First Monday

Preparing for online peer support for Punjabi men's mental health by Kulvir Bahra, Shuranjeet Singh, and Taimour Ahmed



Abstract
In the context of the COVID-19 pandemic, some Punjabi men have supported their mental health through digital peer support interventions. However, there is little research which reflects upon the impact of peer support education for people who identify as culturally, linguistically, or geographically Punjabi. This review aims to map, discuss and appraise the scholarly literature concerning Punjabi communities and peer support education. Open-source articles published in English were sought through Google Scholar due to broadest accessibility. Screened articles were analysed for common themes, summarised, and critically appraised alongside a case study reflection. The findings show that there is a distinct lack of literature which could help to develop and evaluate digital peer support education for Punjabi populations and that future research is warranted. Despite this, some existing research can provide scholarly foundations for such work. Further practice and evaluation is required to understand the potential possibilities and pitfalls for peer support education in Punjabi and racialized communities more broadly. Future research should take a specific focus on the potential for impact in peer support for Punjabi communities to explore the unique needs of the population. Without such research we risk being unable to develop precise and specific peer support interventions which may exacerbate existing inequities within mental health more widely.

Contents

Introduction
Research questions
Methods
Literature review: Key findings
Literature review: Discussion
Case study: Taraki Wellbeing
Limitations
Conclusion and next steps

 


 

Introduction

On 17 March 2020 the U.K. government announced a national lockdown that placed the country into a state of emergency. This was following the spread of SARS-CoV-2, more commonly known as COVID-19, around the world. The COVID-19 pandemic did not affect all populations around the world equally. In-fact, those in the Global South and in low resource settings within the Global North were disproportionately impacted by its varied consequences, whether premature death, mental health challenges, or job losses (Public Health England, 2020; Lawrence, 2020). As such, the extent of global inequity was revealed and exacerbated. Concurrently, the global Black Lives Matter movement was propelled following the brutal murder of George Floyd in 2020 which further heightened the corrosive impacts of systemic anti-Blackness within and across societal and political institutions.

Taraki Wellbeing is a not-for-profit organisation based in the United Kingdom which has responded to particular community issues emerging from the pandemic. Taraki works specifically with Punjabi communities to reshape approaches to mental health and during the height of the pandemic. The organisation conducted citizen scientist-led research focusing on the impact of the pandemic on their audiences (Taraki Wellbeing, 2020).

Following this, the organisation recognised the extent of the mental health challenges, which, if left unsupported, could become particularly disabling experiences for the individual (Spandler, et al., 2015). In this context, Taraki turned to peer support and established its online peer support groups for Punjabi men, Punjabi women, and Punjabi LGBTQ+ groups. The impact of the men’s peer support sessions on participants as well as the high demand meant that the organisation started developing a peer support curriculum to work with and train partner organisations to deliver and evaluate such spaces with their particular Punjabi communities to enable greater scaling.

During the development of this curriculum, the authors recognised that there was a marked gap in the scholarly literature around Punjabi men’s peer support. As such, three key components of the programme were identified to form the basis of this literature review and case study reflection: approaches to mental health in marginalised communities, conceptualisations of peer support, and the potential for connecting and transformative online learning. These concepts formed the foundation of the research question, methodology, literature analysis, discussion, case study, and conclusions which are shared below.

 

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Research questions

The two key research questions for this paper were as follows:

What can be learnt from open access literature about how to structure online peer support education in Punjabi men’s mental health?

How can existing scholarship be supplemented by the evaluation of online learning and peer support in Punjabi men’s mental health?

 

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Methods

Aim of review

The aim of this review was to explore the literature within and surrounding peer support interventions which are aimed at Punjabi men.

Search strategy

A search was conducted on Google Scholar and keywords included ‘Punjabi men’s mental health’, ‘Punjabi mental health’, ‘Punjabi peer support’, ‘peer support education’, ‘race and mental health’, ‘transformative learning Punjabi’. In searches where no obvious results concerned Punjabi communities the search terms were expanded to communities racialized as non-white, which is defined as those communities who experience perceived and actual harm within the context of white-dominant systems. As well as the initial search, reference lists were scanned for any additional articles which may be of relevance.

