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Iqbal Kaur Gill, B.A., B.Ed.,Dipl.Ed. is a graduate student in the M.A Counselling Psychology program at the University of British Columbia. She is working to complete her thesis on Punjabi Sikh parents’ belief about adolescent suicide related behaviors. Currently she is a counselor with the Vancouver School District.
I am honored to contribute an article to the Sikh Foundation on what I consider to be a topic of great importance – adolescent suicide. As the second leading cause of death among youth in Canada, suicide is a somber concern nationally. Despite a growing Punjabi Sikh population in Canada, particularly in the metro Vancouver area, very little has been documented about suicide among Punjabi Sikhs. As a recent M.A. graduate from the Counselling Psychology program at the University of British Columbia, I wanted to begin to address this gap in the mental health literature. I was particularly interested in exploring the beliefs about suicide and suicide-related behaviors held by first generation Canadian Punjabi Sikh parents’ of adolescent children.
I am a second generation Canadian Punjabi Sikh woman residing in the Greater Vancouver Area of British Columbia. For the past five years I have been working as a school counsellor in the South East area of Vancouver where there is a significant South Asian population. One of the many issues I address with students and their families is suicide and suicide-related behaviors. In my counselling practice, I recognize the benefits of offering culturally appropriate services, of helping parents understand the therapeutic process, and ensuring that confidentiality is honored. Although parents are sometimes reluctant at first, I do find that they are willing to listen and to engage the services provided.
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On a personal note, the topic of suicide is close to my heart since my family has felt the repercussions of a youth suicide. As a counsellor and an academic, I aspire to help Punjabi Sikh families prevent unnecessary deaths.
The premise of my study was that parental beliefs about adolescent suicide and suicide-related behaviors influence how parents respond to adolescent suicidal behavior, the treatment interventions they seek out, the treatment services they access, and the barriers they encounter in obtaining such services. I was interested in how these beliefs shape behavior, and to what extent parental beliefs reflect religion and culture. I explored parental beliefs by interviewing three groups of participants: first generation Canadian Punjabi Sikh parents of adolescent children, second generation Canadian Punjabi Sikh young adults, and South Asian mental health and medical professionals, and a community leader, Mr. Harinder Singh, the Chief Programming Officer of the Sikh Research Institute.
Believed Causes of Suicide and Suicide-Related Behaviors
Participants in the study believed there were a number of possible reasons causing adolescents in their community to engage in suicidal behavior; these included difficulties with peer relationships, lack of parental attention, pressure from parents to succeed, teenage hormonal changes, mental illnesses and disconnect with the divine. Peer relationships were believed to have the greatest impact upon adolescent’s mental health. Mr. Grewal, a parent participant of the study, noted the importance of peer relations for adolescents:
I think that growing up at that age is difficult enough, so maybe her friendships, her acceptance from other teenagers. I mean could be responsible for [suicide]…
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Reaction to Suicide and Suicide-Related Behaviors
First generation Canadian Punjabi Sikh parents tend to exhibit shock and anger in reaction to adolescent suicide and suicide-related behaviors. The emotional shock is experienced when parents first learn of their child exhibiting suicidal behaviors. Parents may react with anger when they consider all that they have provided their child, and what the adolescent’s behavior indicates about their home life. Ms. Sandhu, a mental health professional who participated in the study, noted:
I believe, again, besides the one I saw several years ago, the initial response was actually more around anger. Like how could my child make such a choice? What were they thinking? How could they do this to us? Not just themselves, but it becomes a real family issue, how could they do this to us?
The emotional responses to adolescent suicide and suicide-related behaviors may not be completely explained by culture and religion since first generation Canadian Punjabi Sikh parents respond emotionally to suicide and suicidal behaviors in exactly the same fashion as other parents do. However, culture may determine which emotions are considered appropriate to express; anger may not be viewed as an inappropriate reaction to adolescent suicide and suicide-related behaviours by first generation Canadian Punjabi Sikh parents.
Interventions Utilized in Response to Suicide and Suicide-Related Behaviors
Parents identified a number of interventions they were likely to access in the circumstance of suicidal behavior. These included seeking support from the Gurdwara, accessing western medical health care, opening a line of communication with their child, monitoring the adolescent’s behavior, and obtaining support from family members. Ms. Sandhu, a mental health participant, noted the tendency to resolve issues within the family:
I know that when there are issues in the home, whether it’s a child with suicide ideation or whatnot there are other means that people use, though therapy is kind of like at the very bottom of the list. And mental health intervention is at the bottom of the list. But you know consulting with other family members or having a prayer or trying to find something kind of within their own toolbox to assist in the issue prior to coming to mental health services. And by the time they come to us, they have pretty much tried a lot of other things.
