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Mental health: ethnic minority carers’ experiences

What different cultures can teach us

Culture is about the practices, knowledge, and beliefs that are more or less shared among a group of people. Most carers we spoke to believed that we can all learn a lot from cultures that are different to our own. People said that learning from each other can teach us how best to help families affected by mental health problems.

Sense of community and strong family values
Many carers felt that in White British culture people focus mostly on themselves as individuals: they are 'preoccupied with their own life'. Several carers commented on the differences between life in Britain and life in their country of origin.

 

Amar thinks the fast pace of Western life means we lose touch with the natural world and family...

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Age at interview: 51
Sex: Female
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I have lived and worked in four continents, so I have the opportunity to experience different cultures at different pace, so hence I can speak that this is faster than the cultures I've lived. Although it was different times and yes, other cultures may have speeded up and thinking similar, however, some cultures are more in touch with the wider environment, the natural environment and family. And animals, whereas we're becoming more and more distanced from the natural environment, never mind our family, you know, away from our natural self. But the family is becoming a distant. I notice more of that when I went to live abroad, about 15 years ago, the family, -God where's the family gone, we're so distant, so dispersed and now it's just, nobody wants to know. You can't even look at somebody, we go on the bus or train, you daren't look at people, because people going to threaten you or do something and that's sad really and yet on the other hand, they say UK is a country where pets are loved a lot, animals are loved, but people, I don't know? And also some of the eastern ways of life, you know, how you listen to your body, look after and food as well now, oh I don't know, with beef and BSE and with animals and the bird flu, being a vegetarian versus meat eating and the impact on health, things coming. Yeah, maybe we need to listen and promote and learn from other cultures.

In contrast, in many other cultures, people tend to think of themselves as part of a family or community. One man said that in his native Sri Lanka, 'when someone is sick, the whole family suffers.' Others remarked that close knit families and communities meant those who are sick would not be left 'to fend for themselves' and that 'family involvement would be the norm'. 

 
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Aiko says that in Japanese culture you put yourself aside to care for those who are vulnerable.

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I know in Japan, so I really don't know, but I only know one example as my grandparents. When I, when my grandfather had cancer he had a big operation, my grand mum, at the time she had really dodgy legs, and her knees weren't that well at the time. In her late 60s, from her, although they both lived in central Tokyo, my grandfather was in hospital more than six month, and it took about, one way to get to the hospital from my grandmother's home, to go, -about one hour. Because included quite a long walking distance, and my grandmother couldn't afford taking taxi every day at the time, but she visited my grandfather absolutely every single day, no break whatsoever. I think that is in the blood I think. But a different generation began to act different way. Around my generation still we do have that attitude, if you're married, if you have child, or children, or someone to look after we don't put our self before anybody else. We do the opposite, put our self on the side, your first priority is to whomever's most vulnerable, and then the next is about you, which doesn't come up to surface very often. But I didn't force myself to do that I don't think, no, if so probably I wouldn't be here.

In particular, some carers believed the way people with mental health problems in the UK are 'locked away' and separated from the community is unhelpful, making them feel rejected and lonely.

 

His white British friends advised Anton to put his mother in a care home.

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Age at interview: 63
Sex: Male
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Well I've got a lot of White British friends in the church and everything. And some of them come and give me a bit of advice, and some of them said, “oh, this is no life for you Anton, why don't you put her in a home, because she'll be happy with people of her own age”, and all these things, “you've got your life to lead”, and all these things. So, knowing they're social starter family life doesn't surprise me, so this is it. And then once again I find in the white British families, that even the children, -well the parents stick them in, like put them in a nursery this, that and the other, then. So when their children grow up home, and their parent's need, they also put them in institutions, yeah it's very sad. 

There was a time I used to go and preach in the old people's home, and then they're there, and after I do the service, a lot of the old ladies will hang on to my hand and squeeze and won't let me go. And then the only time you see a lot of traffic in the old people's home are Mother's Day, Father's Day, Christmas, that's the time you find plenty of cars parked. Other times -dead; they're dead, and then you some time, when I speak to them, well they are, some of them don't even live locally, and that's why they're dead, yeah. And just imagine though, say as a parent, I tend to think, as a parent they bring up the children and spend a lot of time, sacrificing everything, and they expect, -well when the time comes for them they might get, you say in accounting terms, some sort of return, but no. This seems the same old story, as soon as you, -well like -as soon, in their sort of society when their parents can't look after themselves, there goes to the institution, and that's it. So then you can't blame them, because they done the same thing, yeah.