Inclusion criteria

The following inclusion criteria were placed on all studies:

A total of 17 studies met the inclusion criteria, out of which a range of papers were excluded due to being out of topic and scope. This paper is intentionally focused to try and understand the granularity and applicability of topics, beyond which we felt this paper could become a very generalised paper without a strong narrative structure and applicability. We feel that this paper will have the potential to enable more focused research which balances both knowledge making and implementation in grassroots contexts.

Analysis method

After the initial searches had been completed, 256 articles were identified as being potentially useful to this review. Subsequently, the abstracts and key findings of these articles were screened in duplicate. Following this, full text articles were assessed for eligibility in duplicate and 17 papers were left which were included in this review.

This article undertakes a narrative review (Baumeister and Leary, 1997) to provide a summary, thematic analysis and interpretation of scholarly literature in relation to the research questions. In doing so, it presents the connections as well as the gaps in the literature focused in and around peer support education for Punjabi men. The process for undertaking this narrative review included:

 

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Literature review: Key findings

Mental health in racialized communities

Literature specifically concerning Punjabi men’s mental health was sparse or non-existent within the database search. As such, the search terms were expanded into mental health within Punjabi communities and racialized communities more broadly to try and understand emerging knowledge, trends, points of comparison and gaps. The studies which emerged largely considered the provision and application of mental health interventions.

According to the studies, mental health interventions and their effectiveness have historically not been considered in relation to racialized communities. By approaching mental health through a single-lensed, Western-centric paradigm, experiences of racialisation were rarely considered within the domain of mental health outcomes. While conceptual reflections on mental health were still scarce, moving into the 1990s there began to be an increasing importance placed on the service delivery of psychological therapies within ‘ethnic’ or racialized communities. It was evident in several articles that delivering psychological therapies in such contexts was an evolving priority within the context of fewer minoritised ethnic populations accessing psychological support from existing services. Griner and Smith (2006) attempt to quantify the effectiveness of culturally specific interventions for mental health by stating that using a targeted approach towards a specific cultural or racialized group was four times more effective than groups with a mixed variety of cultural and racialized backgrounds. In this sense, the literature in this review concerning mental health and race took a more specific focus on the delivery of psychological services, such as talking therapies, and their need to be adapted to particular racialized experiences. Literature about Punjabi communities and mental health was incredibly limited within the inclusion parameters. Within this search the very limited literature on mental health in Punjabi communities explored conceptualisations of depression (Chahal, 2018). In particular, there is said to be a lack of understanding around what depression is in practice which leads to fewer people speaking up, increased isolation and seeking support only in crisis situations (Chahal, 2018). It is within this lack of awareness or conceptualisation that increases tensions, feelings of helplessness and being unable to confront these challenging subject matters.

Peer support

Peer support in mental health includes activities between people who share similar lived experiences, including: diagnosis, racialization, migration, sexual orientation, to name but a few. It is intended that peer support offers connection and provides hope in supporting people with their mental health (Yee, 2019). However, it again became apparent that there is no literature on such topics within the context of mental health in Punjabi communities. As such, the search terms were expanded.

Whilst assessing the key themes and narratives of included papers it became apparent that peer support was closely tied to the creation of ‘safe spaces’. While some may assume safe spaces are a recent phenomenon, included literature focused on their historical development throughout and within psychological as well as activist spaces. ‘Safe space’ practice was said to have originated in the 1940s as described by Professor Vaughan Bell when psychologist Kurt Lewin trained leadership candidates in ‘sensitivity training’. Later the term was used in the 1960s and 1970s by Moira Rachel Kenney to describe gay and lesbian spaces in bars, campus settings and within activist organisations (Harpalini, 2017). It should be noted, however, that this origin does not consider similar practices within racialized and Indigenous communities which have historically been excluded from mainstream discourse surrounding mental health support.

