Role of social networks in the pathway to care of Chinese people living with a diagnosis of severe mental illness in England

Abstract

Background: Current literature suggests that there is an underutilisation of mental health services among Chinese people in England and that most Chinese people only come into contact with mental health services when a crisis occurs. However, there is limited evidence to enhance understanding of how they enter and navigate through the mental health systems. Objectives: This study aimed to examine the pathway experience of Chinese people living with a diagnosis of severe mental illness and the experience of their social networks who became involved in this journey. Methodology: Adopting a phenomenological approach, this study involved 55 interviews relating to 16 Chinese people with severe mental illness. Participants included Chinese people with severe mental illness, their families and Chinese speaking workers working in different service settings. Data was analysed with the aid of the QSR Nvivo software program. Findings: This was the first qualitative study to help understand the experience of Chinese people with severe mental illness in England. It confirmed that language difference, a lack of knowledge about how to access mainstream services and different conceptualisation of the experience of mental illness were significant barriers to seeking help. However, contrary to existing literature, this study found that not all Chinese people with severe mental illness experienced delays in receiving professional support. The health beliefs and attitude of their social networks towards mental illness were the main factors shaping the duration and direction of individual journey. Family played an important role throughout this journey but most families did not have adequate resources to meet the mental health needs of their relatives. Therefore, they had to seek help from mental health professionals, Chinese speaking workers and their overseas connections. Discussion: The stigma attached to mental illness was reported as the key explanation for delays in help-seeking. The impact of stigma was felt more strongly by Chinese male than female family members. The worry that mental illness would ruin the family name and the family would lose face in the community explained the reluctance of Chinese men to seek help for their close relatives with severe mental illness. Chinese speaking workers provided vital resources for Chinese people to access mainstream mental health services. However, the strong belief in self-reliance and the perception that Chinese people held a more stigmatising attitude towards people with mental illness explained why some participants were resistant to seek help from outsiders, especially people from the Chinese community. Additionally, Chinese people living in remote areas were unable to reach and access these resources because of the unavailability of such resources in rural areas. Conclusion: This study expands our conceptual understanding of how the stigma associated with mental illness impacts on the utilisation of mental health services among Chinese people in England. Chinese speaking workers play an important role in facilitating access to mental health services. Hence, it is important to explore and develop different strategies to de-stigmatise mental illness so that Chinese people living in different parts of England can utilise resources from the Chinese and wider community.