Overcoming a fear of mental illness

Chinese-American parents place a premium on their adolescents' academic success, but they may be less attuned to these young people's psychological well-being. Mental illness in particular can be daunting unknown territory for them, says psychologist Cindy Liu, PhD.

"Mental illness is something these families fear — they don't know what to do if it arises in a family member," says Liu, who directs multicultural research at Beth Israel Deaconess Medical Center's Commonwealth Research Center in Boston.

It's a particular problem among Chinese-Americans since many lack education about the complex nature of mental illness and may therefore label those with such conditions as morally defective, Liu says. "For a culture that relies heavily on the community for resources and support, this belief about mental illness can threaten the family's access to vital connections," she says.

These families may also fear they'll "lose face" if others know their family member is struggling in this way, she adds.

To educate these parents and help troubled young people get the help they need, Liu and Florida A&M University assistant professor Huijun Li, PhD, are designing and studying psychoeducational workshops that draw in Chinese-American parents by appealing to their desire to help their children succeed.

"We thought that the most culturally competent way to address mental health issues with these parents was to say, ‘We know it's important to you that your children do well in school,'" says Liu, "‘and one way to ensure their success is to address their mental health concerns.'"

The team is conducting the intervention with the help of a $20,000 grant from the American Psychological Foundation. This grant, made possible by the Okura Mental Health Leadership Foundation and given in collaboration with the Asian American Psychological Association (AAPA), is open to AAPA members who are seven years or fewer postdoctorate. Proposals can address research, practice or training issues.

In the study, the team will randomly assign 200 Chinese-American parents to one of two community-based workshops. Both will provide general education on two serious mental illnesses — major depressive disorder and psychosis — and compare parents' reactions to them. The team wants to see those reactions, says Liu, because it can be difficult to distinguish between these conditions' signs and symptoms. In addition, if parents are particularly fearful of psychosis, it may be so alarming it might prevent them from seeking help for their children. (There are no solid data on rates of these mental illnesses in Chinese-American youth, Liu notes. That said, Chinese-Americans likely underreport mental illness because of stigma, and Asian-Americans tend to underuse mental health services compared with other groups, she adds.)

One workshop will provide purely didactic information on the two disorders and encourage more informed attitudes toward mental health issues. The other will retain those elements and add videos and live testimonials from Asian-Americans who have sought help for these conditions.

It's important to test that format because the personal aspect of mental illness is where the stigma lies, believes Liu: "It's easy to gravitate toward data and the facts, but when it comes down to trying to get help for somebody else or for yourself, it may take hearing about someone's personal journey to motivate you to seek help."

The team will use several elements to ensure the workshops' accessibility to parents, Li adds. Besides explaining how the information ties to their children's academic and social success, the psychologists will teach the workshops in Cantonese, English or Mandarin, depending on each group's makeup. They'll also present information on psychological or psychiatric services as one health-care alternative to consider, instead of the only one.

"We want to respect their traditional approaches to health-seeking," says Li.

At the end of the workshops, the team will give parents written vignettes that portray children with both disorders to see how well they can distinguish between them. They will then ask what course of action they'd take if their own children exhibited such symptoms. They'll use that information to tailor future workshops, such as by specifically addressing barriers parents have said prevented them from seeking help. The team is excited about sharing a model of mental health literacy that places mental health in the same framework as physical health.

"When we feel sick physically, we go to see a doctor. When we feel sick or distressed emotionally, it's also OK to see a doctor," Li says.

Tori DeAngelis is a writer in Syracuse, N.Y.

To apply for an AAPA-APF Okura Mental Health Leadership Foundation Fellowship, go to APF funding for an application. The next deadline is Oct. 1.