As well as describing the history of safe spaces, some of the literature demarcated the concept further. ‘Safe spaces’ were broadly described as spaces that help individuals to talk and discuss possible issues that need a solutions-based approach. These spaces could be within a wide range of settings, e.g., a hospital, within carceral and psychiatric institutions, secured environments, safe houses, or within peoples’ homes and communities. Safe spaces are described as a space that ‘can provide a break from judgement, unsolicited opinions, and having to explain yourself. It also allows people to feel supported and respected. This is especially important for minorities, members of the LGBTQ+ community, and other marginalised groups’ (Yee, 2019). However, building on these conceptual features, Arao and Clemens (2013) suggest a need to move the definition of ‘safe spaces’ more towards ‘brave spaces’ suggesting a collectivist approach, wherein all participants have the opportunity to shape the group norms and expectations as being more consistent with the overall goal of social justice education than one in which the facilitators dictate the terms of learning (Freire, 1970; hooks, 1994). Evidently the place and definition of ‘safe spaces’ are dynamic concepts which are being questioned, challenged and developed as time goes on.

In practice, one paper presented an example of safe spaces and their positive impact for Muslim students in the U.S. given an ongoing climate of overt violence and latent hostility towards Muslim students in higher education and society more broadly (Nasir and Al-Amin, 2006). Based upon student feedback one of the most valued aspects of being a Muslim student was having a sense of belonging which came from small acts of kindness in acknowledging their faith to ensure students do not feel ostracised (Nasir and Al-Amin, 2006). These examples may seem quite trivial to read, but they present an important example of how important safe spaces, a key component of peer support, are especially working with marginalised communities.

Finally, further studies focused on how Indigenous knowledge and practices had been integrated into pedagogical approaches for learners. A project with the indigenous Māori and Pacifika cohort of learners, based in New Zealand which focused on the pastoral side of teaching, concluded that the following four areas of focus were needed: ‘(i) use effective practices for teaching and learning, (ii) grow independent learners, (iii) support the empowerment of the learner and (iv) harness the positive cohort effect’ (Curtis, et al.,, 2012). They reported that culturally oriented pastoral support were important factors for success (Prebble, et al., 2002). The cohort valued a ‘culturally specific study space, a provision of food with study initiatives, and peer mentoring to support good study habits’. Inclusive of peer support interventions, this project within the educational space highlights the potential for approaches based in non-Western knowledge to improve and uplift the lives of marginalised groups. Such themes around peer mentoring and its importance within the context of educational settings was reflected in several further studies so as to enhance a ‘sense of belonging’ and ‘opportunities to establish social networks’ (Prebble, et al., 2002; Thompson and Weiser, 1999).

Historically there are a broad range of peer support and safe spaces interventions that have already occurred across a wide range of global contexts from both Western and Indigenous knowledge perspectives. This has helped evolve the narrative behind the importance of peer support, safe spaces and peer mentoring within contexts of ongoing marginalisation. While this literature emanating from Punjabi communities is lacking, there is an evident connection between their use and the potential for upliftment in such contexts. It is hoped that future practice and research can begin to expand upon and enable further scholarship in the area.

Approaches to education

While literature on peer support in Punjabi communities was neglected there were significant gaps in assessed literature relating to approaches to online peer support education. Therefore the search terms were expanded to try and incorporate approaches to education more generally. A range of studies were therefore included which could help to understand the landscape of approaches to education, some of which overlapped with mental health, as will be described.

