Introduction

In today’s current climate, the prevalence of long-term mental health conditions continues to rise globally. Many Western and Eurocentric models utilised in modern healthcare services remain dominant, following the principles of symptom management and pharmacological interventions. However, these dominant models often overlook the consideration of intersectionality and its contribution to shaping an individual’s identity and mental health narrative.^1,2 

Ignoring the cultural factors which influence a person’s healthcare journey can lead to misdiagnosis, treatment dropout, or marginalisation, further enhancing health inequalities. It is therefore imperative to consider the importance of understanding culture not just as a demographic factor, but as central to the experience, interpretation and management of mental health. Reframing long-term mental health care and integrating cultural knowledge into clinical, policy, and community practices can aid a better awareness of the individual, their background and how that shapes their mental health.³ 

Understanding culture and mind

Culture plays a vital role in how we think, feel, relate and make sense of our experiences and mental health struggles. It contains a deep meaning, encompassing elements of our beliefs, norms, values, perceptions and behaviours; all of which contribute to creating our sense of self.⁴ 

In the context of mental health care, culture impacts the way diverse individuals interpret their experiences and relate to their suffering. It is well documented that those from racialised communities continue to face significant disparities in access to mental health care. They are more likely to require crisis support and often report more negative experiences within mental health services. Examples like this place significant challenges to access, outcomes and experience that are compounded by cultural sensitivities that are not always acknowledged or understood in clinical practice. Understanding the intersection between the culture and the mind helps take the first steps in bridging these gaps, in help-seeking behaviours and tailoring approaches to individualised cultural needs.^4,5

Medicalisation vs cultural meaning-making

Within Western psychiatry, mental distress is often framed as a biological dysfunction which requires a clinical diagnosis and treatment. This is done by following specific protocols and diagnosis regulations in understanding an individual's mental health. 

In this view, it can be useful to allow the individual to gain an insight into receiving a diagnosis of their suffering; however, considering the cultural meaning emphasises the social, historical and personal narratives through which individuals cope with their lived experiences. These narratives can largely differ according to an individual's culture and diversity.^6,7 

For example, in some African or South Asian contexts, some individuals with conditions such as psychosis and schizophrenia can place cultural interpretations on their experience in the form of spirit possession and religious communication, rather than a diagnosis of a condition. It is therefore important for clinicians to be mindful of these influences in how they approach and interact with clients from various backgrounds, needing sensitivity in how their experiences are explored.⁸ 

Cultural dimensions of long-term mental health

Several factors can influence how an individual's culture impacts their mental health care journey. 

Diagnosis and stigma

Diagnosis and stigma are deeply embedded in culture, influencing how mental health is understood. Across different societies, cultural beliefs influence how symptoms are recognised as either signs of illness or carrying an individual's spiritual personal meaning. This can impact the way individuals seek support, whether it be a medical professional, spiritual leader or traditional healer. However, in some societies, there is great stigma held towards experiences of mental illness, being associated with shame and social exclusion. These cultural variations impact whether individuals internalise stigma, acting as a barrier to hiding their distress rather than seeking support in their recovery. Understanding these dynamics is essential for developing mental health systems that are responsive to cultural meaning.^9,10

Conceptualisation 

Western psychiatric models often conceptualise mental health based on symptom management and recovery. In contrast, many cultural frameworks view mental distress as a dynamic and socially embedded process. Rather than focusing solely on symptom reduction, recovery in these contexts often involves social recovery in community reintegration and understanding personal narratives. Alternative cultural healing practices may include ritual, storytelling and collective care, offering spaces to reclaim their identity.¹¹

Identity

Long-term mental health conditions can profoundly disrupt a person’s sense of self, leading to feelings of self-disconnection and isolation. However, some cultural models suggest alternative ways of making sense of this suffering, with some traditions interpreting this as a meaningful experience. For example, in many Indigenous cultures, mental suffering may be seen as a spiritual collective calling in the community associated with deeper insight towards oneself.^12,13

Culturally competent care

While cultural competence is widely promoted in mental health care, it often remains at the level of superficial awareness without implementing real, active change. In doing so, it poses risks of recognising cultural differences without deeply engaging with the power dynamics and systemic barriers that shape care and accommodating these differences. 

Providing culturally responsive practice requires moving beyond competence to highlight an individual's responsibility and accountability in their own practice to help transform services to align with the values and needs of the communities they serve. This shift involves acknowledging historical and structural injustices, addressing power imbalances between professionals and clients from marginalised groups and how this has impacted healthcare infrastructures.^14,15 

For example, Māori health models in New Zealand insist that mental health services reflect Indigenous worldviews and uphold self-determination. These practices highlight the importance of community engagement, collaboration, and building ties with communities. Such culturally competent care is not just about understanding culture, but about transforming systems to respect and empower the communities they serve.¹⁶

Implications for policy and practice

Rethinking outcome measures 

Many mental health services often rely on standardised psychometrics in directing recovery. Such measures often include symptom reduction scales or clinical recovery markers. While being the gold standard, these pose limitations in capturing the full range of what well-being and personal recovery mean across diverse cultural contexts. These tools tend to privilege biomedical understandings of health while overlooking relational, spiritual, and communal dimensions that are central to many people’s experiences of healing.^17,18 

As a result, this may raise a disconnect in capturing the lived realities of those they aim to support. While strides have been taken in some services to integrate capturing social and personal recovery, the evidence-based investigation of these measures remains limited. It is essential for designing policies and practices that truly reflect and respect the diverse ways in which people define and experience recovery. ^17,18

Ethical considerations

When considering culture in care, there are some ethical considerations to be mindful of. In building cultural awareness, it should not be a means to justify harmful practices but rather inform frameworks that uphold universal cultural principles that are grounded in human rights models. Ensuring this incorporation into the building blocks of practice ensures all individuals receive safe, respectful, and ethical treatment. This requires ongoing reflection and dialogue with communities that reinforce partnerships that protect the well-being of those experiencing mental distress.^19,20

Systemic transformation

Decolonising mental health 

Decolonising mental health can be defined as critically examining the dominance of Western and Eurocentric theories and treatment models, which often marginalise understanding and addressing mental distress. Decolonising mental health involves re-centring these frameworks to integrate non-Western knowledge into healthcare systems. It also involves shifting power toward those most affected by mental health interventions by promoting co-design and shared decision-making with service users, families, traditional healers and community leaders. Creating spaces where this is considered can help build a more inclusive transformation of services.²¹ 

Summary

Culture acts as a fundamental component in how mental health is understood, lived and treated for many marginalised groups that come into contact with mental healthcare services. The meanings individuals assign to psychological distress are deeply embedded in cultural narratives, values, and belief systems. It is imperative to consider how paradigms can capture the richness and diversity of these perspectives, moving away from a universal one-size-fits-all approach. 

There is a pressing need to address the complex realities of long-term mental health for more culturally attuned approaches that respect the meanings people assign to their suffering and healing. Listening to and validating the voices of marginalised communities is not only ethically necessary but also critical to designing interventions that are responsive and relevant. Rethinking long-term care through a cultural lens offers new pathways to healing, dignity, and inclusion, making services more equitable.