The social dimensions of health and illness in the Sri Lankan Tamil diaspora: Implications for mental health delivery

Immigrant communities are often not well served when it comes to mental health services. A fundamental reason for this may lie in differing cultural concepts of what it means to be healthy. The aim of this paper is to capture how Sri Lankan Tamils with a diagnosis of depression, newly arrived to Toronto, Canada, conceptualize health, and to determine whether this conceptualization is shared by care providers who provide service to this community. The data are derived from a qualitative study based on interviews with 16 Sri Lankan Tamil immigrants who self-report being diagnosed with depression and 8 service providers who work with the community. Findings show that the Sri Lankan Tamil community emphasizes social functioning as the hallmark of health. Study participants see depression as linked to a breakdown in social functioning. The community also holds an integrated notion of health, one that encompasses physical, mental and social components. Responses show little evidence for a belief in the role of the supernatural in causing mental illness. Medication is seen as part and parcel of ill health; it is sought during overt illness but its preventive action is not well understood. Service providers do not fully understand the community’s notions of health and illness. It can be surmised that the social dimensions of health and illness are fundamental to this community. Being well means being able to fulfil one’s social role. This suggests that the provision of social support services, vocational services for instance, needs to be a key component of mental health services. Acculturation into concepts of preventive health including the role of medication in maintaining health and preventing relapse is also important.