The Report does not relate directly to this Ministry although it could be used as a supporting document to present to expert committees of the United Nations, which oversee the Government’s implementation of a range of international human rights treaties. The Ministry’s Human Rights Division is, for example, co-ordinating arrangements for a presentation in May 2003 of New Zealand’s second report to the Committee on Economic, Social and Cultural Rights in Geneva. That Committee examines parties’ performance in relation to the international Covenant on Economic, Social and Cultural Rights, whichincludes the right of everyone to ‘the highest attainable standard of physical and mental health’.
Ministry of Health
There are a number of initiatives by the Ministry of Health that have direct and indirect impact on Asian mental health concerns; these include:
Delivering on Mental Health Blueprint targets - continued resourcing in mental health up to specified Blueprint levels will allow for better targeting of services for many groups, including Asian peoples
The Report on Progress - which provides feedback on the effectiveness of service delivery. The needs of Asian peoples would be expected to figure in these surveys
The Mental Health Workforce Development Programme - launched in May 2003 to ensure appropriate numbers of mental health professionals are trained. Included in this programme are measures to ensure that Asian mental health requirements are included in the training curriculum
The Like Minds Like Mine Project - aims to reduce the stigma of mental illness and the discrimination that people with experience of mental illness face. It has specified that Asian peoples as a group require more attention in destigmatisation efforts in the latest strategic plan
Primary Health Organisations (PHOs) - PHOs have the potential to improve services to the Asian communities through the implementation of the Primary Health Care Strategy. Essential to PHO development is responsiveness to the makeup of local populations
Knowing the People Planning - a joint project between five DHBs and the Ministry of Health to improve responsiveness, planning and accountability of services to people with long term serious mental health conditions. Because of the person-focused approach adopted by this project, assessment can be made of whether a person’s cultural needs are being addressed during their treatment and recovery
Auckland Public Health Project - the Ministry is providing $150,000 per year to fund the Asian Network in an advocacy, networking and community development role around Asian health issues, including mental health. Part of the project brief includes changing broader public policy that currently impacts on the Asian community such as immigration services and translation resources.
Ministry of Women’s Affairs
This Ministry consulted with women throughout New Zealand to identify the Government's priorities for New Zealand women and the discussion document Towards an Action Plan for New Zealand Women (December 2002) has been widely circulated. In it, the Ministry notes the changing demographic profile of women, especially the growth of Asian communities. Migrant and refugee women are one of the key target groups. As an outcome of consultation, the Action Plan could identify the need for specific priorities to respond to the mental health needs of this group.
Ministry of Youth Affairs
Some elements of Youth Affairs' ongoing work programme may be relevant to Asian peoples and their mental health concerns. Particularly relevant work items include:
The Wellbeing of Young Peoplejoint research portfolio with the Health Research Council. Over the next three years this will involve the development and completion of a national health and wellbeing survey of young people from school-leaving age to 24 years of age. It is possible that the survey could include an Asian over sample and mental health-related questions could be asked
Maintenance of linkages with operational agencies and other departments with such linkages. For example, providing advice to the Ministry of Health on the implementation of Youth Health - A Guide to Action (jointly developed by Youth Affairs and the Ministry of Health), which makes specific mention of Asian youth and new migrants from non-English speaking backgrounds and identifies as one of its goals 'a measurable improvement in young people's mental health'
The release in June 2003 of the resource MAYBE it's DEPRESSION: A guide for parents of troubled young people and other work associated with Youth Affairs' ongoing leadership and co-ordination of implementation of the New Zealand Youth Suicide Prevention Strategy.