The focus of some literature concerned online education and self-development in the context of post-secondary education and mental health. According to the Joint Information Systems Committee [JISC] (2021) prior to the pandemic affecting the higher education sectors, mental health had become a prominent issue amongst students suggesting that ‘58% of students say their mental health is worse than it was when the pandemic started’. In the literature, a consortium-based project entitled ‘Positive digital practices’ led by Open University (2021) in partnership with five other organisations (University of Warwick, University of Bradford, JISC, Student Minds and University Mental Health Advisors Network, Office for Students), was started to help address mental health challenges that prevail within the further education and higher education sectors. This consortium developed a range of projects, including; ‘Our journey’, a smartphone application as well as new ways of working that will ensure that both staff and students receive the support that they need within their studies and within their teaching and supportive roles. Another intervention, led to the need to develop an online microcredential course hosted on FutureLearn and created by Open University in collaboration with the Mental Health Foundation (U.K.-based mental health support charity) to help train new and existing teachers within the practice of embedding mental health within the curriculum (Perryman, et al., 2019). These digital approaches to mental health education and support demonstrate the innovation of services given the context of increasing mental health concerns for post-secondary students during the COVID-19 pandemic.

Further studies took a focus on pedagogical transformational models as an approach to education. A case study was cited from a group of historically Black colleges and universities (HBCU) in the U.S. where a transformational educational focus was taken based on relationship, recognition and realisation from a Black feminist perspective. This type of nurturing support shaped the HBCU environment where students felt emboldened, empowered and uplifted (Darrell, et al., 2016). Furthermore, some studies focused on the transformational potential of learning circles as a way of engaging and uplifting communities. Learning circles are when one is asked to ‘put your knowledge in a circle where it is not yours anymore, but it is shared by everyone’. Both Grazzini (2013) and Seale (2013) openly described similar areas around the notions of a ‘constellation of practice’ when ‘we’ act as brokers of knowledge across many institutions to act as problem solvers and knowledge brokers. As Grazzini (2013) elicits towards a more ‘cosmic education’ which resonates along a connection to a spiritual understanding that ‘we are all related’ and that ‘everything in the universe is interrelated’ (Grazzini, 2013). Such approaches can be particularly helpful when working with historically excluded and marginalised communities to counteract extractive and exploitative educational processes.

Within the transformational pedagogy literature there were also moments of highlighting the importance of trauma-informed pedagogy which grew out of research on post-traumatic stress disorder, intergenerational trauma, sexual violence and assault, and more recently by the impact of COVID-19. From the range of papers within the trauma-informed practice showed a strong link towards how this could be transformational for the individual’s own personal journey.

Understanding the challenges that individual people face as ‘personal problems ... often lead[s] researchers to emphasise individual interventions’ [1]. This further confirms the need for a deeper understanding of the needs of those who are going through a ‘journey of healing’, which is an ever more relevant concept in our current world. The connection between trauma and learning is made apparent in studies which focus on the impact of trauma on learners (Arnwine, 2019; Harrison, et al., 2023; Golden, 2020) further emphasising the importance of a trauma-informed pedagogy as an educational and transformative approach.

While approaches to education in the assessed literature demonstrate a high level of diversity, they are helpful in demonstrating the breadth of approaches available to support communities in our current society. While peer support itself is rarely explicitly mentioned, underlying pedagogical approaches are shared which demonstrate some key foundations which can be used to inform peer support education for mental health within marginalised communities.

 

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Literature review: Discussion

The literature assessed and summarised above demonstrates some key areas of scholarship which are relevant to work around online peer support education for Punjabi men’s mental health. Circling back to the research questions it is evident that although the open access literature in this study cannot directly inform online peer support education, it does provide an important set of conceptual tools which can be used in developing its foundations and approach. Furthermore, the literature assessed in this review demonstrates the need for further open access scholarship on such topics.

Most notably, the approach of transformative pedagogy is a key element which can tie together peer support with marginalised communities and experiences of education/learning. Taking a transformational pedagogical approach to online peer support education for Punjabi men can situate such opportunities in a liberatory framework which ultimately seeks to transform and uplift individuals as well as society more widely. The writings of Pablo Freire and bell hooks are undoubtedly important in structuring any approach to peer support and peer support education. Therefore, they offer a practical set of tools to develop peer support education for Punjabi men which use existing frameworks shaped by generations of scholar-activists.

