Improves the lives of Hong Kong’s ethnic minorities by reducing suffering and providing opportunities
CASE STUDIES ON SUPPORTING ETHNIC MINORITIES WITH MENTAL HEALTH NEEDS
#2 SARA: FAMILY CONFLICTS AROUND FORCED MARRIAGE
BACKGROUND
Sara is a 20-year-old Pakistani girl, born and raised in Hong Kong. She is a conscientious student and has had good grades, until last year. She is now in her 2nd year of University and has her final exams in a month.
Last year her father informed her that after her exams she is expected to move back to Pakistan and marry her cousin. A decision not made by her, but by her parents and her extended family. She is not happy with this marriage because she wants to continue to with further education, however this is dependent on the permission from her husband’s family. She does not know much about her cousin except he is a high-school dropout who does not speak much English.. She tried to talk to her mother about this situation, however she just got upset as she thought she was going against her family’s decision. In her eyes it would be shameful to the family to say no to this marriage. She was hurt by her mother’s reaction and did not dare to talk to her father about it.
She is feels low and is unable to focus on her studies. She keeps on worrying about her future meaning she cannot sleep, has a loss of appetite, and has lost weight significantly. Sometimes when she feels helpless she cuts her wrists. She hesitates to talk about this to her friends as it’s a family matter but has mentioned it to one of her friends saying ‘she would be getting married soon’. She feels helpless as she feels like no one can help her.
On one occasion she cut her wrist so deep that she was unable to stop the bleeding. Her friend saw it and accompanied her to the hospital. Her friend mentioned to the doctor that she seemed to be under a lot of stress, and it could be due to her impending marriage in few months’ time.
Treating doctor referred her to the hospital clinical psychologist.
ISSUES FACED BY CLIENT
• Forced marriage
• Not able to continue her education (possibility)
• Conflicts with mother – lack of support from her
• Lack of support/ no one to talk to
• Mental health symptoms
• Self-harm behavior
WHAT CAN BE DONE TO HELP
• Safety planning (considering self-harm behavior) and all the emergency contact information
• Suicidal risk assessment (possibility of informing close family members if necessary)
• Identifying a person (her friend or other family members) to keep an eye on her and seek help if needed (considering her self harm tendency)
• Emotional awareness and management
• Exploring coping and alternative healthy coping mechanisms rather than self-harm
• Practising self-care/ mental well-being - acknowledging the fact that issues cannot be resolved quickly, but how she can still maintain her well being
• Diagnosing unhelpful thought patterns and exploring alternatives
• Working with the client to explore the situation
o What are the various options in terms of her marriage
o What can be changed and what cannot be changed
• Acceptance of the situation that she cannot change – what can help her in that
• Exploring support system/ community support
Improves the lives of Hong Kong’s ethnic minorities by reducing suffering and providing opportunities
• Exploring with the client possibility of family involvement
CHALLENGES FOR PRACTITIONER
• Reluctance from the client to open up and share the family matters
• Reluctance from the client to accept help from the social worker they are not from the same culture
• Her concerns about how her family may react if they know that she is taking help for this matter
• Deep rooted problem – not sure how much can be resolved through counseling
• Not sure if the family is ready to cooperate / would agree with any help / whether to involve family at all
OTHER SUGGESTIONS FOR ADDRESSING THE CHALLENGES
• Ensure confidentiality
Example:
‘’ You might be worried about others knowing your problems, but rest assured that the information discussed in this session will not be told to anyone, unless it is likely to put someone at risk of self harm/harm to others.’’
• 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?”
• Empathetic responses
Example:
“I’m sorry to hear that you have been dealing with these. I understand that it is not easy for you.”
• Provide psychoeducation
Examples:
“Anxiety/ depression can be due to some problems that you are facing in your life. Talking about the your problems may help you more than just talking about symptoms.”
“Counseling provides you some space and time to talk about your difficulties, something which you are struggling with.”
• Detailed history taking
Examples:
Family history, marriage history, enquire about education, hobbies, coping, religious practices, any issues at home, personal issues, symptoms
• 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 your culture. 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 some hesitancy to share if you have any problems in your family. 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.”
REFERRALS TO OTHER SERVICES
• Psychiatrist considering the self-harm tendency
• Medical follow up for her wound
Improves the lives of Hong Kong’s ethnic minorities by reducing suffering and providing opportunities
The Zubin Mahtani Gidumal Foundation Limited, known as The Zubin Foundation (registered charity in Hong Kong - IR 91/12344).
小彬紀念基金會 (香港註冊慈善機構 IR 91/12344) 。
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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
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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