Office of Ethnic Affairs
The Office of Ethnic Affairs provides referral and information services for ethnic communities and policy advice to Government about ethnic communities. Current activities include:
Chinese Poll Tax Reconciliation Process - In February 2002 the Prime Minister formally apologised to early Chinese New Zealand settlers who paid the poll tax and their descendants. A consultation process was established to determine appropriate forms of reconciliation, and the Office of Ethnic Affairs is working with representatives from the early settler community on a proposal to put to Government
Ethnic Perspectives in Policy is a resource for government agencies to use when developing policies or services for ethnic communities. It sets out a framework of the Government's policy values and outcomes for the ethnic sector, and provides guidelines on policy development, consultation with and being responsive to ethnic communities, and other useful information
Language Line is a pilot telephone interpreting service co-ordinated by the Office of Ethnic Affairs. The service, operating in six government agencies, provides telephone interpreting in over 30 languages. Participating agencies are ACC, Department of Internal Affairs, Housing New Zealand Corporation, the Ministry of Social Development, New Zealand Immigration Service, and the Police. The service was launched on 30 April 2003 and is scheduled to run for 12 months.
The Police work with Asian communities in a number of ways, for example:
An Asian Liaison Officer is based in North Shore Waitakere Rodney District, working with Asian organisations and contributing to Chinese radio discussing recruitment, burglary, personal safety and driving, etc
Counties-Manukau District has a South Asian Liaison Officer, who works with Indian, Sri Lankan and other South Asian communities
Mäori Pacific Ethnic Services of the Office of the Commissioner has run workshops to discuss current safety issues and trends with ethnic communities. There is good representation in these workshops from Asian communities, and workshops have been carried out in Auckland, Wellington and Christchurch
Police has established a Strategic Ethnic Advisor position in the Mäori Pacific Ethnic Services to provide strategic guidance and support for policy development and services delivery to the national office and districts, focusing on other ethnic groups (including Asian) other than Mäori and Pacific peoples
The Police is among the six government agencies using the Pilot Telephone Interpreting Service co-ordinated by Ethnic Affairs
Police Districts are encouraged to actively engage different ethnic communities in the development of their annual business plans
Police is in the process of developing a Police Ethnic Peoples Responsiveness Strategy.
Statistics New Zealand
Statistics New Zealand produces a number of publications and information services for researchers and planners, including specific information on Asian New Zealanders. Some relevant documents are:
Asian People 2001 Census of Population and Dwellings
Ethnic Groups 2001 Census of Population and Dwellings
People Born Overseas 2001 Census of Population and Dwellings.
Additionally, Statistics New Zealand has consulted widely on its document Draft Recommendations for the Review of the Measurement of Ethnicity and has run Asian focus groups for the 2006 Census of Population and Dwelling consultation.
Collating the feedback from the Asian community consultations (2002)
After Elsie Ho submitted the final draft of the report (late September 2002), the Mental Health Commission sent a draft copy to various Asian community representatives and people who work closely with these communities in order to get feedback. Two consultation meetings were held on October 21, 2002 (Auckland) and November 11, 2002 (Wellington). The Mental Health Commission also received e-mail comment from people who were unable to attend these meetings. Overall, approximately 50 people gave feedback.
The report set the scene for open discussion about Asian mental health. The Mental Health Commission encouraged people to use the report as a discussion starter and not to be confined to only discussing its content. The feedback can be categorised into seven general areas:
the social consequences of the migration experience
the problem of resolving mental health concerns for Asian peoples
problems with existing services – fragmentation and lack of co-ordination
- structural solutions
- operational solutions
the value of the MHC report and ways to manage negative publicity
where to next for the Asian project and the MHC?
a) Contextual Issues that Set the Scene for Potential Asian Mental Health Problems
At the beginning of the report a demographic profile is outlined detailing five Asian groups (Chinese, Indians, Koreans, Cambodians and Vietnamese) selected on the basis of size, relative increase or unique migration experience. Consistently, feedback from consultations stressed the importance of this profile as a backdrop to understanding the nature of Asian mental health problems. Moreover, the growth of the Asian population and its relative size in comparison to Pacific peoples was seen as justification for more emphasis being paid to Asian concerns.
