What are ethnic Chinese experiences of mental health services in Aotearoa New Zealand?

Ethnic Chinese form one of the world’s largest diaspora populations. In Aotearoa New Zealand, they are a fast-growing and diverse population, made up of both immigrants and non-immigrants from a variety of different backgrounds. The current literature, mainly from international sources, indicate that ethnic Chinese underutilise mental health services relative to non-ethnic Chinese. However, the reasons for this are uncertain.

This study seeks to provide a baseline of qualitative, lived experience data that has been previously unavailable in the local context of Aotearoa New Zealand. The aim is to complement routinely-collected quantitative data, inform directions for future research and inform future initiatives to improve the experience of mental health help-seeking for Aotearoa New Zealand’s ethnic Chinese population. This research could have wider relevance to other ethnic Chinese diaspora populations worldwide, particularly those living in Western countries. It may also have applicability to other immigrant or diaspora populations, who can also face issues with accessibility, and cross-cultural acceptability, of mental health services.

This study was a qualitative study, based on semi-structured interviews with ethnic Chinese mental health service providers, patients and their family members. A general inductive approach was used to analyse of raw data, with Levesque’s conceptual framework for access used to aid analysis. The important cultural role of Confucianism to ethnic Chinese, including on its views of mental illness, and the ethical implications of this, meant that Confucian and bioethical perspectives were also incorporated into the analytical framework.

This study was divided into three main parts. Part One is an empirical study involving 12 interviews with mental health service providers who had particular experience and expertise around providing services to ethnic Chinese patients. Part Two is a bioethical analysis, introducing a moderate Confucian familist approach as a method of introducing family-centred mental health services in a culturally acceptable way. This was based on unpublished data from the service providers’ interviews, along with additional interviews conducted with former mental health patients. Part Three is an empirical study, based on 16 semi-structured interviews conducted with both former and current mental health service users, as well as their family members, recruited from across Aotearoa New Zealand.

The experiences of ethnic Chinese using mental health services in Aotearoa New Zealand could be categorised under two overarching meta-themes: structural violence and symbolic violence. Structural violence describes the harm caused by the cumulative effects of a wider social structure, causing, in the words of Johan Galtung, ‘unequal power and unequal life chances’ for those so disadvantaged. In the case of ethnic Chinese in Aotearoa New Zealand, language and culturally appropriate mental health services are unrecognised, unavailable and unaffordable, causing delayed mental health help-seeking, prolonging distress and causing harm. Symbolic violence, meanwhile, describes the harm caused by being excluded and alienated from societal norms and orders. In the case of ethnic Chinese in Aotearoa New Zealand, the stigma and shame attached to mental health diagnoses, and the application of societal norms without regard to the individual patient’s context, inflicts symbolic violence, disrupting mental health help-seeking as well as therapeutic pathways, and causing harm as a result.

Three main sets of recommendations are proposed to begin addressing the shortcomings identified in Aotearoa New Zealand’s mental health system for ethnic Chinese. The first set of recommendations are changes which could be implemented by health practitioners working with ethnic Chinese, including greater awareness of unmet need for mental health services, and prioritising of individualised determinations of family dynamics. The second set of recommendations are mental health service interventions specifically targeted to ethnic Chinese populations, including better resourcing for the delivery of language and culturally appropriate mental health services, and increased cultural competence training. The third set of recommendations involve emphasising a cultural safety approach in Aotearoa New Zealand’s mental health system, to provide for greater flexibility and responsiveness to the diversity present within Aotearoa New Zealand’s ethnic Chinese population. This would also have significant potential to benefit non-ethnic Chinese populations.