Improving Community Mental Health Services for Canadians of South Asian Origin: Using Culturally Adapted Cognitive Behaviour Therapy (CaCBT)

Dr Nagina Khan and Dr Farooq Naeem

Professor Kwame McKenzie has pointed out that ‘the health system is not working for some groups and that they wanted a deal which would give them hope rather than cement their misery for another decade.’

So, who are the individuals that the health system is not working for? They are the people living in low-income areas with a considerable shorter life expectancy than the host populations in high income countries. In our current research article, we focused on such a group, Canadians of South Asian Origin.

We looked at the racialized residents that had experiences which they described as being incapacitated by chronic diseases and so they could not access good mental health care and for whom positive outcomes from treatment were worse than other groups and the host population in Canada. There are 2.6 million South Asians in Canada, yet, there are limited mental health services that are culturally appropriate and there are very few formal culturally adapted treatments that have been implemented or evaluated. We felt that research for service user benefit and positive outcomes should be developed with service users and community partners involvement at the inception of our project.

With funding from Health Canada, CAMH collaborated with the following organizations:

The Mental Health Commission of Canada (MHCC)
Moving Forward Family Services (Vancouver),
Punjabi Community Health Services (Greater Toronto Area)
Ottawa Newcomer Health Centre (Ottawa)

We had the involvement of South Asian clients, care givers and family members, mental health providers and South Asian community leaders. This led to a more creative way of conducting our research where individuals said that they felt that they can open up and trust services and researchers with their personal and mental health experiences.

This study aimed to create a CaCBT manual for the SA Canadian population living with anxiety and depression. In order to do this, we had to culturally adapt CBT, and explore participants’ understanding of mental health, their experiences with mental illness, access to mental healthcare, and to elicit the recommendations to improve treatment for this group.

To improve provider knowledge and treatment of culturally appropriate care for South Asian Communities, we created and offer several resources for mental health professionals and for the general public to access free of charge.

Furthermore, our work involved carrying out interviews where people were encouraged to talk freely about specific pre-determined topics. We recruit individuals from four different target groups through our partnering agencies within the target local community.

Five themes emerged from the analysis, that were important to our clients and those groups who accessed our mental health services,

Awareness and preparation were factors that influenced the way people understood therapy and their mental illness.
Access and provision were barriers that stopped people from accessing services for treatment.
Assessment and engagement were really about people’s experiences of getting treatment that actually helped relieve their issues.
Adjustments to therapy was focused on the way people and groups wanted changes to be made to the standard CBT intervention.
Ideology and ambiguity this confusion centred on factors that individuals could not control such as racism, immigration, discrimination, and other socio-political aspects but at the same time these factors also subjected them to mental health issues and illness with little provider support or intervention to understand their difficulties.

We found that participants who received CaCBT reported lower levels of mental illness symptoms and higher self-reported overall health than those receiving standard CBT. The number of mental health visits to a psychiatrist, psychologist and other medical doctors was also significantly lower in the CaCBT group, indicating that expanding this therapy more widely in Canada could reduce strain on the healthcare system.

You can access our full report here.

Our research and project team created knowledge translation materials that can be accessed by providers and the general public from the links below:

Training package

CaCBT Manual: that gives mental health professionals hands-on techniques for implementing the therapy including quick tips, handouts, and easy-to-use summary sheets (available in English and French).

Training Videos: to supplement the manual and enrich trainees’ experience while learning about CaCBT. Videos include role-play scenarios, learning activities, and summary of concepts to help learners enhance their CaCBT training experience. Click here to view the entire playlist.

Information Flyer for Mental Health Professionals:Provides details about CaCBT, along with quotes from service users and mental health professionals about their experience with the intervention (available in English and French).

For general public

Information Flyer for Service Users:

Provides CaCBT information on what to expect from the therapy, and quotes from individuals who previously received the intervention (Available in English).

read the article

Article Details
Culturally Adapted Cognitive Behaviour Therapy (CaCBT) to Improve Community Mental Health Services for Canadians of South Asian Origin: A Qualitative Study
Farooq Naeem, Nagina Khan, Nazia Sohani, Farhana Safa, Mehreen Masud, Sarah Ahmed, Gary Thandi, Baldev Mutta, Azaad Kasaam, Kamlesh Tello, Muhammad Ishrat Husain, Muhammad Omair Husain, Sean A. Kidd, Kwame McKenzie
First Published June 27, 2023 Research Article
DOI: 10.1177/07067437231178958
The Canadian Journal of Psychiatry

About the Authors

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Dr Nagina Khan, Ph.D. is a Senior Postdoctoral Researcher, Cultural Psychiatry & Health Inequalities (CHiMES), Department of Psychiatry, Oxford University. She is working on the Experience based investigation and Co-design of approaches to Prevent and reduce Mental Health Act Use: (CO-PACT) study. Nagina has worked as a Scientist at Centre for Addiction and Mental Health (CAMH) on the mixed method study focused on the Cultural adaptation of CBT for Canadians of South Asian Origin. She was a Medical Research Council (MRC) Research Training Fellow, her research was centred on complex interventions for people with depression, University of Manchester. Post-doctoral studies were undertaken at the NIHR School for Primary Care Research, UK focusing on First episode Psychosis in Young People Using Early Intervention services. Other research interests include, Social Justice in medical education, Professionalism in undergraduate medicine and Incentivisation Schemes in healthcare for HICs and LMICs. Nagina is an Editorial board member of the BioMed Central Medical Education Journal. She is also the BMJ Leader Editorial Fellow.

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Dr Farooq Naeem, Ph.D. is a Professor of Psychiatry at the University of Toronto and a psychiatrist at the Centre for Addiction & Mental Health, and Principal Investigator of the Culturally Adapted CBT for South Asians Research Study. Farooq has pioneered techniques for culturally adapting cognitive behaviour therapy (CBT) that have been used to adapt CBT in South Asia, North Africa, Middle East, Kenya, China and now for South Asians in Canada.