Lost in Translation:

1
Lost in Translation

• A Study of Asian Womens Perceptions of
• Mental Health
• Chandni Mehta

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Outline of presentation

• Introduction
• Literature review
• Methodology
• Findings and discussion
• Summary
• Conclusion
• Clinical implications
• Recommendations
• Dissemination

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Introduction

• National www.statisticw.gov. uk
• NHS Mental Health (NIMHE,
  2003)
• Inside Outside, the
  national strategy for
• black and ethnic minority
  health
• www.nimhe.org.uk/priorities/bl
  ack.asp
• Local 2001 Census, non-white 2-3 of the county
  
• of Gloucestershires population
  6 of the
• population of Gloucester
• www.gloucestershire.gov.uk/index

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Introduction

• Rationale Gloucestershire BMHT
• The Researcher
• www.doh.gov/mental
  health
• Research aims
• --To gain understanding of Asian Womens
• frame of reference- includes linguistic,
  religious
• and cultural categories which affect
  behaviour and
• structure attitudes to mental health.
• --To explore contexts in which mental health
  concerns are most
• likely to be experienced.
• --To gain insight into models of coping with
  stressful experiences
• and the support network commonly used.

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Literature review

• Definition of Culture, Race, Ethnicity and Mental
  Health.
• Culture, Language and the Differentiation of
  Emotional States.
• The Mental Health of Asians in Britain.
• Understanding Asian Womens mental health.

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Definitions

• 'Culture
• that complex whole which includes knowledge,
  beliefs, art, morals,law, custom and any other
  capabilities and habits acquired by man as a
  member of society (Rack, 1982,p13).
• Race is a biological term. As used by
  biologists it refers to differences in the
  inherited, i.e.genetics, constitution of
  different groups within species (Rack, 1982,
  p15).
• The term ethnicity acknowledges the place of
  history, language and culture in the construction
  of subjectivity and identity (Stuart Hall, 1992).
• The term ethnic is taken to mean ( for the
  purpose of ethnic monitoring and census
  designation) a mixture of cultural background and
  racial designation.

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Definitions

• A British government paper (for collecting health
  statistics) sees ethnicity as a mixture of
  culture, religion, skin colour, language and
  family origin (NHS Management Executive, 1993).
  The main broad ethnic groups referred in British
  health surveys and research are
  African-Caribbeans, Africans, Asians and Whites.
• In short, race is physical, culture is
  sociological and ethnicity is psychological
  (Fernando, 2002).
• .

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Definitions

• WHO defines Health as complete physical,
  mental and social well being
• Kakar (1984) states that the term mental
  health is a rubric, a label which covers
  different perspectives and concerns, such as
  absence of incapacitating symptoms, integration
  of psychological functioning, effective conduct
  of personal and social life,feeling of ethical
  and spiritual well being and so on (Fernando,
  2002). However, Culture determines both the
  perception and level of concern in the case of
  each of these qualities

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The mental Health of Asians in Britain

• Primary care research on common mental disorders
  among Asians-
• Pakistani patients in Manchester prevalence 42
  (Hussain, 1997).
• Indian women in west London prevalence 30
  (Jacob et al, 1998)
• Similar prevalence in both cultures (Bhui, 2001)
• Epidemiological and ethnographic studies
  reporting higher community rates
• common mental disorders among Asians in India,
  Pakistan and UK (Mumford
• et al, 1996 Commander et al, 1997).
• Most of the studies have been largely limited to
  first generation migrants.
• There is less data on British-born Asians and
  their access to primary care.

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Understanding Asian Womens mental health

• Women make up over half of the general
  population, play a significant role in
• the work force and assume the major
  responsibilities for home making and
• caring for our children and other dependent
  family members. The complex
• interplay of all these factors can have a major
  impact on womens mental health
• and have wider consequences as a result of
  multiple roles that women adopt
• in our diverse communities.
• Currer,1996 Krausse, 1989 Fenton and
  Sadiq,1996 Scattolan and Stoppard
• 1999 Li and Brown, 2000 Bottorf et al, 2001
  Hussain and Cochrane, 2002
• Barn and Sidhu, 2002
• Knowledge about mental health experiences from
  these studies is derived
• largely from those who have contacted services,
  using primary care and
• hospital admission as a sample frame.