Family members could potentially serve as an excellent support system for the parents and for adolescents experiencing suicide-related behaviors; however, it is also possible that receiving assistance from family members could delay medical and mental health treatment for adolescents.
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Barriers to Accessing Mental Health Services
The study identified particular barriers first generation Canadian Punjabi Sikh parents encounter in accessing mental health services when dealing with adolescent suicide and suicide-related behaviors. These identified barriers included a lack of understanding about mental health, a lack of awareness about the mental health services available in the community, and a cultural stigma upon mental illnesses. A lack of exposure to the concepts of mental health and mental illnesses was noted as possibly preventing parents from fully understanding mental health issues, such as adolescent suicide and suicide-related behaviors. Ranjit, one of the young adult participants, noted her difficulty in discussing the concept of mental health with her parents:
Sometimes I think it’s just because the lack of understanding. And my mom, she’s never talked about learning psychology in India. It’s like you’re either happy, unhappy, you’re good, you’re bad. There’s no grey area.
The abstractness of mental health concepts may make these concepts more difficult for parents to grasp, which may lead parents to overlook the need for mental health services.
Participants identified membership in the Punjabi culture as a barrier to parents seeking mental health care services in the case of suicide and suicide-related behaviors. The study found that while parents perceived the Sikh religion as an advocate for mental health services, suicidal behavior may be concealed in order to protect family honor and to reduce the cultural stigma of mental illness.
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Help Seeking Behaviors
The study revealed constructive changes in the help seeking behaviors of first generation Canadian Punjabi Sikh parents dealing with adolescent suicide or suicide-related behaviors; in recent years parents have been accessing professional help more readily. The Punjabi Sikh community has recognized mental health illnesses to affect the Punjabi Sikh community. Consequently, the community is more open to the benefits of professional help in dealing with the illnesses. Also, there is less of a cultural stigma attached to mental illness than in the past; mental illness does not bring dishonor to a family to the degree it once did. Mr. Singh, the community leader participant of the study, noted this shift in help seeking behaviors: So I think there is this whole idea of honor, this whole idea of who you are as an individual. It’s changing; it’s more dynamic. In the Diaspora, you are beginning to have families, beginning to talk about this. So it’s not considered dishonor, they are still hiding it, but it’s not as much of a bad thing if you talk about it [mental health] as it was earlier.
Participants felt that better understanding about mental health would result in first generation Canadian Punjabi Sikh parents seeking mental health support services for their adolescent children exhibiting suicidal behaviors.
In summary, this is the first study to describe first generation Canadian Punjabi Sikh parents’ beliefs about adolescent suicide and suicide-related behaviors, and to identify how they contextualize adolescent suicide and suicide-related behaviors. The study found that first generation Canadian Punjabi Sikh parents are aware of many protective factors against suicide and are able to help reduce the risk of adolescent suicide and suicide-related behaviors. The study also found that parents would benefit from learning more about the causes and warning signs of suicide, the protective and risk factors for suicide, and the available mental health care services. Mental health clinicians are in the best position to develop and deliver such educational programs.
The findings of this study empower mental health professionals to work within first generation Canadian Punjabi Sikh parents’ framework and to provide culturally sensitive and appropriate services for parents with adolescents experiencing suicide-related behaviors. This integrated perspective would take into account the context in which the clients situate suicide, which contributing factors they identify, and which interventions they are likely to embrace. Mental health care service providers need to reach out to the parents to help them to access necessary services for their adolescent children. Clients who feel confidentiality will be honored are more likely to access mental health services. Developing a therapeutic alliance with parents may allow parents the opportunity to be more open in sharing their experiences and engaging in the therapeutic process.
Although barriers to accessing mental health services persist, the Punjabi Sikh community does need to be acknowledged and commended on its efforts to being more open to receiving mental health care services. The community would do well to recognize the progress it has made in addressing the issue of suicide and suicide-related behavior, and continue to raise awareness of adolescent suicide and suicide-related behaviors. Gurdwaras, in particular, are recognized as a very efficient way of disseminating information about mental health issues for Punjabi Sikhs. Informational sessions held at Gurdwaras have the potential to reach a large number of Punjabi Sikh families. Having information presented in a public forum affords community members a degree of privacy and reduces the risk of stigma attached to mental illnesses.
By my research I hope to initiate a public dialogue among members of the Punjabi Sikh community about adolescent suicide and suicide-related behaviors, a topic that has been silenced in the past due to cultural stigma. It is important to help Punjabi Sikh parents understand the phenomenon of adolescent suicide in order to prevent the unnecessary deaths of Punjabi Sikh youth. I invite medical and mental health professionals to contribute further research to this area to assist us to better meet the needs of Punjabi Sikh youth.
The complete thesis is available here. (This link will lead you to the abstract of the thesis and provide access to the thesis in PDF format.)