Mental Health of Ethnic Minorities in Hong Kong

Findings of the Ethnic Minority Well-being Centre Between 1 January 2021 and 31 December 2022

March 2023

Shilpa Patwardhan, Winnie Ng, Shalini Mahtani, The Zubin Foundation

Edited by Rosie Lanham

PROFILE OF CLIENTS

From 1 January 2021 to 31 December 2022, The Ethnic Minority Well-being Centre accepted 213 ethnic minority (EM) individuals to benefit from counselling services

Gender

Ethnicity

85% of our clients were female Pakistani (43%), Indian (25%) and Nepali (15%) were the largest ethnic groups that received counselling

SEVERITY AND RISKS

of clients were ranked as ' severe ' or 'extremely severe ' on the standardised Depression, Anxiety, Stress Scale (DASS).

80% 23% of clients exhibited a risk of suicide or self-harm Majority of them had repeated thoughts of a passive wish to die

PRESENTING SYMPTOMS

The most frequently presenting symptoms included:

Age Group

More than half the clients (58%) were youth; categorised as those, aged 30 years old or below

MEASURING EFFECTIVENESS OF OUR COUNSELLING

Anxiety Depression Stress

Self-harm tendencies Low selfesteem Anger management

A randomised controlled trial study was conducted to evaluate the effectiveness of the counselling service, and a total of 120 clients were enlisted

The results showed that participants who received counselling experienced greater reductions in their depression (-11 67 vs -2 80 in the control group) and anxiety (-7.70 vs. -2.23 in the control group) symptoms, as well as greater improvements in their quality of life related to their mental health (+12.77 vs. +3.08 in the control group).

The HKU findings report is available on Mental Health of Ethnic Minorities Online Resource Platform for Professionals – see link in the last page of this infographic

1. Family Conflicts

A. Parent-Child Conflicts

Differing Generational Values: Different from their traditional parents, many EM youth were born and raised in Hong Kong and have been exposed to a more contemporary Western culture. The difference in values has created conflicts in daily life across a range of issues, from how children should dress, to views on education, work and marriage

Forced Marriage: Forced marriage is common practice amongst Pakistani clients. Refusing a forced marriage would bring shame on the family As a result, women are coerced into marrying against their will

Love Marriage: Conflicts occurred when love marriages took place without family approval, often resulting in persistent, lifelong grudges

The Girl Child: Daughters are often seen as less important than sons in EM families Their education is of lower priority and they are not supposed to express opinions, emotions or any sign of suffering.

Domestic Violence: Disturbed or complicated family environments due to domestic violence are psychologically damaging They can also contribute to further conflict between parents and children For example, children are sometimes angry at their mother for continuing to accept their father despite history of being violent.

B. Marital Conflicts

Patriarchal Families: Patriarchal family systems result in power imbalances Sometimes a husband may try to exert power through physical violence against his wife, if she does not comply with his wishes.

Husband-Wife Disagreement: Conflicts occur when the mother is blamed for childrens' behaviour or perceived short comings, as well as when there is financial hardship within the unit or pressure to financially support extended family

Other Intimate Relationships: Extramarital relationships can be a cause for marital discord, especially when the women stay in the marriage, despite knowing about the husband's affair(s) Parallel marriages or multiple marriages are accepted in Islam Some women reported suffering with mental health issues in relation to having to accept polygamy within their marriage

Communication Failure: Marital discord can result from lack of communication with the spouse This is particularly common in forced marriages, where separation or divorce may not be an option for the couple

C. Conflicts with Extended Families

Extended family play a big part in ethnic minority culture. They are often involved in important family decisions This can create stress and tension between the couple

2. History of Trauma

A. Physical Disciplining

Physical or emotional abuse at the hands of parents is often a part of a disciplining strategy and is widely accepted in certain cultures This can result in trauma to the children

B. Sexual Abuse

Abuse can happen at the hands of a close family member, a distant relative, a peer or an outsider If the abuser is a family member, parents prefer for their child to hide this fact and the victim does not receive any support to deal with the trauma.

C. Domestic Violence/Parental Marital Discord

Domestic violence between couples can cause trauma for the violated spouse - but seeking help is rare This is also traumatic to children: either as victims themselves or as witnesses and silent sufferers.

