Culture-Specific Information Related to Assessment and Treatment

English language particularly challenging, so Koreans often won't present at services because of embarrassment about not communicating well.

Strong stigma associated with mental health disorders.

Refusal of treatment.

Belief in the use of traditional medicines.

Lack of recognition of problem as mental illness — counselling not common in Korea (psychotic delusions with religious content are regarded as a spiritual problem and not a mental health one).

Often seek help from pastor who is not necessarily trained to recognise mental illness.

Protection of family reputation is critical. Mental illness affects family reputation and hence marriage prospects.

Anxieties about confidentiality.

Buddhist and Christian values influential for some Agnostics.

Belief in self-help.

Unfamiliarity with mental health services.

Women blamed for family problems.

Prefer short-term, focused and problem-solving approach.

Marital counselling/therapy needs adapting for cultural norms.

Practitioners seen as authority and expert.

'Dependency' on therapist a cultural norm and will need managing accordingly — clinician may be regarded as friend for life.

Kibun is a concept not directly translatable, the closest concept is a person's mood or state of wellbeing. In Korean culture taking care of others' kibun is essential in being respectful and maintaining relationship. This involves not being argumentative, confrontational, giving bad news, or ignoring the social ranking of a person. Disturbing kibun could be cause for a client not returning to treatment.

Language barriers

Strong stigma (including getting family consent for mental health assessment - mental health of individual seen as the family's illness).

Shame and guilt prevents people discussing problems outside of family.

Lack of recognition of the illness (seen as imbalance of 'doshas' in Ayurvedic context).

Belief in the use of traditional medicines.

Ideals of emotional restraint and self-control.

Anxiety stigmatized so often described as 'shyness' or 'nervousness' and no treatment sought.

High degree of filial piety and family loyalty, hierarchical family system.

Normalcy of dependency where helplessness is accepted as part of life.

Caste, class and socio-economic standing create culture specific stress. Indians often caught between highly structured system and Western culture.

Pleasing family and increasing status a priority.

Gender-role divisions pronounced.

Family therapy appropriate but because family is not necessarily seen as a 'system', it may need adapting.

Disease is perceived as bad karma (Buddhists and Hindus).

Hindu values impactful.

Muslim values impactful.

Practitioners seen as authority and expert.

Expectations of practitioner are strongly shaped by traditional guru-disciple relationship, so referrals for therapy should be by the GP.

Women blamed for family problems.

'Dependency' on therapist a cultural norm and will need managing accordingly.

Language problems.

Somatization of complaints.

Stigma - mental health of individual seen as the family's illness.

Lack of trust in one's ability to make changes.

Tend to deny, somatize and endure emotional problems or cope by joking about mental health - "smiling depression".

Dealing with established family hierarchy.Protection of family reputation.Strong stigma.Although strong stigma with adults, children with mental illness seen as bringers of luck.

Mostly Catholic with some Muslim, Buddhists and Hindus.

Fatalism and religiosity (magico-religious attribution of illness).

Trusting fate to Divine will.

Many seek help from church (85% Catholic), or Mosque.

Practitioners seen as authority and expert.

Prayer and spiritual counselling accepted and important.

Often use 'albularyos' (faith healers) first (because of the compassion they display).

The value of self-reliance and self- control.

'Tremendous shame' associated with mental illness. Losing control of the mind brings shame to individual and whole group.

Amae - a "non-verbal empathic orientation, a fondness for unanimous agreement and hesitation of self-expression" (Doi, cited in Mike, 2003) is fundamental to the emphasis of group over the individual.

It allows for the expression of conflict and self-assertion in families and close knit groups. The implication for practice is that conflict within tighter circles and relationships is tolerated once amae is established. The clinician however, is not likely to share this established trust and intimacy, and so traditionally Japanese clients are more likely to be reserved in expression of distress and emotion.

Buddhist, Shintoist, Confucian and Taoist values influential for some Christian minorities.

Agnostics.

Suicide - committing suicide is regarded as honourable and the ultimate form of self-control. It fits with the socially pervasive moral belief that self-sacrifice is worthy.

Women blamed for family problems.

Prefer short-term, focused and problem-solving approach.

Practitioners seen as authority and expert.

Marital counselling/therapy needs adapting for cultural norms.

Language barriers.

Stigma.

Belief in the use of traditional medicines.

Unfamiliarity with mental health services.

Shame and guilt prevents people discussing problems outside of family.

Disease is perceived as bad karma (Buddhists and Hindus).

Some Muslims (Bangladesh, Pakistan) may have fateful attitude as illness seen as Allah's will.

Women blamed for family problems.

Prefer short-term, focused and problem-solving approach.

Practitioners seen as authority and expert.

CBT and Mindfulness approaches may be appropriate, as well as family therapy.

Marital counselling/therapy needs adapting for cultural norms.

'Dependency' on therapist a cultural norm and will need managing accordingly.

Language barriers.

Stigma associated with mental illness.

Shame and guilt.

Help-seeking behaviour.

Filial piety.

Family reputation.

Saving face.

Dependency a normalcy.

Confucian, Taoist and Buddhist principles influential in cultural values.

Islam in Malaysia (minority in China, Vietnam).

Women blamed for family problems.

Prefer short-term, focused and problem-solving approach. CBT recommended.

'Dependency' on therapist a cultural norm and will need managing accordingly.

Marital counselling/therapy needs adapting for cultural norms.