Asian New Zealanders excluded from the mental health conversation

Mental health experts are calling for a holistic national strategy to be created to include the Asian community as the country marks Mental Health Awareness Week.

Stats NZ projections show Asians will account for 26 percent of the population by 2043, an increase from 16 percent of the population recorded in the 2018 census.

Academics say the country needs to make plans to cater to the changing demographics, noting that Asian communities are still being marginalised in the mental health discourse.

A lack of research and understanding of mental health issues, a "one-size-fits-all" approach, an inadequate workforce, lack of community engagement and insufficient funding are among the main concerns, they say.

Rita Chi-Ying Chung, a professor emerita in the counselling programme at George Mason University in the United States, has been working in this field since the 1980s.

Chung acknowledges there has been progress in recent years but says "things are a bit slow".

As the only bilingual psychologist in Wellington in the '80s, Chung was asked to help with translation and settlement of Southeast Asian refugees following the Vietnam War. She speaks Cantonese.

"At that time, I noticed how inadequate the mental health system was in effectively treating Southeast Asians," she says. "At least now they know not all Asian countries speak the same language."

Chung says there has typically been a lack of cultural responsiveness of mental health professionals in understanding Asian culture and the cultural impact on mental health.

"Asians in general express mental health in a different way than Europeans and, therefore, it leads to misdiagnosis and poor treatment," she says.

Few Asians are accustomed to discussing feelings, and they don't necessarily seek traditional Western methods of mental health treatment, Chung says, instead preferring to receive help that is based on their own culture healing practice.

Pakistani advocate Mehwish Mughal, who led an Asian mental health project with Te Papa, says activists, advocates and scholars have been calling for attention to these issues for decades, yet their voices have been ignored.

"We learnt about the sheer multitude of ways in which people from our communities seek support beyond mainstream biomedical and psychological pathways," she says.

"These interventions are highly beneficial and often feel safer for many but, unfortunately, they are rarely what's on offer in standard mental healthcare," she says. "Holistic support for our communities needs to start from a place of understanding that healing can be found in a lot of different places, not just standard therapy."

'By Asian people, for Asian people'

Mughal believes Asians have been left out of important conversations relating to mental health reform.

"As a rule, we remain strikingly absent from high-level discussion and planning in mental health," she says. "Either people think there aren't any serious issues within our communities that need addressing ... or they don't care. The result is that we are invisible."

Psychologist and behaviour analyst Sehar Moughal, who is also from Pakistan, says the current system is frustrating, arguing that it's time to move away from "raising awareness" towards "what is already working for the communities".

Moughal says there needs to be more research "by Asian people, for Asian people, with Asian people" to inform better approaches.

"The dominant narrative in the academy - where therapy models are tested and tried, in advocacy and policy work - seems to reinforce (the notion) that Asian people have a stigma against mental health," she says.

"We keep using therapy models that are clearly not working for our people and then 'find fault' in them for 'not engaging'. ... How can you provide therapy or support to someone when you have a limited perspective of their lives?"

She says labelling Asian people as having a stigma against mental health is effectively stopping any conversation from happening.

"Reinforce to the communities what is already working for them, ask - don't tell them - and I bet many will join the conversation," she says. "We have 'othered' Asian people before the conversations have even started. We need to stop that."

Kelly Feng, chief executive at Asian Family Services, agrees there is a lack of research on Asian mental health. Her organisation has also observed a growing diversity in family distress, mental health issues and social care needs.

She says its Asian helpline recorded a three-fold increase in call volumes during Covid-19 compared to pre-pandemic times, while its mental health counselling sessions for Asian clients saw a 138 percent surge.

"Surprisingly, there has been no systematic research on the well-being and mental health of Asians in New Zealand for almost two decades. The last nation-wide study on Asian mental health dates to 2002," Feng says.

"Understanding the unique challenges faced by Asian communities in New Zealand and addressing the barriers to mental health support is essential. It's a call to action to provide the necessary resources and support to ensure equitable mental health outcomes for all."

Te Papa Asian New Zealand histories curator Grace Gassin, who is also part of the museum's Asian mental health project, says as someone of Chinese/Pākehā heritage, she sees the effects of the Asian community's marginalisation in this space daily.

"How is it that a museum has come to play a not insignificant role in drawing attention to these issues?" she asks. "Where has our health leadership been in this space all these decades?"

There appears to be a consistent lack of will to engage with people from our communities - whether grassroots advocates or mental health professionals - on the issue of Asian mental health, Gassin says.

"It's quite startling and, frankly, puzzling that this is still the case in 2023 with such a large and increasing proportion of our population identifying with one or more Asian heritages," she says. "This situation is untenable and needs to change."

Preparing for the future

Aside from a dysfunctional system, the lack of a linguistically and culturally capable workforce dealing with Asian clients is also a concern.

Ray Law, a registered social worker who works as a family counsellor and a lecturer in the tertiary educational sector, says very few Asian students, particularly those with Chinese heritage, study counselling and go on to work as counsellors in the field.

When discussing disparities, the narrative of the curriculum is largely focused on those between Pākehā and Māori - sometimes involving Pasifika peoples - while ignoring Asian or Middle Eastern communities, Law says.

Asian students, especially Chinese, often struggle to find a role in counselling after graduation, he says.

Law says they often lack experience, adding that the system should provide better support for counselling graduates.

"We need a long-term plan to reflect the changing demographics of New Zealand. ... Don't wait until it is too late," he says.

"If we put in some effort now, those students will have five- or 10-years' experience in five- or 10-years' time."

Chung says when she was studying psychology at Victoria University in Wellington in the late '70s, she walked into a classroom and saw Asian faces, she immediately knew that she walked into the wrong class. However, now more Asian New Zealanders are signing up for subjects in relation to mental health.

She says Asian communities need to promote professions related to mental health and understand why they're worth pursuing.

"We're our worst enemy," she says. "Money doesn't buy happiness. We as a community need to be more reflective of the well-being of the next generation."