Beating the wife is a common thing in many families that I know; I never thought of seeking help for that.

- 45 years old, Female

4. Other Issues

Large family size is not uncommon in some ethnic minority populations, a typical Pakistani family may have between 4 and 5 children The wife is usually responsible for managing the household and looking after all the children

This can be challenging for women in Hong Kong as there is a lack of support from extended family who may live in Pakistan

A. Financial Stress

This was intensified during the pandemic Many faced job losses and difficulties in finding new employment which created financial stress for the families

B. Pandemic-Related Stresses

The main contributors were job insecurity, family separation resulting from travel restrictions, stress from online schooling (especially due to lack of space) and lack of community support

Compliance with counselling treatment was also affected during the pandemic as there was a lack of privacy in the small homes of our clients, and with many family members around, it was difficult to conduct counselling online for some clients

C. Others

Clients also came to us for other common issues, like relationships with their partners, loss of friends/families, and physical health problems.

OUR

LEARNINGS - FOR PRACTITIONERS

1 2 3 4

Family and culture play an important role in EM mental health

Many issues faced by clients are specific to EM communities Clients have expressed reluctance in seeking help elsewhere, as they felt their issues may not be understood. It is therefore vital for professionals to be aware of cultural differences and enhance their understanding of EM cultures.

Building a relationship with clients and gaining trust

While one may not be knowledgeable about all aspects of a different culture, practitioners should be ready to understand and learn, and allocate enough time to get to know the client Understanding and empathy are key

Understand underlying issues and not just the symptoms

Clients may not be able to articulate their feelings in words due to language barriers and many of our clients believed that although they were given medication to manage their depression and anxiety, they were not given an opportunity to explore the root causes.

Exploration of the underlying issues through detailed history taking such as their family history, education, marriage, etc. would be useful, and should be approached with cultural sensitivity

Encourage clients to share their story

At The Zubin Foundation we found that the following actions helped clients to open up to their counsellors:

(i) Reassuring confidentiality,

(ii) Teaching them about mental health, and

(iii) Sharing the benefits of seeking help

5 6 7 8

Helpful and proven interventions

Our treatment protocol is based on Cognitive Behavioural Therapy (CBT). The intervention strategies such as emotional management, cognitive restructuring, promoting self-care practices, acceptance and problem-solving strategies were found useful Outside referrals for psychiatric help were also important when there was a need for psychiatric medications or a risk of self-harm

Monitor progress of at risk clients

For clients who are receiving parallel psychiatric treatment, mental health practitioners may seek to encourage compliance with psychiatric treatment and support clients to complete it

Deep-rooted issues take time to address

Many of the issues underlying mental health symptoms such as anxiety arising from marital conflicts or forced marriage cannot be resolved in a short period Practitioners may explore options available with the clients, work on accepting what cannot be changed and focusing efforts on things that are within the client's control.

Low-literacy clients

The CBT model of therapy may pose a challenge when applying it to clients with no formal education. We overcame these challenges by using pictures, diagrams and simple language We also tended to use more behavioural strategies.

OBSERVATIONS

Directory for Psychiatric Resources

Demand is high for public psychiatric services and there is a long waiting time. This can demotivate clients to seek professional help More information on pro-bono or subsidised schemes to access private psychiatric services in English and EM languages would be useful

Collaborative Service Model

Clients may be hesitant to see other mental health service professionals due to concerns of language, cultural barriers or confidentiality

We found that for some clients, counselling on its own was insufficient. However, sometimes clients refused to be referred to other services A possibility that should be explored is The Zubin Foundation to work with Integrated Community Centre for Mental Wellness/schools/hospitals to develop a service model to co-support clients, especially those at risk.

Local Ethnic Minority District-based Mental Health Ambassadors

A team of ethnic minority mental health ambassadors in each district should be trained to help raise awareness of mental health amongst grassroots ethnic minorities, identify individuals with mental health needs and refer individuals to resources

Online Resource Platform for Professionals:

https://www.zubinfoundation.org/mental-health-resources/

aninitiativeofTheZubinFoundation

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念 基

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