Overcoming Stigma: Mental Health Awareness for International Students & Scholars

Tuesday, November 3rd

9:00am to 10:15am

Grand Ballroom A

Presenters

Jennifer FrankelMarketing DirectorInternational Student Insurance

Andrew JanuszInternational Student and Scholar AdvisorNorthern Arizona University

Boshi WangGraduate AssistantCenter for International EducationNorthern Arizona University

Deborah ParrisAssociate DirectorInternational Student AdvisorEmbry Riddle Aeronautical University

Agenda

● What’s Going On With Our Students

● Intro to Mental Health

● The China Example

● Seeking Care

● Understanding & Seeking Treatment

● Case Study

● Resources

● Discussion & Questions

What’s Going On?

46% Diagnosed(NIMH, 2013)

39.8%

27%

38.5%

(ACHA, Spring 2013)

(UCLA Incoming Student Survey 2013)

Lowest in 30

years!

Mental Health Care – Underutilized

Mental Health Need, Awareness, and Use of Counseling

Services Among International Graduate Students, Journal of American College Health

Source: Hyun, Quinn, Madon, & Lusting, 2010

Introduction to Mental Health

Mental health is “a state of well-being in which the individual

realizes his or her own abilities, can cope with the normal

stresses of life, can work productively and fruitfully, and is able

to make a contribution to his or her community.”

- CDC

What is Mental Health?

Mental Health for International Students

All international students face great stress

• Culture shock

• Major adjustments

Those with an underlying mental health issue can become more acute

Initial Upset

• Dropped into “English” zone

• Living situation

• Food

• Difficulty effectively connecting with others

• Being “different” by looks, by accent, by

habits

• Reluctance to ask for help

Communication Styles

• Verbal/Non-Verbal

• High Context/Low Context

Interpersonal

• Boundaries

• American-style friendships

• Peer pressure

• Parental expectations

• Values challenged

Identity

• Far from friends & family

• Acculturation – may need to reformulate

identity and personality

• Social class

• Race

• Discrimination

• Challenge to skills and abilities

Academics

• Language comes into play again

• Different types of education – absorb v.

synthesize and analyze

• Formal/informal classroom

• Fear of failure

• Presentation styles

• Multiple choices

• Major determination by whom?

Finances

• Can be a great stress factor

• Torn between family/sponsor and school

demands

• Obtaining funding from home

Culture & Stigma

• Mental illness is highly stigmatized in

many cultures

• Could prevent possibility of marriage

• Loose face because “imperfect”

• Low mental health literacy or little

services available

• Study abroad to avoid problems at home

World Stigma

Mental illness often

goes undiagnosed

and untreated

among international

students due to

negative

connotations

associated with the

subject around the

world.

Culture and Mental HealthThe Chinese Example

31%of all international students studying in the United States are Chinese

Open Doors. (2015). 2015 Infographics.

Adjustment Issues

• Social Interaction

• Social Support

• Filial Piety

• Language Barriers

• Homesickness

• Academic Difficulties

Liu, M. (2009). Addressing the mental health problems of Chinese international students in the United States, Advances in Social Work, 10, 69-86.

○ Traditional value - Harmony○ Confucian impact○ Taoist impact○ Self-restraint○ Face

Impact of Traditional Chinese Cultures

Yip, K. S. (1999). Traditional Chinese Confucian, Taoistic and medical mental health concepts

in pre-Chin-period. Asian Journal of Counseling, 6, 35–55.

The “Guo Xue” (National Culture)

textbook used in China’s

elementary schools

Students study “Analects of Confucius”

at school in China

Mental Health Issues vs. Neurological Weakness

(or Neurasthenia)

Believe that psychological

problems are caused by

physical problems

Seek help for their physical

problems instead of the

psychological problem

心理医生(shin li yi sheng)－”Psychological Doctor”

Kleinman, A. (1986). Social origins of distress and disease: Depression,

neurasthenia, and pain in modern China. New Haven, CT: Yale

University Press.

Online surveys were conducted to the

Chinese students at NAU in 2016

Examined students’ mental health

status, help-seeking behaviors and

barriers, and social activities

Approved by NAU IRB

Sample size = 48 (15% of the NAU

Chinese students population)

Research Study at NAU

Wang, B., and Janusz. A. (2016). A Survey of Mental Health of Chinese Students at NAU.