In spite of this growth, people stressed the fact that ‘Asians’ were not a monolithic group. Divergence by language, culture and migration status (eg, international student, migrant, refugee and asylum seeker) identified significantly different experiences. Recognition of this divergence was seen as important in terms of responsiveness to Asian mental health problems. In fact, the only unifying aspect of Asian communities was their overwhelmingly urban character.
b) The Social Consequences of the Migration Experience
Many people suggested that the risk of mental health problems was greater for Asian peoples given the difficulties of unemployment, social isolation and adjustment to a new society. Moreover, migrant Asian women were seen as particularly at risk, for part of the migration process was often to start a family. The stresses of childcare compound the stresses associate with migration.
c) The Problem of Resolving Mental Health Concerns for Asian Peoples Although the prevalence studies cited in the report suggested Asian peoples experienced mental health problems at similar levels to the general population, many people asked why Asian peoples were not presenting at similar levels. American hospital studies note this trend also. One answer to this question could be the high degree of stigma that is associated with mental health problems within Asian communities. Somatisation of mental illness was common when Asians visited their GP, for example. Another reason could be that many Asian peoples preferred traditional or holistic approaches that were culturally more appropriate. Accompanying this are issues related to the availability of interpreters and knowledge of service availability. Are current services able to offer culturally appropriate care?
d) Problems with Existing Services – Fragmentation and Lack of Co-ordination At an organisational level, many people thought that existing programmes and funding arrangements lacked co-ordination across Ministries and Departments when it came to Asian issues. This fragmentation was also evident amongst Asian service providers. Many people who attended the meetings, for example, did not know of the services others were offering, and were surprised by the amount of effort that was being put in by some people and organisations.
Compounding these problems were feelings that Asian mental health was under-resourced. Psychiatric services for refugees, for example, often saw psychiatrists with caseloads of 70 or more with no support (eg, psychologists, nurses or occupational therapists); while support services such as interpreters and advocates tended to be disconnected from mental health services. This situation meant mainstream Asian mental health professionals were often called upon to fill gaps and act as interpreters, supporters, and advisors on Asian issues. This all stood outside their job description and such tasks were in addition to their day-to-day workload. Often unremunerated, many of these people felt ‘abused’ by the additional demands placed upon them.
e) Possible Solutions A number of solutions were offered to the current problems surrounding Asian mental health. Essentially, these could be divided into two distinct categories: structural solutions and operational solutions.
There was a clear recognition that achieving structural change in Asian mental health involved lobbying for funding and encouraging a co-ordinated government response. Lobbying, however, also requires a co-ordinated approach from the Asian communities themselves so unification through politicisation was seen as a necessary first step. In practice this means that Asian community-based services, Asian researchers and professionals need to organise, share information and support one another.
Once co-ordination amongst Asian communities was achieved, the next step would be to encourage the government to adopt a multi-agency approach, where various problem areas are picked up by agencies with the most expertise in that area. It was noted that some Auckland non government organisations (NGOs) had already developed holistic models making available a wide range of services, so starting from scratch was not necessary. However, additional funding was needed to ensure such services could be offered.
Research funding was also required in order to target areas that were under-researched, such as Asian women, youth and older people (specific research methodologies need to be developed to deal with Asian peoples); while the current purchasing arrangements for services needed to change. Fees for service purchasing were seen as counterproductive to the development of Asian services. This did not allow for the development of expertise. Consequently, people may get inappropriate service (eg, an Indian professional assigned to a Korean consumer, the assumption being all ‘Asian’ people are the same). There was a need to align services with needs.
At the broad policy level, concern was expressed about the current immigration guidelines, which were seen as insensitive to Asian peoples. Although New Zealand had targeted the Asia-Pacific region as an economic alliance, immigration policy was seen as contributing to mental health risk by limiting family migration; a major protective factor for Asian peoples. Within mental health services policy change towards a more family-focused approach was also seen as necessary.
