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CASE STUDIES ON SUPPORTING ETHNIC MINORITIES WITH MENTAL HEALTH NEEDS
#3 SARIKA: MARITAL CONFLICTS AND DOMESTIC VIOLENCE
BACKGROUND
Sarika is 32 years old married women from India, living in HK with her husband and 2 sons (8 and 4 years) for more than 5 years. She is an art graduate and used to work as a salesperson before her marriage. She likes to paint and make sketches, but she has stopped as she is fully occupied with housework and taking care of her kids.
Sarika does not have a good relationship with her husband. The marriage took a turn when she found out her husband was involved with an extramarital affair a few years back. Though he ended the affair, the relationship between them was never the same . Her husband is dominating, short-tempered, and does not take any responsibility at home. He views his only role as solely to earn money. He spends most of his time either at work or with friends. Her in-laws are in India she has no communication with them as they partook in a ‘love marriage’, it was not approved by his parents . Her in-laws are also financially dependent on her husband which Sarika is not happy about. On occasions Sarika brings up household and financial issues to her husband, it has turns into fights and, on many occasions, Sarika heas been physically attacked by her husband. Sarika has never officially complained about DV but the police were involved on one occasion, and for now he has stopped with the physical violence. Sarika’s parents are in India. Sarika prefers not to talk to them about her issues as they are old and sick. Her husband lost his job during the Pandemic and was only able to get another one with a very low salary; the financial burden has worsened the overall situation at home.
Her financial problems have increased the conflicts at home. She has started feeling very sad throughout the day and often has crying spells. Not being able to share things with others has left her feeling trapped. At times she wants to separate from her husband, but she is afraid that she is not equipped to handle the kids alone and she does not have much support from anyone. She is also on a dependent visa sponsored by her husband, so she believes she cannot separate from him in HK. She has sleepless nights and has lost weight over the last 6 months. She keeps on worrying about the situation and has panic attacks, especially after the fights at home.
She called the police after one such fight at home, as she thought her husband was on the verge of hitting her again. Police did not take any action as there was no DV but referred Sarika to a Social worker at the family center.
ISSUES FACED BY THE CLIENT
• Marital discord
• Domestic violence in the past and can happen again
• Financial worries
• Issues with the extended family- not being favored by them, financially dependence from them
• Lack of support from parents/others
• Parents- sickness
• Mental health symptoms
How to help
• Clarifying on safety procedure- how to seek help in terms of DV
• Emotional awareness and emotional management
• Healthy routine and encouraging self-care, hobbies, taking some time out and for self, exercise, involvement in the community
• Diagnosing unhelpful thought patterns
• Exploring various options for her marital relationship, clarifying what she wants to do and can do
• Acceptance of the situations that she cannot change, but still focusing on the things that she can change (such as safety/ self care/ hobbies etc)
• Exploring support network – other relatives/in-laws/friends
the lives of Hong Kong’s ethnic minorities by reducing suffering and providing opportunities
• Means of improving communication with husband
Improves the lives of Hong Kong’s ethnic minorities by reducing suffering and providing opportunities
• Exploring the possibility of involving the husband in the therapy
CHALLENGES FOR THE SOCIAL WORKER
• Reluctance from the client as the social worker is not from the same culture
• Her concerns that others may know
• Some language barriers
• Husband may not be ready to be involved
• Resistance from the client to explore options
SUGGESTIONS FOR ADDRESSING THE CHALLENGES
1. 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 there is likely to be a situation that put you at risk of self-harm/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 these. I understand that it is not easy for you.”.
4. Provide psychoeducation
Examples:
“Anxiety/ depression can be due to some problems that you are facing in your life. Talking about the problems can 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.”
5. Detailed history taking
Examples:
Family history, marriage history, enquire about education, hobbies, coping, religious practices, any issues at home, personal issues, symptoms
6. 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 cultures. 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.”
7. Tips for clients having language barriers
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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Tel 電話: +852 2540 9588 E-mail 電郵: info@zubinfoundation.org Website 網址: www.zubinfoundation.org © 2023 The Zubin Mahtani Gidumal Foundation Limited (registered charity in Hong Kong - IR 91/12344). All rights reserved.
Improves the lives of Hong Kong’s ethnic minorities by reducing suffering and providing opportunities
• Invite a friend trusted by the client as a translator/ arrange a professional interpreter if client might feel comfortable
• Use of simple English / use more diagrams/ pictures
8. Tips for exploring if family members/ husband (in this case) can be involved into the therapy
• Explaining how the symptoms are related to the underlying family conflict
• Suggesting that involving a family member/husband can be beneficial
• Exploring with the client if this is a feasible option/ any concerns regarding this
• Offering help to talk to that family member
• Respecting the client’s decision in case she/ he is not ready to get the family involved at this point
9. Tips for exploring a support network for the client
• Explaining the purpose of the support network
• Exploring support from different sources – close family/ extended family/ other relatives/ friends/ social organizations/ community
• Different social networks can play different roles in supporting the client – like practical support/ emotional support/ financial support/ support for child care/ support for safety, etc.
• Creating a list of people/organizations that clients can approach with their contact information
• Creating a plan on maintaining support network
REFERRALS TO OTHER SERVICES
• Psychiatrist if the symptoms persist
• Information on the shelter system/ referral in case of DV
• Referral to a legal representative in case client wants to separate from her husband in the future and need to sort out the visa issues
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