Help-seeking Behaviours

CALD Child and Adolescent Mental Health Resource

eCALD Supplementary Resources

The New Zealand Youth ’07 survey reported that 20 percent of Asian male students and 31 percent of female students reported ‘poor’ mental and emotional health. In particular, Indian students reported higher than average symptoms of mental illness (Yeo, 2012). In New Zealand, schools tend to make the most referrals to child and adolescent mental health services, where social, interpersonal and family problems are of concern. Referrals made by caregivers are often influenced by culture and the caregiver's perceptions of emotional and behavioural problems. Many studies of mental health in Asian and refugee background communities highlight family’s behaviours of hiding mental illness, which involves not actively seeking treatment and keeping an individual’s problems hidden from the community. Treatment is seen as a last resort, only to be used when the family member’s problems have deteriorated to the point where they can no longer be handled within the family (Cheng et al., 2010; Morrison & Downey, 2000; Wynaden et al., 2005).

Some Asian, Middle Eastern and African clients may seek alternative treatments, including the use of traditional medicines, prayer and visiting temples and churches (Ho et al., 2002). Some prefer seeking help from GPs from the same country of origin, based on the belief that these GPs have a better cultural understanding of their mental health problems. Others will seek non-culturally matched GPs to maintain confidentiality and to reduce the likelihood of information being divulged to their community (Wynaden et al., 2005).

People from Asian/MEA backgrounds are more likely to somatise, ie, report physical rather than psychological symptoms (Ho et al., 2002; Wynaden et al., 2005). This can lead to misdiagnosis or under-diagnosis of mental health disorders (Ineichen, 2008; Leong & Lau, 2001). Leong and Leach (2010) stress the need to understand Asian beliefs and attitudes towards mental health, as their delay in help-seeking behaviours can mean that by the time client’s make their first visit to mental health services, the client may already have elevated levels of distress and hopelessness, and clinicians may have to attend to the first meeting as an emergency situation (Ho, Au & Amerasinghe, 2015).

Working with families (Kirmayer, 2011)

Senior members of families from collective cultures expect to be consulted about any health problems that their child/adolescent has and to accompany the young person to health appointments. The tendency to focus on the young person as the client must be supplemented by close attention to the family system and social network, which can include crucial members in other countries. It is important to acknowledge and welcome family members who accompany the child or adolescent client. Rather than excluding them because of privacy, meeting family members together before meeting alone with the client can be an important step to building trust and a source of valuable information.

Rules of confidentiality and disclosure should be applied in a way that respects cultural context. For CALD families, the cultural legitimacy of parental authority over adolescents should be taken into account. For counseling and treating youth, interventions should be framed in ways that avoid alienating family members or aggravating intergenerational conflicts. Similarly, disclosure of diagnostic issues and family “secrets” (eg, about traumatic events) should be approached carefully, with an understanding of what is at stake for the family. When ambivalence towards treatment or non adherence is an issue, involvement of such mediators as a key family member or trusted family ally in discussions of the different treatment alternatives can strengthen the therapeutic alliance, empower the family and provide necessary support to the client (Kirmayer, 2011).

Traditional healing

Use of multiple sources of help is common among migrants, who may consult traditional forms of healing as well as biomedical practitioners (Kirmayer, 2011; Kleinman, 1980). If medications are being considered or prescribed, it is important to enquire about whether the client is using any home remedies or complementary medicine that might interact with the metabolism and effectiveness of a prescribed drug (Lin, Smith & Ortiz, 2001). Broad questions about the use of any medication, food or substance taken for health or medicinal purposes can be followed by specific questions about the use of commonly available substances, such as Ginkgo biloba, and about whether clients receive medicines from family, friends or country of origin. Finally, questions about previous or ongoing consultations with a doctor, healer or helper from their own or other communities can uncover medication use or other health concerns that can affect adherence, treatment response and coping (Groleau, Young & Kirmayer, 2006).