Finally, a policy approach to destigmatisation of mental illness within Asian communities was seen as necessary, where relevant media (such as Chinese newspapers) were used as the delivery medium. The Like Minds campaign was seen as the most likely vehicle to champion such work.
Operational solutions offer pragmatic remedies to current problems in Asian mental health. Two general areas were identified by people who attended the consultations: broad social supports and information for Asian migrants; and mental health focused solutions for the people who deliver services for Asian peoples.
Providing information to migrants before they migrate and after they arrive was important. In particular, advice on New Zealand’s laws and customs, where to go for help if needed, and where and how to access language education were paramount. Targeted services on arrival providing language and social supports was suggested as a way to facilitate integration.
For actual mental health services a number of recommendations were made. First, it was noted that most initial presentations of mental health problems were to general practitioners (GPs). So GPs should be at the centre of a mental health response where access to interpreters, translators, knowledge about Asian approaches to health, and complementary traditional approaches were available. GPs could also be informed of the service options and be able to refer to the most appropriate service. Primary Health Organisations (PHOs) could also be of central importance for Asian mental health delivery.
The problem of Asian diversity was also discussed in terms of service delivery. One possible solution could be an Asian mental health team, similar to that operating for Mäori and Pacific peoples. Another option would be to have mental health teams adopting one Asian area or language group so that all areas are addressed across the teams and DHBs.
Capacity building was another issue that was seen as necessary. Encouraging Asian peoples, especially those with Asian language skills, into the mental health workforce and related professions was one means of creating a more relevant and culturally sensitive service.
f) The Value of the Asian Report and Ways to Manage Negative Publicity
Apart from feedback relating to the issues identified in the report, comments were also received noting the value of the report and ways to manage any negative publicity that may be generated. Polarised views were expressed. Some did not consider the possibility of negative publicity as a major concern. The value of the report was in its informed contribution to debates surrounding Asian issues. Others, however, were more concerned about negative publicity and identified ways to placate negative comment. The following comments were made:
The report should emphasise the commitment of Asian New Zealanders and their contribution. The fact that Asian peoples are setting up their own services is indicative of this. Most Asians are coping well
Immigration has both costs and benefits. You cannot have a process where only benefits are the result. There are inevitably some costs in order to realise the gains
The report should emphasise the normality of the research findings. The report does not necessarily identify unique ‘Asian’ issues. The issues are actually relevant to migrants, refugees and international students generally. Also, many of the issues are similar for Mäori and Pacific peoples
The report needs to stress mental health and not mental illness.
Finally, there was comment regarding the limitations of the report. It should be noted that it only looks at a sub-group of Asian peoples and that existing research is limited in breadth and depth. These comments were taken on board and most found their way into the report’s foreword.
g) Where to next for Asian Issues and the Mental Health Commission? Comments regarding the development of the Asian Project and the MHC’s work in this area were made. First, it was suggested that the MHC could act as a clearinghouse for Asian-based research. Second, the MHC should liaise with government agencies and encourage or sponsor research. Third, the MHC should use its monitoring role to scrutinize DHB performance in regards to Asian peoples. And finally, the establishment of a permanent reference group could be set up to look into all Asian issues for the MHC.
Blueprint for Mental Health Services in New Zealand: How Things Need to Be, (1998) Mental Health Commission.
Ho, E., Au, S., Bedford, C., and Cooper, J. (2003) Mental Health Issues for Asians in New Zealand: A Literature Review. Mental Health Commission.
Hsu, F. L. K. (1971) Psychological Homeostasis and Jen: Conceptual Tools for Advancing Psychological Anthropology, American Anthropologist, 73, pp.23-44.
Tse, S (in press) Use of the Recovery Approach to Support Chinese Immigrants Recovering from Mental Illness: A New Zealand Perspective, Psychiatric Rehabilitation Skills.
1 These ideas may resonate with Mäori and Pacific people also.