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Methodology

• Research design
• Sampling technique and description of sample
• Focus group selection
• Consent
• Venue
• Sample group
• Data gathering techniques
• Analysis of data
• Ethical consideration
• Methodological limitations
• Strengths and weaknesses

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Participants profile

• Characteristics Participants (n16)
• Marital state Single 1
• Married 14
• Divorced 1
• Occupation Employed 12
• Retired/housewife 4
• Education UK and abroad 13
• No qualification 3
• Country of birth Britain 3
• Abroad 13
• Age lt35 3
• 35-50 7
• 51-60 2
• gt60 4
• First language English 2
• Gujarati/Hindi 13/1

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Participants profile

• Characteristics Participants (n16)
• Home circumstances
• with children/partner 13
• extended family 3
• Religion
• Hindu 16
• Muslim 0
• Sikh 0

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Examples of Research Questions

• What do you understand by the term mental
  health?
• How do you come to understand that you are
  stressed or distressed?
• Do you feel that these feelings, events or
  experiences have affected your health? In what
  way?
• How do you cope? What helps? What does not help?
• Suppose you needed help with mental health
  issues, what kind of help would you seek and
  accept?

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Findings and Discussion

• Research Question 1 Understanding of the term
  mental health
• British-born D
• I think what people define as mentalif you
  look back on history, you think of mental
  institutions
• P agrees
• Yes, mental is very harsh word, meaning
  madness, severe condition.
• B, a wife and mother, originally from India said
• In India if you say the word mental it
  will mean madnessgandathey are avoidednot
  spoken to.
• P married with two children living here since
  childhood commented
• Even here when we mention mental you get
  put into a boxit has stigmait is seriousit is
  long term.
• British-born L stressed, Using the word mental
  leads to devaluing the personmore so in
  Asianbut it is wrong.

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Findings and Discussion

• Perception of mental illness Schizophrenia and
  Postnatal depression.
• British-born L
• Schizophreniait is a severe illnessit
  needs to be treatedthese people are suffering
  from that conditionthey are not aware.
• Participant T spoke about her personal experience
  in dealing with PND
• Its just the baby blueseveryone goes
  through it. I dont think older generation
  understand like people get post natal
  depressionthey dont even know what menopause
  isthey just live with it.
• Participants (gt 60 years) used familiar Gujarati
  words and phrases to describe their feelings of
  worry, tension, pain, upset (chinta, dukh, man
  munjan)

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Findings and Discussion

• Mind body link,
• Participant C stated
• you cant really separate mind and
  bodyif you are not happy, you feel lethargic
  you just cant separate it.
• Loneliness, Participant U
• When women come from Indiathey do not know
  the languagethey cant go anywhere or do
  anythingthey are stuck in the house and if
  husband goes to workthe lonelinessit can turn
  into depression.
• Description of the term Mental health,
  British-born S
• It is to do with what you think and how
  you cope with everyday things and how it has
  bearing on your mindthe way you thinkmind gets
  overloaded and stresses you outit affects your
  feelings and then affects your life.

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Findings and Discussion

• Research question 2 Mental health concerns,
  experiences, expressions and context
• Health was defined in the context of their of
  their roles, their families and
• their commitments.
• Participant T said
• When depressed, people are unable to take
  responsibilities at home, work.children,
  familyand can not carry on your normal life.
• Participants described their experiences of
  stress in various way, by
• attributing to external life events, normalising
  their feelings, offering
• explanations and accepting stress as a part of
  modern living.
• Participant B said You hear a lot of word
  depression now, you never used to beforeevery
  word is like I am stressedyou know everything is
  stressful now than ever before.

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Findings and Discussion

• Emotional states linked to external events
• Participant BH
• can happen after any loss like bereavement,
  relationship, work, marriage as a natural
  responsenormal sadness.
• Participants (gt60 ) a small number described
  their emotional experiences
• that seemed similar to that of clinical
  depression but no one attributed their
• feelings to hormones or chemical imbalance or
  the term depression.
• British-born S
• you feel sad, you cry, you dont want to see
  anyone, you dont want to speak to anyone, you
  dont care about the way you lookyou dont want
  to eat, you dont sleep, you cant concentrate,
  you dont enjoy anythingeverything becomes an
  effort.

