Beliefs about mental illness among Chinese in the west

Chinese are less likely to use mental health care than other ethnic groups in the Netherlands, yet present more serious symptoms at the first consultation. However, the reason for these differences is unknown because of the scarcity of research. This doctoral research sets out to shed light on mental health care utilisation among this group. It further examines the adequacy of Dutch mental health care services for them. Results show that the Chinese studied regarded Dutch health care as their primary method of managing general and mental health problems. The beliefs they expressed about mental illness did not seem to differ from those current in the West in ways that would form a major barrier to seeking help from mainstream services. Although cultural differences were observed which might create barriers to mutual understanding between health professionals and Chinese care users, they were not such as to prevent Chinese from accepting and benefiting from Dutch health care. The results of this research suggest that the main barriers have to do with practical factors, e.g. low Dutch proficiency, lack of knowledge of the health system, or language and communication problems. Other barriers include lack of cultural sensitivity among professionals and the failure of the health system to take steps to overcome these problems. The study also showed that Chinese in the Netherlands form a heterogeneous group in terms of their origins, migration patterns, socio-economic status and levels of integration. Service providers and policy makers should take the diversity of the Chinese group into account and pay more attention to issues such as communication barriers, knowledge of the health care system, attitudes of professionals and discrimination.

Journal of Public Health, 1999

Background This study aimed to identify the barriers encountered by Chinese people with mental health needs in England which hindered their obtaining appropriate help from the National Health Service (NHS). Methods Attenders at Chinese community centres in health authority districts with resident Chinese population in excess of 2000 were invited to fill in a 12-item Chinese Health Questionnaire (12-CHQ). Individuals who scored two or above, indicating a high probability of a mental health problem, were invited to undertake a semi-structured interview. Results A total of 401 completed the 12-CHQ. Eighty-six (21.4 per cent) screened positive and 71 (82.6 per cent) agreed to be interviewed. Although 70 (98.6 per cent) were registered with a general practitioner (GP), there were long delays before they made contact with health professionals, and the GP was the first port of call for help in only 27 (38.6 per cent) interviewees. Fifty-two (74.3 per cent) had encountered difficulties when they sought professional help. The main barriers were language, interviewees' perceptions of symptoms as somatic rather than psychiatric in origin, lack of knowledge about statutory services, and lack of access to bilingual health professionals. Doctors, particularly GPs, were pivotal in the management of their conditions. The majority were prescribed psychiatric medication with only a small number in contact with community psychiatric services. Unemployment and social exclusion were common. Stigma associated with mental illness and limited knowledge in the community were identified as the causes for the widespread discrimination experienced by the interviewees. Conclusion The mental health needs of these Chinese people were not adequately met by statutory services, nor could they rely on family and friends for care and support. Training for health service staff and access to health advocates are essential to maximize the effectiveness of health professional-patient contacts. The promotion of better understanding of mental illness by the Chinese community is important, and greater flexibility within the NHS is required to ensure those professionals with bilingual skills are used to the best effect.

Journal of psychiatric and mental health nursing, 2017

Late presentation and low utilisation of mental health services are common among Chinese populations. An understanding of their journey towards mental health care helps to identify timely and appropriate intervention. We aimed to examine how Chinese populations make sense of the experiences of mental distress, and how this understanding influences their pathways to mental health care. We undertook in-depth interviews with fourteen people with mental health problems and sixteen family members. Thematic analysis was used to analyse data. Different conceptualisation of mental distress and the stigma attached to mental health problems explained why most participants accessed services at crisis points. Because of mental illness stigma, they were reluctant to seek help outside of the family. Participants used a pragmatic pluralistic approach to incorporate ritual healing and western interventions to manage mental distress as they travelled further on the pathway journey. Families play a k...

Counselling Psychology Quarterly, 2001

This study explores Singaporean Chinese clients' beliefs about psychological problems by comparing their beliefs with those of non-clients and professional counsellors. These three samples were asked to indicate the extent to which they would agree with three belief models, the Chinese indigenous model, the Western psychological model, and the other model. It was found that clients and non-clients were more likely than therapists to endorse the indigenous belief model. Amongst the indigenous sub-models, Chinese medicine was the most endorsed across the three samples; and clients and non-clients endorsed Chinese medicine more than therapists did. The indigenous belief model, especially Chinese medicine was endorsed more by Buddhist and Taoist clients than Christian or non-religionist clients; and by clients holding lower educational quali cations.

