A knife above the heart

Mental Health Nursing,  Jul 2003  by Yeung, Echo

• E-mail
• Print
• Link

Concepts of mental health are notoriously culture-specific. Chinese society has particular views of mental illness which require a special understanding. A new pack has been developed in Liverpool to help mental health professionals engage with Chinese people who need care and treatment. Carly Marie Barraclough met Echo Yeung, the author of the pack (pictured below)

'I don't think many people know why it is called Endurance,' reflects Echo Yeung of her training manual/resources pack. Endurance: improving accessibility to mental health services for Chinese people aims to help professionals understand the unique difficulties of working with this client group. 'Endurance in Chinese is made up of two words, "knife" and "heart": a knife above your heart and you still have to endure.

'Endurance is considered a virtue in Chinese culture: people have to endure pain and suffering before they can achieve what they want to achieve. The reason I chose 'endurance' was not because I want to endorse this virtue. Instead I want to reflect on it in the context of mental health. I think that Chinese people have to endure a lot for a number of reasons.'

Speaking to Echo some months after the launch of the pack last year allows an opportunity for ad hoc evaluation of the work that she completed under the Merseyside Health Action Zone (MHAZ) fellowship scheme.

Echo worked as a social worker for Liverpool social services, while on secondment to MHAZ when she carried out her research project. She now lectures full time at Liverpool Community College.

The fellowship offers front line staff, time away from their jobs to develop new approaches around supporting the needs of people with ill health or social care problems. In Echo's case, it was delving into the problem of how mental health services often fail to meet the needs of Chinese people in the UK resulting in a low up-take of services by that community. Educating professionals by putting mental health issues into a culturally sensitive context can help engage the Chinese community and help them make choices about their own care, Echo says.

Nine months on since the launch, Echo says she feels she is 'just at the beginning of a very long journey'. At the end of this year, evaluation questionnaires will be sent out, but, she says, it will be hard to assess the pack's impact. To find out what works and why, all healthcare professionals continually evaluate their work, comparing results and building on examples of best practice over time. But stigma and cultural barriers to discussion of mental health issues within the Chinese community will remain.

Echo's 'journey' began in February last year. A consultation period involved sessions with individuals/focus groups to get feedback from professionals working with Chinese people with mental health problems, including community mental health teams, psychiatrists and Chinese community groups. Interviews with carers/service users followed so those already 'in the system' could contribute ideas about the kind of information they thought professionals ought to know. Two workshops, where participants from different mental health care settings were invited to comment on Endurance, was the final part of establishing the evidence base, and concluded the run up to the launch.

The pack is structured into five sections, incorporating background information on the Chinese community in this country and their belief system in mental health, including the typical help-seeking pattern of Chinese people when there is a family member suffering from a mental illness. case studies, to put practice into context are included, and practitioners are encouraged to explore the implications for their own practice. Exercises to be used by trainers for group discussion, or by individual readers for reflection and evaluation, conclude the 'practical' element of the pack. Recommended texts, a reading list and appendices including useful contacts complete the resource.

Endurance has received an encouraging response so far, with professionals reporting positive outcomes to using it in practice. Louise Wong, Chinese mental health development worker with the Wai Yin Chinese Women Society in Manchester says: 'I found the case studies were particularly useful for delivering a training session. I always find it hard to express some concepts or theories without a practical example.

'Well, I have a lot now! In general the resource pack has covered all areas, and I think it is a good start.'

On another level, working on the pack forced Echo to think about service development and her own work on the front line. For example, the question of interpreters when interviewing Chinese service users and their families raised interesting points. Confidentiality is extremely important to Chinese families, and the stigma of mental health must be considered by the professional in the framework of the honorific Chinese culture, she says. Even younger service users, Echo says, who could speak English, preferred to use a family member to interpret rather than an 'outsider'. This would often be a freelance interpreter and a member of the local Chinese community, with obvious implications for confidentiality. The variable quality of interpreters emerged as a key issue. They must be made fully aware of the need not to repeat what they have heard, in contrast to the bias that could be introduced when a family member gave translations.