In responding to the second research question, any online approach to peer support education for Punjabi men’s mental health based in transformative pedagogy will contribute to a novel area of scholarship and research. Currently, the areas of peer support in racialized communities, online learning, and transformative learning are not in conversation. As this project develops it can contribute to an emerging and exciting field which seeks to harness technological innovation to enable transformative pedagogical experiences through peer support training for racialized groups. As such, it can be evaluated and commented upon from a variety of perspectives, including social sciences, psychology, educational studies, and digital learning.

 

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Case study: Taraki Wellbeing

As this literature review is situated in practice-based research it is important to outline its foundations in community mental health. Taraki Wellbeing is a volunteer-led not-for-profit organisation working with Punjabi communities to reshape approaches to mental health. The founder of the non-profit did so following his experiences of mental health challenges. Subsequently, he recognised the systemic issues wherein Punjabi communities, and racialized communities more broadly, were unable to access mental health education and support in a way which worked for them. Starting in October 2017, Taraki has worked loosely with Punjabi communities mainly in the UK around the topics of mental health awareness, mental health education, social and peer support, as well as research.

As has been mentioned, Taraki worked closely to support its communities during the COVID-19 pandemic. One avenue of work included developing online peer support spaces for Punjabi communities. These spaces evolved from previously in-person sessions which took place in two major U.K. cities. By offering these spaces throughout the pandemic, Taraki realised the potential for peer support interventions within their communities. Similar spaces were coordinated and developed focusing on Punjabi students working from a peer support model (Taraki Wellbeing, 2021). During the pandemic, Taraki secured some grant support to develop a curriculum aimed at training individuals in peer support for Punjabi men. This curriculum is to be delivered and evaluated with partner organisations, where those being trained will ultimately run peer support spaces within their geographic, or online, localities. This model aims to share peer support knowledge and expertise with wider audiences so as to disrupt any potential monopolisation of the peer support space within Punjabi communities.

Taraki’s work is undertaken through an intersectional and strengths-based approach. Inspired by the work and writing of Kimberle Crenshaw (1991) and Patricia Hill-Collins, Taraki aims to speak to complexities within Punjabi communities and the experiences of overlapping marginalised identities. In taking an intersectional approach, Taraki tries to counter essentializing discourses and confidently confront complexity through building community-based infrastructure and working alongside a range of those from Punjabi backgrounds. Alongside this, Taraki takes a strength or asset-based approach to its work (Russell, 2021). This means that Taraki does not look at its audiences through a deficit model but rather tries to understand challenges through the systems, structures and resources that work well. An example of this is an approach to mental health which does not project Western discourses but attempts to locate communication and practice at the intersection of mental health and faith (Taraki Wellbeing, 2022). In doing so, Taraki tries to be innovative in its approach whilst not projecting interventions into its audiences which have not been critically considered.

Overall, Taraki is working to bridge the gap between scholarship and community practice in mental health. Through its online peer support educational intervention aimed at Punjabi men, it hopes to improve access and opportunities for those wanting to make a positive change in their communities. Whilst focusing on the systemic and social enablers of mental health challenges, the group looks to place power back into the hands of its communities.

 

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Limitations

Being honest and open about limitations is a key aspect of activist scholarship that promotes ongoing learning, openness and a will to enable positive change. It would be naive to assume that scholarship is ‘objective’ and therefore an honest assessment of personal and academic limitations is required to situate writing within subjective perspectives.

First and foremost, as this paper was written during ‘free’ time by a team of racialised researchers, the majority of whom are survivor-researchers, there is always a challenge to ensure methodological rigour is met. As the group did not have collective institutional access to academic databases the decision was taken to include only open access literature. This decision undoubtedly limits the quality of this literature review as many articles concerning these topics of importance exist behind a paywall. However, this was just not possible nor probable across a team where institutional access was not held by all. In future research it would be prudent to collaborate or partner with an academic institution to co-create, research and write a paper on such topics. However, this also brings its own access-related issues, namely the requirement of academic networks, access to funding, and most of all, time to build ongoing relationships. As a group, the authors hope that this paper demonstrates their will and desire to conduct research, so as to act as a platform to further contributions to knowledge when it is most appropriate.

