CASE STUDIES ON SUPPORTING ETHNIC MINORITIES WITH MENTAL HEALTH NEEDS
#6 AAFSEEN – LOW LITERACY CLIENT
BACKGROUND
Aafseen is a 45-year-old married female from Pakistan, staying in Hong Kong for more than 20 years, with her husband and 4 children. She came to HK after her marriage. She was born and brought up in Pakistan and dropped out of school after primary 2. She is able to read and write some basic Urdu. She is not able to read and write in English, but can speak some basic English, which she learnt from her friends in the community center. She likes to do embroidery on clothes and used to stitch dresses for herself and her family members; she never did it as a means of earning money; but rather as a hobby. She likes to do make up and get dressed up nicely as part of her routine. She is also a good cook.
Aafseen’ s husband is a dominating person, who tends to get angry about small things and would beat her up frequently. As per her experience, DV was part of almost every marriage that she knew, so did not think of seeking any help for it. He was also very strict with the children and at times would use physical punishment as the method of discipline. The whole family was receiving CSSA assistance, her husband would only do part-time jobs but not very regularly. Aafseen is responsible for all the household work and taking care of her kids, while her husband would be responsible for all the outside work including buying groceries, shopping, visiting the social worker, etc. They have 3 daughters (aged 17, 15 and 11 years) and 1 son (10 years).
Aafseen’ s support system included her sister (living in Pakistan) with whom she would talk over the phone regularly. She also had few friends in the neighborhood, but she would not generally share her stresses with them. She did not have much support from her brothers and her mother (who was very old and herself dependent on her brother).
Aafseen’s husband lost his mother in early 2020 and he got stuck in Pakistan for over 9 months, due to the travel restrictions of COVID.
By nature, Aafseen is a very anxious person. She has a tendency to worry about many things including but not limited to her children’s future, their health, behavior, and her husband’s interaction with them. However, her anxiety worsened when the travel restrictions were implemented. She was feeling very stressed and overwhelmed due to the additional responsibilities like shopping, interacting with social workers (for CSSA), and taking care of all the outside transactions. On a couple of occasions, she received a complaint about her son fighting with others and she started worrying about how she would be able to face all the things if the matter escalates further. So, she would not allow them to leave the house/go to the park; but rather expect them to just sit at home and play on their own. She started getting angry at them if they didn’t listen to her, she also slapped them on a couple of occasions. Her sleep was affected, and she also started getting a panic attack if she heard some news related to COVID. On one hand, she was happy that there is no DV as her husband is not around, but she was also worried about her husband not being able to come back as it was very difficult for her to take care of everything on her own.
One time she was asked to visit the social worker in relation to CSSA assistance. She was extremely anxious as she thought that they might stop CSSA. She went there with one of her friends. The social worker felt that she was not emotionally stable and might benefit from some counseling support.
ISSUES FACED BY THE CLIENT
• Domestic violence
• Extra responsibility in absence of husband
• Anxious nature
• Mental health symptoms - Anxiety, worry, anger
• Increased irritability
• Dealing with the issues like her children getting into fights with others
• Anger control issues and child maltreatment
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
• Anxious about getting infected by COVID
INTERVENTION THAT CAN BE HELPFUL FOR THIS CLIENT
• Emotional awareness and emotional management including anger management tips
• Teaching some breathing techniques/ meditation techniques
• Setting up a healthy routine, and how to incorporate the additional, delegating some of the work to the children (age appropriate)
• Psychoeducation – about HK laws related to child maltreatment, finding out the alternative methods for disciplining kids, some parenting tips
• Encouraging self-care, hobbies, taking some time out for herself, exercise, involvement in the community
• Exploring unhelpful thought patterns underlying anxiety and anger control issues
• Problem solving – when her children get into fights
• Some psychoeducation about COVID situation
• Acceptance of the situations that she cannot change – travel restrictions
• Working on the things that she can still do
• Exploring support network – other relatives/in-laws/friends
• Making a list of different organizations/ resources where she can approach if she needs any help
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
• Language barriers
• Low literacy – cannot read and write
SUGGESTIONS FOR ADDRESSING THE CHALLENGES
1. Ensure confidentiality Example:
‘’ You might be worried about others knowing about your problems, but rest assured that the information discussed in this session will not be told to anyone, unless there is any emergency situation like some risk of selfharm/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 about counseling
Examples:
“Anxiety/ depression symptoms can be due to some problems that you are facing in your life. Talking about the problems 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
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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 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.”
7. Tips for clients having language barriers
• Invite a friend trusted by the client as a translator/ arrange a professional interpreter if client might feel comfortable
• Online support for translation
• Use of simple English, repeated explanations, slower pace, ensuring client’s understanding before moving ahead with next concept
• Use of diagrams/ pictures to explain concepts
• Use of some videos / some online material if appropriate
8. Involvement of client’s children (eldest one)
• Explore client’s eldest child for translations, helping her with some of the age appropriate tasks (shopping/ outside transactions / communicating with the social worker)
8. Resources on Domestic Violence
Explore with the client if she would like to receive any help with DV in the future/ providing some information booklets
10. Engaging client husband
Explore with the client if she would like to involve her husband in therapy in the future
REFERRALS TO OTHER SERVICES
• Psychiatrist if the symptoms persist
• Referral to be involved in some same interest classes / community groups
• Organizations providing translation services (face to face/ online)
the lives of Hong Kong’s ethnic minorities by reducing suffering and providing opportunities
Improves
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 .
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the lives of Hong Kong’s ethnic minorities by reducing suffering and providing opportunities