 
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Wei does not want her husband to go to hospital because it is part of her culture to care for him...

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Age at interview: 61
Sex: Female
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I'm his wife. Who else is going to take care of him if not me? To find someone else to take care of him, it's not right. We Chinese are different from Westerners; we don't like to put him in old people's home. We can't do that. In Vietnam, there is Chinese saying, but I can't speak for the young generation, 'once married, it's till death apart', take care of each other until the very end. Who doesn't want to be taken care of? One takes care of each other whenever one needs it. That's the way it is. This is our culture. If you put him in that place and not care for him, it'll be quite sad. We are used to eat Chinese foods, western foods are not suitable. Never mind. Take care of him until old age. No other ways.

Some African-Caribbean carers emphasised how in the West Indies, many people with mental health problems continue to be an important part of the community. People just don't make such 'a big deal' out of it when people are unwell. One woman said that the move towards 'care in the community' in the UK means things are improving. Living in a close knit community can help carers because more people could 'muck in', stop by during the course of the day, and help out with shopping, transport or keeping them company. 

Some said that the downside of putting the family first, even before yourself, was that it could also lead to carers not being able to help themselves. The same thing was said about living in extended or polygamous families. Carers from different ethnic backgrounds also said that the 'next generation' in their community didn't always share more 'traditional' family values.

Views on health services
Some people were critical of the reliance on medication in the British mental health care system and said in other cultures the focus was more on caring, comforting and encouragement.

Others felt that the UK system can be needlessly complicated. For instance, in a crisis it can take 6-7 professionals, from police officers to psychiatrists, to get someone admitted to hospital. Elsewhere things could be quite different.

 
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He thinks the police in the USA are better at helping families affected by mental health problems.

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Age at interview: 72
Sex: Male
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In America, where I come from, you can go to a police station and say to the police, sir, I have a son who has a mental problem, his name is so and so, his address is so and so. And in case you see him in the stall, or something like that, he needs medical treatment. And the police would take down everything. The minute something happen, poom, the police will get the ambulance, right into the hospital instead of jail. But you don't have that kind of system here. And the only, -another thing, the policemen are not trained to do all these things. Like my son, the policeman came, he was so rough on him, you know although he has mental problem. The police are not trained. The police don't know what is mental health. The police does not know how sick he is. But, to me, if you, if every community would work with the law enforcement, hand in hand, things might get better, you know. American, some towns, not all, some towns, to me, they are very, very good. I can go the police station, and say to police, see my son, he's mentally sick. And any trouble, send him to the hospital right away. But then again, here, you can't, you can't send them to hospital. You have to get your doctor. You've got to get psychiatrist. You've got the two policemen. You have to get nurses. You get all, six or seven people have to come before this thing. In America, -poom [claps hands], you go. They save a lot of trouble, you, -they will help the patient too.

Another carer thought we could learn from cultures where family participation in the hospital care of loved ones is more welcome and where professionals are more willing to discuss their care. 

 

In some African societies, families can personally care for loved ones in hospital.

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Age at interview: 63
Sex: Male
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Now for example I was telling, they laugh at it, I said 'the solution for the health service is the African solution' then they said 'how come?' Now if you go to a place like Nigeria or Kenya, if somebody goes into hospital the family turns up there, pitch a tent on the ground, or stick in the corridor, and then they will wash, clean, do all the things for the patient, feed them and everything. The doctors and nurses will do the clinical bit, you know, people, -all the families come, that sort of a business. Now in England you see, they expect the nurses and doctors to do everything, now of course they can do everything, but then you need money, resources, now no one in England wants to pay any tax. Take the political parties, tax is a taboo subject, so if you don't pay tax then you won't have the money to engage people, so either you pay tax, or the family have to do it, so this is a problem, you know. I tried to explain to them things like that, because there's nothing new under the sun, every problem has been here before, and then instead of trying to reinvent the wheel, you ask other people, well how do you do it, then they will come and tell you. 