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Findings and Discussion

• Research question 3 Coping Methods
• Praying/religion
• Talking
• Hard work/activities
• Crying
• Self reliance/outlook
• Philosophy of endurance
• Belief in fate/destiny/Gods will
• Finding inner strength/soul

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Findings and Discussion

• Research question 4 Seeking help
• On the whole participants were reluctant to
  see their GP but were willing to accept
  counselling if offered.
• British-born L remarked
• As soon as you go to doctor they will give
  you antidepressants right away
• They do not want to understand what the
  problem is.
• Participant C stated,
• I guess some of us now may be go to Doctors
  but basically well saywhat is he going to do?
  Give us medicine? What is that going to do? We
  dont want medicine.
• The participants from the Gujarati speaking group
  commented on language
• difficulties and communication problems during GP
  consultation.
• Approaching GP for physical problems seen as
  requiring medical treatment.

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Findings and Discussion

• Counselling
• The need and request for counselling and the lack
  of opportunity to access
• this choice was prevalent in this group of
  women.
• British-born D stated, you need to talkyou
  need to know where you can
• get help, whether friends or counselling. We
  should have options.
• Participant L agreed, CounsellingI dont think
  there are enough centres
• offering counsellingthats why the initial
  problem starts very tiny and
• accelerates and there is nowhere confidential.
• Participant C added, You need counsellor in
  your culture and religion to
• understand however good the counsellor are they
  never understand the
• culture are coming from.

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Summary

• Key findings from this small- scale local
  study in Hindu women
• The spectrum of normality and pathology is
  different in Asian community.
• Holistic approach to health including mental
  health is adopted, viewing mind and body as one
  affecting person as a whole.
• Health is defined in the context of roles, family
  and community.
• Participants understood and established a link
  between life events and emotional distress.
• Coping strategies include prayer/religion,
  talking,hard work and family support.
• No specific descriptions emerged for the term
  mental health, nevertheless there was an
  acknowledgement by younger participants that
  mental health probably constitutes thinking,
  feelings, emotions and coping and they perceived
  mental illness as a more stigmatising term
  referring to severe, serious long-term condition
  requiring medical treatment.

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Conclusions

• Mental health concerns appear similar to those
  experienced by women in mainstream society what
  is different is the way these concerns are
  understood, experienced, expressed, communicated
  and coped with.
• Many elements of these health concerns and their
  description of what constitutes mental health
  may be understood from an English cultural
  perspective, but direct translation into a
  Western illness category is neither appropriate
  nor acceptable to these Hindu women.
• This study shows that cultural and religious
  beliefs exert a major influence on Hindu womens
  frame of reference which affects behaviour and
  structures their attitude to mental health. In
  this respect, the findings support previous
  research (Beliappa, 1991 Furnam and Malik, 1994
  Cochrane and Fazil,1998 Hussain and Cochrane
  2002).

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Clinical Implications

• This study has provided valuable insight into
  Asian womens health concerns and related issues.
  Unless these concerns are better understood and
  accepted, many Asian women are likely to remain
  outside of the available mental health
  facilities.
• Data reveal that Hindu women are coping with
  distress by working within their
  religious/culture frame of reference, using
  coping methods as they did for treatment of their
  problems.
• Since distinction between coping and treatment is
  not clear, one needs to explain why and at what
  point Asian women engage formally with health
  services as well as to help explain service
  uptake and utilization by this group.
• This study cannot impose change, only inform and
  recommend.

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Recommendations

• This study has highlighted the urgent need to
  move away from commonly used terminology such as
  mental health/mental illness to describe
  emotional conditions.
• There is a clear case for accepting that mental
  distress could remain unreported and
  medicalisation is not considered appropriate to
  deal with distress.
• Positive coping strategies, including religion,
  must be encouraged and incorporated into support
  network and counselling framework.
• There is a need for bilingual and bi-cultural
  health professionals in different sectors, such
  as primary care, mental health centres,
  hospitals.
• There is a need to teach health professionals the
  culture norms and values regarding mental health
  issues of various minority groups.