Background: Low knowledge of and discrimination regarding mental disorders (MDs) may underpin lower access to mental health care by ethnic minority groups. Aims: In Chinese-Australians, in relation to schizophrenia and depression, to assess (a) labels attached to MDs, (b) conceptual distinctiveness of MDs, (c) labelling accuracy against an Australian representative sample, (d) how syndrome variations may infl uence labelling, and (e) effects of exposure to MDs on labelling. Method: 418 subjects were asked to indicate the labels they would apply to vignettes of depression and schizophrenia and whether they were exposed to these disorders personally or socially. Results: The sample was broadly representative of the Australian-Chinese community: 51% and 47% 'correctly' labelled the vignettes. Depression and schizophrenia labels were consistently discriminated and clustered with different other labels. Labelling accuracy surpassed Australians'. Labelling did not vary substantially between syndromes. Exposure related to increased labelling accuracy for depression. Conclusions: Accuracy in labelling major forms of MDs does not appear low in Chinese-Australians and seems higher than in the Australian community. MDs were discriminated although syndrome variations were not. Findings dispute that low mental health care access and uptake is due to low recognition and discrimination of MDs in Chinese-Australians.

Journal of Clinical Nursing, 2006

Aims and objectives. This study examined the cultural attribution of distress in the Chinese, the special role of the family in distress and the specific emotional reactions within distress dictated by culture.Methods. This phenomenological study illustrated the narrative representation of the experiences of suffering by the Chinese patients with mental illness. Twenty-eight Chinese–Australian patients and their caregivers were interviewed together in their homes. They were invited to talk about the stories of the patients’ experiences of suffering from mental illness. The interviews were recorded and transcribed to be further analysed according to the principles of narrative analysis.Results. The results of case narration indicated that (1) because of the influence of Confucian ideals, interpersonal harmony was the key element of maintaining the Chinese patients’ mental health, (2) Chinese patients’ failure to fulfil cultural expectations of appropriate behaviours as family members contributed to disturbance of interpersonal relationships and (3) Chinese patients’ failure to fulfil their familial obligations contributes to their diminished self-worth and increased sense of guilt and shame.Conclusion. The findings of the present study suggest that Chinese people's well-being is significantly determined by a harmonious relationship with others in the social and cultural context. Psychotherapy emphasizing an individual's growth and autonomy may ignore the importance of maintaining interpersonal harmony in Chinese culture.Relevance to clinical practice. The results of this study contribute to the essential knowledge about culturally sensitive nursing practices. An understanding of patient suffering that is shaped by traditional cultural values helps nurses communicate empathy in a culturally sensitive manner to facilitate the therapeutic relationship and clinical outcomes.

2014

In this article, the authors explored Cantonese-speaking older Chinese migrants knowledge, attitudes and expectations regarding mental illness. They obtained verbatim data from semi-structured interviews with eight participants recruited from London-based Chinese and church communities in Britain. They analyzed the data using the principles of Grounded Theory and in-depth content analysis. They examined cultural idioms in participants' accounts. Findings suggested that Western diagnostic categories of mental illness were alien to participants. They had a culturally constructed way of defining and characterizing mental illness. Participants used idioms of ‘nerve’, ‘mood’, ‘behavior’, ‘personality’, ‘normal life’, ‘compassion’ and the idiom of ‘others’ to construct an alternative world for stigma management. They erected an invisible but permeable barrier to limit access to their normal world. The role of traditional Chinese culture of Confucianism was significant in shaping perceptions and conceptions of mental illness. This article offered another perspective on the alternative world of Chinese migrants' cultural understandings of mental illness, an area with limited understanding at present. The authors discussed important implications for future research and social policy.

Journal of Community Psychology, 2004

Based on a sample of 1747 from the Chinese American Psychiatric Epidemiological Study, this report examined perceived barriers to mental health treatment. Two factors emerged, namely practical barriers, which included cost of treatment, time, knowledge of access, and language, and cultural barriers consisting of credibility of treatment, recognition of need, and fear of loss of face. Average ratings of all practical barrier items were higher than cultural barrier items, demonstrating the importance of pragmatic considerations for this population. In a novel attempt, this study examined the empirical link between these perceived barriers and actual mental health service use. The practical barrier factor showed significance in predicting service use for both the whole sample and a subsample of individuals with at least one lifetime mental disorder.

International Journal of Social Psychiatry, 2007

Background: Low knowledge of and discrimination regarding mental disorders (MDs) may underpin lower access to mental health care by ethnic minority groups. Aims: In Chinese-Australians, in relation to schizophrenia and depression, to assess (a) labels attached to MDs, (b) conceptual distinctiveness of MDs, (c) labelling accuracy against an Australian representative sample, (d) how syndrome variations may influence labelling, and (e) effects of exposure to MDs on labelling. Method: 418 subjects were asked to indicate the labels they would apply to vignettes of depression and schizophrenia and whether they were exposed to these disorders personally or socially. Results: The sample was broadly representative of the Australian-Chinese community: 51% and 47% `correctly' labelled the vignettes. Depression and schizophrenia labels were consistently discriminated and clustered with different other labels. Labelling accuracy surpassed Australians'. Labelling did not vary substantiall...