 

In the USA Gou could go to weekly meetings at the hospital and talk to health professionals about...

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Age at interview: 72
Sex: Male
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Over there, one thing good over there, we have, when he was in New Jersey, we have two meetings a week, on Tuesday, it's the parent and the patient, if I have a patient there, I will, I can go in there and the patient and the parent, and there will be a head nurse or a psychiatrist or somebody there to organise the meeting. And my son can say anything to me and I can give a good, -and I can answer him back. Then a psychiatrist will say, will tell my son he is wrong or I am wrong or something like that, you know. A friendly, -this thing. And to me, that is very, very helpful, because sometimes -you don't say things in anger, things go better. My son has his view, I have my view, or my son wants something, I will say, “I will try my best to do it”. And that is very helpful. And on Thursday night, seven to nine, it's only the parent meeting and the parent can voice the concern and every, -about the medication, can ask any question and can give all their views, which is, to me, is very helpful too, which we don't have it in this country. And to me, to me that was very good, because one Sunday I went to see my son in the hospital and my son says, “oh there's no toilet paper” and my son say, “the patient had to use their underwear to clean themselves”. So I was a little bit worked up, or something. I went to the office and here this woman, black woman, big black woman was sleeping on the chair. And I woke her up. I say, “excuse me, excuse me, there's no toilet paper in the toilet, and the patient need toilet paper”. And she looked at me, she says, “who do you think I am? A supply person?” And I was, was really very annoyed. I say, “you're lucky it's not my son otherwise I get a lawyer in”. I would get the newspaper in too. And one thing was good, I was able to bring the matter up at the next meeting. The person which chaired the meeting was surprised, and she said to me, “I'm glad you brought that up. We will look into the matter”. And next week she came back, she apologised, she says, “yes it did happen, and she made excuse for her. She has been working double shifts”. But I said “that's no excuse”, you know. And she says, “thank you, thank you for giving attention to the hospital. We'll make sure it won't happen again”. Because to me, all these meetings are important, because you can bring up what you see, you do not like, or you think is wrong.

A couple of people questioned whether a patient's individual rights (e.g. to refuse medication) should be more important than the efforts of others to improve their health. An example was given of Indian institutions where psychiatric medication is made without taste so it can be added to food without the knowledge of the person taking it. Other carers disagreed with the approach of treating people without their knowledge.

 
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He raises the question of whether a person's recovery or human rights should be the priority.

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Age at interview: 74
Sex: Male
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In passing may I mention this' In places like India, the family involvement is the norm. Clinicians expect and even demand the co-operation of relatives because it is expedient financially and otherwise. Medication is made tasteless so that it could be given to the un-cooperative and 'recalcitrant' patient mixed with the food. So the question of non-compliance and its attendant problems do not exist. One would ponder here about what takes priority - the recovery of the patient or his human rights?

 
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She thinks medicine should sometimes be hidden in drinks to help people get better (played by an...

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Age at interview: 59
Sex: Female
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Rather than forcing you should give them treatment, if the person doesn't take treatment you should give something in the water or in the food, and that way you can find out the 'cureness'. But if they say that, we should, -the law is very bad for this country. When the person has a mental balance then they don't say or hesitate taking the medication, but this kind of schizophrenia or any mental depression or many mental illness, the doctor should give the treatment in food or any available drink, when they refuse it they should do like that and cure the person. This is my personal opinion.

What other cultures can learn from British culture
Several carers from African and South Asian backgrounds said in their culture there were more negative attitudes to mental health problems than in other cultures. They felt that their community needed to learn more about mental health problems from the British or West Indian perspectives so it would be easier for people to ask for help (see 'Negative attitudes to mental health problems').

The UK social security system, which provides financial support from the government, was also seen as a good model for other countries as it could put carers' minds at ease and make them less dependent on family support. People were also grateful for a National Health Service (NHS) which, despite its weaknesses, is free of charge.


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Last reviewed September 2018.

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