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CASE STUDIES ON SUPPORTING ETHNIC MINORITIES WITH MENTAL HEALTH NEEDS
#1 SABIA: STRESS OF MANAGING BIG FAMILY
BACKGROUND
Sameena is 36 years old married female, from Pakistan. She has been living in HK for almost 16 years, and came here shortly after she was married. She got married after graduating from high school and could not pursue further education as her husband did not allow it. She used to play sports while at school and she loves traveling, and hiking; however, she could not continue with any of her hobbies after her marriage.
She has 6 kids. The eldest daughter is 15 years old and the youngest is just 2 years old. 2 of her sons (6 and 10 years) are hyperactive and have fallen behind in their studies. She keeps receiving complaints from school about them fighting and their low marks. She has tried disciplining them but the situation has not changed.
Her husband is her first cousin and he cannot tolerate the misbehavior of his children and blames Sabia for it. He lost his job during the pandemic and has been doing some part-time jobs since then. There is little communication between the couple and he prefers spending time with his friends rather than at home. Sabia’s sister is in Hong Kong but she is busy with her own family and cannot offer much help to Sabia. Her parents-in-law in Pakistan always blame her for their children’s shortcomings and expect her to fix the situation alone.
Sabia feels totally exhausted taking care of her kids all by herself. She always complains of headaches, backache, and low energy while doing chores, especially after her last pregnancy. She feels sad and alone, which leads to crying spells as she feels underappreciated.. She constantly worries about the future of her sons and how to control their aggression. Her own outbursts are frequent, especially towards her kids, and she feels helpless as nothing seems to be working. She has many sleepless nights and has lost weight as a result. She visits the General Out-Patient Clinic (GOPC) at the public hospital every other week to get help with her headache but does not feel any better.
One time the doctor at the GOPC referred her to a social worker at the clinic after noticing her record of frequent visits. She was hesitant to talk about the family matters but went to see the social worker as her friend insisted.
ISSUES FACED BY CLIENT
• Stress of taking care of the big family
• Lack of communication and support from the husband
• Being blamed for children’s issues
• Children with behavioral issues, possibility with special educational needs
• No time for herself
• Mental health symptoms
• Physical symptoms
• Unable to pursue further education after marriage
WHAT CAN BE DONE TO HELP
• Emotional awareness
• Stress management/anger management
• Recognising unhelpful thought patterns
• Accepting situations that she cannot change while focusing on those that she can
• Time management
• Assertiveness
• Encouraging Self-care, hobbies, taking some time out for herself, exercise, involvement in the community
• Delegation of work
• Exploring alternative routes for helping her kids
the lives of Hong Kong’s ethnic minorities by reducing suffering and providing opportunities
Improves the lives of Hong Kong’s ethnic minorities by reducing suffering and providing opportunities
CHALLENGES FOR THE SOCIAL WORKER
• Reluctance from the client to open up and share their family matters
• Reluctance to accept help from the social worker as they are not from the same culture
• Not sure what counseling is
• Her concerns that others may know
• Some language barriers
SUGGESTIONS FOR ADDRESSING THE CHALLENGES
1. Ensure confidentiality
Example:
‘’ You might be worried about others knowing your problems, but please rest assured that the information discussed in this session will not be shared, unless the situation is likely to harm yourself /harm to others.’’
2. Give time and show readiness to listen and understand
Example:
“I am here to listen and see how I can help you. Would you like to tell me what has been bothering you?”
3. Empathetic responses
Example:
“I’m sorry to hear that you have been dealing with this. I understand that it is not easy for you.”
4. Show some understanding of client’s culture
Examples:
o Greet Muslim clients by saying “salaam-ale-kum“ (Peace be upon you” in Arabic), standard salutation in the Muslim community
o Be aware of some important festivals such as Ramadan (holy month for Muslim) or Diwali (One of the most important festivals in Hinduism) and check if rescheduling is needed to so clients can celebrate those occasions.
5. Provide psychoeducation
Examples:
“Many times, stress/tension can be presented in the form of physical symptoms like headache/ backache/ body pain/ some digestive problems and if that is the case, they will not just go away with pain killers but rather need some alternative talking treatment. Do you feel you might have similar thing?”
