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By the Versus Team | May 2022 | Category: Mental Health & Community Wellbeing

Reading time: approximately 6 minutes | Audience: Community Members, Clinicians, Social Workers

 

Mental health is one of the most difficult conversations to have in any language. In a second language — one you are still learning, one that does not carry your emotional vocabulary, one in which you cannot fully express the texture of your inner life — it can feel almost impossible.

Across Italy’s diverse immigrant and multilingual communities, this difficulty is compounded by something deeper: the stigma that surrounds mental health in many cultures, the fear of being labelled as weak or unstable, the belief that psychological suffering is a private matter to be endured within the family rather than disclosed to a stranger. For many people living in this intersection — between cultures, between languages, between the life they left behind and the one they are building — mental distress is not just common. It is often invisible.

This article is about making it visible. It is about understanding why mental health stigma is particularly acute in multilingual communities in Italy, what the barriers to help-seeking look like, and what individuals, families, clinicians, and organisations can do to break down those barriers with care and respect.

The Particular Mental Health Burden of Migration

Migration is, by its nature, a form of loss as well as gain. People who migrate — whether by choice, economic necessity, or forced displacement — leave behind not only a place but a language, a social network, a sense of belonging, and often a version of themselves that existed in relationship to those things. The process of rebuilding in a new country, a new language, and a new culture is psychologically demanding in ways that are consistently underestimated.

Research published across European health systems — including Italian studies conducted by the Istituto Superiore di Sanita and international migration health bodies — consistently shows that migrants face elevated rates of depression, anxiety, post-traumatic stress disorder (PTSD), and psychosomatic illness compared to non-migrant populations. Among refugees and asylum seekers — a significant presence in Italy given the country’s position as a primary entry point to Europe — rates of PTSD and complex trauma can be extremely high, particularly among those who have experienced violence, detention, or perilous sea crossings.

And yet, this population is consistently under-served by mental health services. Not because the services do not exist, but because the barriers between the person in distress and the help available are multiple, layered, and too rarely addressed.

The Stigma Barrier: How It Manifests in Different Communities

Stigma around mental health is not unique to immigrant communities — it exists broadly in Italian society, as it does across Europe. But it takes particular forms in different cultural contexts, and understanding those forms is essential for anyone hoping to bridge the gap.

In many North African, Middle Eastern, and South Asian communities represented in Italy — including Moroccan, Tunisian, Egyptian, Pakistani, and Bangladeshi communities — mental illness may be conceptualised in spiritual or religious terms rather than clinical ones. Depression may be understood as a lack of faith or a spiritual failing; hearing voices may be interpreted through a religious rather than psychiatric lens. Seeking help from a mental health professional may feel like a betrayal of these frameworks, or may be seen as unnecessary if prayer, community support, or religious guidance is considered the appropriate response.

In Chinese communities — one of the most established immigrant groups in Italy, concentrated in cities like Prato, Milan, and Rome — a strong cultural emphasis on social harmony, collective reputation, and self-sufficiency can make any public disclosure of psychological struggle feel deeply threatening. Mental illness carries the risk of bringing shame not just on the individual but on the whole family.

Among sub-Saharan African communities, the concept of mental illness itself may be understood differently — framed in terms of spiritual attack, witchcraft, or communal disharmony rather than individual pathology. This does not mean these communities are resistant to help — it means that the framing of that help matters enormously.

When someone cannot find the words for their pain — in any language — that silence is not indifference. It is often the loudest possible signal that they need support.

The Language Barrier: Why It Goes Deeper Than Words

Emotional experience is linguistically encoded in ways that resist easy translation. Research in psycholinguistics has consistently found that people process and express emotion differently in their first language compared to a second — that the emotional charge of words, the availability of nuance, and the sense of authenticity in self-expression are all tied to the language in which we first learned to feel.

For a person from Morocco living in Bologna who is experiencing depression, trying to describe their inner state in Italian — a language they may speak functionally but not emotionally — is not just a linguistic challenge. It is an existential one. The clinician who hears a flat, brief account of symptoms and concludes the patient seems “fine” or “not very expressive” may be fundamentally misreading the situation.

This is why professional interpretation in mental health settings is not a luxury. It is a clinical necessity. The presence of a trained medical interpreter — ideally one with specific experience in mental health contexts — allows the patient to speak from their first language, with all its emotional richness, and have that meaning conveyed accurately to the clinician.

It also matters who that interpreter is. Gender, ethnic background, and community affiliation can all influence whether a patient feels safe enough to disclose. In some cases, patients from small, close-knit communities may be reluctant to use an interpreter from the same community for fear of confidentiality breaches — a concern that providers should take seriously and address proactively.

What Families and Communities Can Do

Breaking mental health stigma within multilingual communities is not the sole responsibility of healthcare systems. Families and communities have a critical role to play, and even small shifts in how mental health is discussed — or whether it is discussed at all — can make a profound difference.

• Normalise the conversation. Mental health struggles are not a sign of weakness or a source of shame. Bringing them into family conversations, in whatever language feels most natural, begins to dismantle the silence.
• Separate cultural concepts from clinical realities. Spirituality and mental healthcare are not mutually exclusive. A person can observe religious practice and also receive psychological support — one does not diminish the other.
• Reach out to community leaders, faith leaders, and trusted figures. In many communities, the most effective mental health advocates are not clinicians but imams, priests, community elders, or grassroots organisations who carry genuine social trust. Supporting and equipping these individuals to talk openly about mental health is often more impactful than any clinical campaign.
• Know what is available. Italy’s SSN provides access to mental health services through the Dipartimenti di Salute Mentale (DSM) in each ASL area. Many cities also have third-sector organisations offering counselling in multiple languages. Knowing where to point someone who is struggling is itself a form of care.

What Clinicians and Organisations Can Do

For healthcare professionals and organisations serving multilingual communities in Italy, the following principles are foundational:

Screen with cultural humility. Standard mental health screening tools — depression inventories, anxiety scales, trauma assessments — were developed in specific cultural contexts and do not always translate cleanly. Clinicians should use them as starting points, not endpoints, and should be prepared to explore symptoms through the patient’s own cultural framework as well as a clinical one.

Use professional interpreters for every mental health consultation. The stakes are too high for ad hoc arrangements. A mistranslated emotional nuance in a psychiatric assessment can lead to misdiagnosis, inappropriate treatment, or — in the worst cases — serious harm.

Create environments where people feel safe. A clean, private, non-clinical space. A warm welcome at reception. A poster or leaflet in the patient’s language. These details signal inclusion and can be the difference between someone returning for a second appointment or disappearing from care entirely.

Mental health support is only accessible if people feel safe enough to reach for it. Creating that safety — across languages, cultures, and histories — is the most important first step.

 

Published by Versus — Health & Language Mediation Services | versus-srl.org

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