr. Josephine P. Wong (Co-PI & Toronto Co-Lead), Ryerson University; Dr. Kenneth Fung (Co-PI & Toronto Co-Lead) & Dr. Kwame McKenzie (Co-PI), University of Toronto; Dr. David Este (Co-PI & Calgary Lead) & Dr. Daniel Lai (Co-PI), University of Calgary; Dr. Marina Morrow (Co-PI & Vancouver Lead) Simon Fraser University.

    Co-Investigators: Dr. Amy Bender (University of Toronto); Dr. Stephanie Bryson (University of British Columbia); Dr. Naila Butt (Social Service Network); June Clark, Christine Mummery, and Dr. Shireen Surood (Alberta Health Service); Dr. Jamie Livingston (St. Mary’s University); Sridhar Pendakur (Canadian Mental Health Association); Dr. Yogendra Shakya (Access Alliance Multicultural Health and Community Services); Lana Wells (University of Calgary)