“Anxiety/ depression can be due to problems that you are facing in your life. Talking about the problems help you more than just talking about symptoms.”
“Counseling can provide some space and time to talk about your difficulties, something which you are struggling with.”
6. Detailed history taking
Examples:
Family history, marriage history, enquire about education, hobbies, coping, religious practices, any issues at home, personal issues, symptoms
Improves the lives of Hong Kong’s ethnic minorities by reducing suffering and providing opportunities
7. Start the conversation by talking about things that they may be open to explore more Example:
Parenting -
“You mentioned you are stressed about taking care of kids all by yourself. Are there any particular things you struggle more. You mentioned you have headaches especially when you keep on worrying about your kids. Are there any particular things that you are concerned about?
“You have mentioned that you keep receiving complaints about your two sons and you don’t know how to deal with it. Would you like to discuss this further, like what is the root cause, and let’s see if we can figure out more effective ways on how to talk to your sons and if possible, control their anger.”
8. Useful statements if clients are reluctant to talk due to concerns about different cultures:
Examples:
‘’ I may not have been from the same culture, but I have received some training / have done some research/ have handled clients from similar backgrounds. I may not understand everything, but with my experience, I will try my best to understand your problems and help you out ‘’
‘’ I am aware that culture and family is very important to you, so you might feel hesitant to share any family problems. But I can assure you that if you share your problems I can offer you some fresh perspectives that may help you cope with your current situation. Or at least I can find a suitable person to help you if there is a need.”
9. Tips for clients having language barriers
Examples:
o Invite a friend trusted by the client as a translator/ arrange a professional interpreter if client might feel comfortable
o Use of simple English / use more diagrams/ pictures
REFERRALS TO OTHER SERVICES
• Psychiatrist if the symptoms persist
• Referrals to assessment for her children if there are suggestive symptoms to SEN
ACKNOWLEDGEMENT
Thank you to Shilpa Patwardhan, Priya Agrawal and Rabia Siddiqi from the Ethnic Minority Well-being Centre team for developing the case study series and Caroline Longley and Mel Pikul for editing it.
ABOUT THIS CASE STUDY SERIES
The case study series is part of the capacity building work of The Zubin Foundation’s Ethnic Minority Wellbeing Centre. The aim of the series is to raise awareness of the common issues ethnic minorities have that trigger their mental health issues and to equip mental health practitioners on how to better support them by presenting some common challenges practitioners may face when supporting ethnic minorities and our learnings from the Ethnic Minority Well-being Centre in addressing these challenges. For the full set of case studies and other useful materials, please go to the Mental Health of Ethnic Minorities Online Resource Platform for Professionals: https://www.zubinfoundation.org/mental-health-resources/
ABOUT THE ZUBIN FOUNDATION ETHNIC MINOTIY WELL-BEING CENTRE
The Ethnic Minority Well-being Centre is a joint project between The Zubin Foundation and the Department of Psychiatry of The University of Hong Kong, funded by Lee Hysan Foundation and Croucher Foundation. It offers free one-to-one counselling service to South Asian from low income families in Hong Kong. The service was provided by ethnically South Asian counsellors who understand the South Asian cultures and speak English as well as Hindi, Urdu or Nepali, native languages of many South Asian individuals. The counselling team also delivered talks and workshops to raise awareness in the community.
For more information about the Centre, please visit: https://www.zubinfoundation.org/our-work/ethnic-minority-well-being-centre/
THE ZUBIN FOUNDATION
The Zubin Foundation is a registered charity in Hong Kong (IR 91/12344), named after Zubin Mahtani Gidumal. We aim at improving the lives of Hong Kong’s ethnic minorities by reducing suffering and providing opportunities. We do this by outreach in the community and driving systemic change.
For more information, please visit: www.zubinfoundation.org .
CONTACT US
Website: www.zubinfoundation.org
Email: info@zubinfoundation.org
Phone No.: +852 2540 9588/ +852 2540 9488
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Improves the lives of Hong Kong’s ethnic minorities by reducing suffering and providing opportunities