Secondly, this paper did not include expansive selections of grey literature in the body of the review. Grey literature, indicating literature which has not been formally published through peer review, is an area which includes reports, evaluations, conference proceedings, community declarations, articles, and blogs. Within and across Punjabi communities there is a lack of peer reviewed literature on the topics considered in this paper. However, there is more literature available through organisations, charities, non-profits and their annual reports, evaluations, and informal writings. Furthermore, there are other creative media which are used to communicate knowledge, such as videos and music, which have not been included in this review. In hindsight, including more grey literature outside of the database search would have been beneficial to conducting the review and developing some relevant findings.

 

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Conclusion and next steps

This literature review and case study was developed in response to a lack of scholarship around Punjabi men’s peer support. To summarise, open access literature through the database searched in this review provides some immediate help to prepare for online peer support education in Punjabi men’s mental health. Once the search terms were expanded there were a range of approaches which could support the foundational development of such interventions. Namely, the place of trauma-informed pedagogy is a key body of scholarship which brings mental health, peer support and online learning into conversation. This is an area of rich knowledge which can be developed upon further through any prospective peer support curriculum aimed at online delivery for Punjabi men’s mental health.

This review opens the possibility for knowledge making in a new and exciting area surrounding mental health and racialised communities. Developing such approaches and bringing seemingly disparate disciplines into discussion is key to enabling sustainable and community-led change. It is hoped that this research can be further refined and developed through the ongoing work of Taraki in its work with Punjabi communities in the domain of mental health. End of article

 

About the authors

Kulvir Bahra was previously working as Learning Design Officer at Warwick Business School within the University of Warwick and is currently transitioning to begin his new role as Digital Development Manager in the Faculty of Business and Law at Open University. He has 25 years of lived experiences of mental health challenges. He has experienced racialised behaviours and seeks to create meaningful and amicable solutions to resolve covert conflicts in a range of settings. His reasons to lead on authoring this paper is to act as a beacon of hope for future lived experience practitioners to come forward and to enable positive change within his communities.
ORCID: https://orcid.org/0000-0002-3607-826X
Google Scholar: https://scholar.google.com/citations?user=JrxC3roAAAAJ&hl=en
E-mail: kulvir [dot] bahra [at] protonmail [dot] com

Shuranjeet Singh is the founder and director of Taraki Wellbeing, an organisation he started in 2017 following his lived experiences of mental health challenges. Shuranjeet is a graduate student and recognises the importance of research and scholarship in developing a stronger evidence base for mental health in racialized communities. Shuranjeet benefits from being university-educated and living in a stable household which has helped him to organise in the mental health space without fear of judgement or shame.
E-mail: shuranjeet [at] taraki [dot] co [dot] uk

Taimour Ahmed is the Project Manager & Mental Health Implementation Consultant at Taraki for the development of Punjabi men’s peer support. Taimour specialises in curriculum development and delivery for social change projects. In addition, he also serves as a researcher and lived experience consultant/advisor for various research and delivery projects. A lived experience advocate, he specialises in subjects that explore mental health at the intersection of key identity markers such as class, race & gender identity.
E-mail: taimour [at] taraki [dot] co [dot] uk

 

Note

1. Goodkind, et al., 2014, p. 1,021.

 

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Editorial history

Received 16 November 2022; accepted 12 December 2022.


Creative Commons License
This paper is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Preparing for online peer support for Punjabi men’s mental health
by Kulvir Bahra, Shuranjeet Singh, and Taimour Ahmed.
First Monday, Volume 28, Number 1 - 2 January 2023
https://firstmonday.org/ojs/index.php/fm/article/download/12931/10769
doi: https://dx.doi.org/10.5210/fm.v28i1.12931