Is the Mental Health System Failing Asian New Zealanders?

A new study has found that Kiwis of Asian descent are less likely to access mental health services—and cultural barriers could be locking them out of the system.

The research, released today by Otago University, found that New Zealanders of Asian descent were less likely than Māori, Pacific and Pakeha New Zealanders to access mental health services. It follows research earlier this year that while Asian New Zealanders experienced higher-than-average rates of mental distress, they were less likely to seek help from mental health services.

The trend where Asian communities are less likely to seek mental health services has been well documented internationally. Those in the sector told VICE that Asian Kiwis might not be accessing these services because of cultural barriers in the mental health system, as well as the strong cultural stigma sometimes attached to mental illness in Asian communities.

Mental Health Foundation chief executive Shaun Robinson says stigma was a "significant barrier for people reaching out for help and accessing mental health services".

"The ideas of saving face, upholding a family's reputation within a community are particularly difficult to overcome… many people from Asian communities who are experiencing mental illness fear they will bring shame to their family," Robinson says.

Alice*, a first-generation Taiwanese-New Zealander with ADHD, says stigma was the key reason why accessing her own mental health care took so long.

"I think I needed [mental health support] from when I was a young age, and I think my parents could see it as well, but they were very reluctant for me to seek mental health care," she says.

Alice says her parents were concerned that she "shouldn't be seen as 'crazy', because it's not very socially acceptable, especially in Chinese culture, to have a mental illness." Her parents believed that in terms of mental health, people were either psychotic or healthy, with no in-between.
"I was essentially not allowed to seek mental health care or any help at all."

Now 24, she was diagnosed with ADHD only after she left home for university, and completed her degree. Even then, she says many doctors she saw didn't believe it was possible for her to have finished her degree while suffering from undiagnosed ADHD.

Alice says because her parents raised her with such a strong work ethic, she would simply work through the struggle, and mask her symptoms.
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There is also pressure within her family for people not to mention mental health issues. "Their first reaction is always to try to hide it, because of the taboo," she says.
When her aunt, diagnosed with bipolar and depression, tried to tell her family, "the kids were hidden away, it was pushed under the table and no one ever spoke about it".

When her aunt later went on to take her own life, Alice says her death was viewed by the family as a "disgrace".
"The stigma is really, really big. Nobody mentions mental illness," she says.

The Mental Health Foundation has established Kai Xin Xing Dong, which aims to inform Asian communities about mental health issues and reduce the stigma.

Robinson says they hear many stories from people who experienced shame or stigma from mental illness, which meant people were less likely to speak openly about their issues.
"As a result, many people only seek professional help once they reach crisis point," he said.
This latest study used data covering the five years from 2008 to 2013.

But the Otago study found when Asian New Zealanders do enter the mental health system, their symptoms are not worse than other groups accessing mental health support for the first time. Asian Kiwis may just have lower rates of mental disorder than other ethnic groups in New Zealand, the researchers say.

"This might reflect the high standards screened for in Asian immigrants or protective factors related to their family and community functioning. There is evidence from other countries that migrant communities begin to suffer higher rates of mental disorders as they acculturate to their host population."

They also speculate that doctors may simply be worse at identifying signs of mental distress in Asian patients, showing signs of "cultural bias when diagnosing mental disorders in different ethnic groups".

International research has found American physicians are less likely to detect depression in African-American or Hispanic patients displaying the same symptoms as white patients. Studies in New Zealand have found that "likewise, New Zealand physicians may be less likely to recognise mental health problems in Pacific and Asian peoples."

That would make doctors less likely to refer their Asian patients on to specialist mental health services.

Michelle Huang, from Bo'ai She: Asian Family Services, says that language is one of the biggest barriers for Asian people who need support.

She says the shame they feel around having a mental illness means that it can be very difficult to ask for help, especially if they need to speak through an interpreter.

Asian Family services provides peer support groups, which Huang says can be very effective.
"They can share their problems, and see that they are not alone."

*Name changed at her request

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