CASE STUDIES ON SUPPORTING ETHNIC MINORITIES WITH MENTAL HEALTH NEEDS
#5 AIMA – TRAUMA, ABUSE AND MENTAL HEALTH
BACKGROUND
Aima is a 20-year-old Muslim female from Bangladesh. She was born and raised in Hong Kong. She is single and is currently an undergraduate student studying at a local university. She used to live with her parents and her 14-year-old brother and recently she has moved out since she cannot cope with the situation in her family.
Aima’s mother has been physically, sexually and emotionally abused by her father for almost 14 years. Aima is immensely saddened and affected by her parents’ conflicting and abusive marriage.
Her mother has no place in Hong Kong to go or talk about the abuse. Her mother is stuck as Aima’s conventional grandparents are not supportive to divorce or a separation from the abusive marriage. To protect herself, her mother would go back to Bangladesh for months. When she is back to Hong Kong, the abuse happens and Aima would often be punished by her mother for her father’s atrocities. This is what Aima shared:
“A little mistake would result in whipping and there were plenty of bruises all over my body. Obliging to religious norms was a must and a slight error while performing my religious duties, would result in acute beating.”
Aima’s father would pull Aima in for resolving the marital conflicts between her mother and him when needed, and most of the time, he just ghosted his two children, leaving them alone.
Aima is feeling angry, frustrated, sad and helpless. She feels abandoned. She does not understand why her mother uses her as a punching bag and she finds her parents abusive and unsupportive. She thinks her home environment was suffocating and toxic. This has resulted in her not being able to focus on her studies. She used to love painting and going out with her friends; however, she couldn’t continue as she has severe emotional distress. Out of anger and fear, she decided to move out to a friend’s home.
Even though she has escaped from her home, she is unable to restore peace in her life. Her abused and distressed mother frequently calls Aima and shares her intention of ending her life. Her aggressive, confused father continues to get Aima involved in their marital conflict. She feels torn between her own life and her role as an elder daughter. Aima fears about her and her brother’s future. She also couldn’t share her home situation with her friend or anyone else as her friend’s family is from Hong Kong of Chinese origin and no one in her new residence understand her family situation.
Out of severe emotional pain & distress, Aima often self-harms herself by cutting her arm and wrists with any sharp object that is available. She also drinks alcohol frequently. She has sleepless nights and is surviving on a bare minimum food intake. She has an assigned social worker that takes her to a clinical psychologist in the Government hospital. However, Aima still feels hesitant to share her family issues.
ISSUES FACED BY CLIENTS
• Parental Conflict
• Mental health symptoms – severe anxiety and depression
• Poor relationship with others
• Lack of support
• Feelings of abandonment
Improves 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
• High academic stress – lack of focus, unable to meet deadlines
• Stress of taking care of younger sibling
• Self-harming behaviors
• Disrupted sleep and appetite
• Alcohol abuse
HELPFUL INTERVENTION FOR THIS CLIENT
Immediate
• Safety planning (due to frequent wrist/arm slashing) and providing emergency contact information. Discuss strategies that have worked in the past to relieve strong emotions
• Risk assessment for self-harm, suicide and violence
• Awareness of self-care practices – discussing the impact of a lack of routine on mental health
• Exploration of healthy ways to manage overwhelming emotions - reduction of alcohol abuse
• Exploring the support system/community support, support from the university
• Exploring ways to create some peace within the family system
• Approach the client in a supportive & polite manner
When client is in a more stable situation and ready to work on the traumatic memories
• Working on her trauma – processing trauma
• Exploring the effects of trauma- thoughts/ emotions/ physiological arousal/behavior
• Exploring the beliefs system and working on that
• Exploring the possibility of involving family members in the therapy, referring for family therapy
CHALLENGES FOR PRACTITIONER
• Reluctance from the client to open up and share the family matters
• Reluctance from the client to share different cultural norms with the social worker
• Fear of the parent’s reaction on disclosing family matters
• Absence of parents from the current scene won’t help resolve the issue(s)
• Being overwhelmed as a practitioner, feeling hopelessness as it is a deep-rooted issue that cannot be resolved easily
OTHER SUGGESTIONS FOR ADDRESSING THE CHALLENGES
• Ensure Confidentiality – Build Trust
Example:
“You might be worried about others knowing about your family issues, but rest assured that the information discussed in this session will not be shared with anyone, unless there’s a risk to your or someone else’s life”.
“I’m here to listen and help you. Would you mind sharing what’s bothering you during these days. I would like to know…”
• Show empathy & validate the client’s concerns – Ensure safety
Examples:
“I’m so sorry to hear you have to go through all this alone. I can only imagine how hard it can be to be in your place”.
“Do you feel comfortable or safe in your current living space? What can I do to ensure safety for you?”
Improves
• Detailed history intake
It may include:
• Family history, parents’ marriage history, religious orientation norms and limitations
• Possible trauma – informed screening such as forms of interpersonal violence, adverse childhood events –exposure to sexual & physical abuse, etc.
• Depressive or dissociative symptoms, sleep disturbances
• Social support & coping styles
• Substance abuse
• Exploring the possible effect of trauma & trauma informed treatments
Examples:
• Explore on how the trauma & abuse symptoms affect the client’s current functioning.
• Assess if the client is in a position/state to narrate the emotionally overwhelming or traumatic events in detail. Try not to push for too much information. Respect the client’s space and emotional state.
• For the follow-up session(s): explore some trauma informed treatments to heal such as somatic experiencing therapy, Eye Movement Desensitization and Reprocessing (EMDR), etc.
• Overcome language barriers via an interpreter, use of infographics or pictures
• Offer a culturally sensitive approach
Example:
• Explore the options the client may have to address her familial conflict. What is acceptable or not in their culture or religion in regard to marital issues.
• Offer support/mediation to family
Examples:
• Explore the option of mediating or intervening with the family, especially client’s mother but only with client’s consent.
• Assess the mother’s wellbeing and safety as her mental health state is affecting Aima’s well-being.
• Educate the mother/parents about the impact of their well-being and behavior on the children (client).
• Be aware and take care of your own emotional responses to hearing a client’s emotional distress and trauma history
Examples:
• Take part in a self-care activity after an emotionally intense session
• Consultation with your supervisor
REFERRALS TO OTHER SERVICES
• Psychiatrist if the severe symptoms persist
• Possible social worker support for the family & the younger sibling
the lives of Hong Kong’s ethnic minorities by reducing suffering and providing opportunities
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