Mental health promotion through the prism of intersectionality: better understanding for more effective action

Jan 31, 2024

Maryse is a Black woman of Haitian origin living in Montreal. She is a nurse, and a few weeks ago, a patient refused her care because of her skin colour. This was not the first time Maryse has experienced this sort of discrimination. Unfortunately, it is part of her life, but since this incident, she has felt sadness and dreads going to work. She has lost her appetite, cries often, and has a hard time with day-to-day tasks. This is the first time Maryse has dealt with this sort of psychological distress, and she doesn’t know what to do to feel better.

She feels isolated and doesn’t know who to turn to. She feels like no one would understand. Mental health is a taboo subject in her circle, and she is afraid of appearing weak or too demanding to her colleagues.

What Maryse is experiencing is not an isolated case. Studies show that racism has a harmful effect on mental health[1]. In mental health promotion, social inequalities such as racism are considered major risk factors. Discrimination, social exclusion, and violence increase the risk of trauma, or even mental health problems.

But seeing racism as the sole factor influencing Maryse’s mental health is an oversimplification. Social inequalities do not occur in a silo and, to respond to them, we need approaches that reflect the multiple positions that people and groups occupy in a society.

Intersectionality makes it possible to refine mental health promotion strategies, because it takes into account the entrenchment of social inequalities and associated risk factors

What is intersectionality?

Intersectionality is a method of analysis that sheds light on the positions and social experiences of minorities and the different forms of exclusion produced when they overlap. In 1989, the Black American feminist Kimberlé Crenshaw introduced the concept to combat the marginalization of Black women in the United States and to better address the specificities of their exclusion. She shows that the reality of people who are at the intersection of several social inequalities is often neglected in the analysis of discrimination.

To better understand this idea, let’s go back to the example of Maryse. As a Black woman, Maryse experiences discrimination based on gender and race

An intersectional approach to mental health promotion therefore considers different forms of exclusion to highlight heterogeneity in mental health and develop more appropriate tools.

Destigmatizing and pluralizing strategies

Stigmatization in mental health is one of the biggest hurdles to seeking help. The majority of the public still perceives mental health issues as negative. When people experience repeated discrimination, as in the case of Maryse, talking about mental health issues is even more difficult. In some cultural settings, people do not discuss mental health at all. For many people of colour, mental health issues are associated with colonization and efforts at control[2]. Mental health promotion has to reflect these different realities. Promoting mental health among Black communities in Montréal, for example, requires sensitivity to colonial history and the discrimination experienced by the Black community[3].

In terms of stigmatization, media representations also have to be considered. Studies show that women and people of colour are overrepresented in negative narratives about mental health[4]. Historically, literature and film have contributed to depicting women and racialized people as morally and psychologically inferior. Since Maryse has both identities, it is no surprise that she would have a harder time getting help. She fears not being heard or that her loved ones will see her as “inferior.” She is reluctant to talk about what she is experiencing at work, afraid that her colleagues will see her as someone who is “too emotional” and “disruptive.”

Intersectionality is much more than a concept, an approach, or a method: it is a tool to take action on social and health inequalities. It calls into question a univeralist principle in mental health promotion and reminds us that we need to adapt our efforts to the plural realities of people and social groups.

[1] On the impact of racism on the mental health of children and youth, see: https://kmb.camh.ca/fr/eenet/documentation/points-de-vue-sur-la-recherche-les-repercussions-du-racisme-sur-la-sante-mentale-des-enfants-et-des-adolescent-e-s.

Report of the Mental Health Commission of Canada on Mental Health in Black Communities: https://www.mentalhealthcommission.ca/wp-content/uploads/drupal/2021-02/covid_19_tip_sheet%20_health_in_black_communities_fr.pdf

[2] See Black Madness: Mad Blackness by Therí Alyce Pickens (2019): https://www.dukeupress.edu/black-madness-mad-blackness

[3] https://www.rcinet.ca/fr/2021/02/16/au-canada-on-vise-lequite-en-sante-mentale-pour-les-communautes-noires/

[4] See Madness, Power and the Media: Class, Gender and Race in Popular Representations of Mental Distress by Stephen Harper (2009).