Research Study at NAU (cont.)

● 89.6% of the participants never talked with mental health

professionals before.

● 79.16% are mentally well

18.75% of the students are having mild mental health issues

6.25% of the students are having moderate mental health issues

2.08% of the students are having severe mental health issues

Wang, B., and Janusz. A. (2016). A Survey of Mental Health of Chinese Students at NAU.

Research Study at NAU (cont.)

Wang, B., and Janusz. A. (2016). A Survey of Mental Health of Chinese Students at NAU.

Research Study at NAU (cont.)

Wang, B., and Janusz. A. (2016). A Survey of Mental Health of Chinese Students at NAU.

Seeking help from mental health professionals is not a common

solution for Chinese students

Self-adjustment, hobby, and talking with friends are the major tools

they use to cope with psychological distress

The major reason students don’t want to get help from mental health

professionals is they don’t think their problems are severe enough.

Additionally, self-adjustment and cultural differences are also the

main factors

What We Found?

Wang, B., and Janusz. A. (2016). A Survey of Mental Health of Chinese Students at NAU.

Seeking Care

Observe and Approach

• Noticing difficulties

• Acknowledging and asking

• Being patient and being willing to listen

• Paying attention to non-verbal clues

• Somatic vs. psychological focus

• Academic, medical, or/and psychological interventions

• Seeking consultation

When to Refer

• Build a baseline

• Notice the changes

• Things to watch for:

- Deterioration in Personal Hygiene or Dress

- Dramatic Weight Loss or Gain

- Noticeable Changes in Mood

- Excessive Absences

- Academic Problems

- Social Isolation and Unusual Behaviors

- Drug and Alcohol Abuse

- Threat of Harm to Themselves or Others

Addressing Myths

• Emphasizing it is a sign of strength

• Explaining confidentiality

- Not on school record/transcript

- Friends, family and sponsor will not know

• Won’t affect visa status

• Cultural competency – counselors are

trained to be open, knowledgeable, and

skillful

How to Refer – Be Proactive

• Introducing counseling

- As building a relationship

- As gaining knowledge about oneself, learning skills,

connecting to resources

• Make the call, walk in together, or invite the counselor to

your office.

• Make no assumptions and ask their provider preference

• Build a relationship with the Counseling Center

Before the Counseling Center

• Understand the resources available on your campus or

community

• Develop relationships with these resources

• Campus & Community Outreach

• Find Creative Ways to Collaborate

• Embrace & Respect your role

• Be Prepared - Orientation

After the Counseling Center

• Set a reminder to follow-up with the student

• Ask questions:

• How did the visit go?

• Do you have a follow-up appointment?

• Be sure to listen, and see if any barriers

• Encourage to go consistently

• Counseling is voluntary

Case Studies

Case Study

You meet a student from China on the first day of international student orientation

who is accompanied by his mother. The mother has been very over protective of

the student and completes all of his orientation registration. When you meet the

student he has difficulty controlling the volume of his voice and has difficulty

focusing during your advising session. The mother shares with you that her son is

autistic and is just having difficulty adapting to his new surroundings and with the

English language. The student’s professor also contacts you that the student has

some behavioral problems and is very isolated inside the classroom.

Case Study

1. Is intervention needed?

2. If yes, what would be the first step towards intervention?

3. What resources that you know of are available at your institution to

support him?

Case Study Ideas

• Set up an appointment with student & mother after

orientation - discuss situation

• What if his support system (mother) is gone?

• Recommend resources available at your institution

• Encourage to go consistently

• Counseling is voluntary

Resources & HotlinesPre-departure, Orientation, Online

www.internationalstudentinsurance.com/explained/

mental-health-video.php

NAFSA Resources

Health and Wellness for International Students

Best Practices in Addressing Mental Health Issues

Affecting Education Abroad Participants

www.nafsa.org/Find_Resources/

Crisis Management in a Cross Cultural Setting: ISSS

http://www.nafsa.org/wcm/Cust/Custom_Cart/Produc

t_Detail.aspx?prodid=450

Mental Health Awareness Video

Resources

Services

● Crisis Text Line http://www.crisistextline.org/Text 741-741

Hotlines

● National Suicide Prevention1-800-273-TALK www.suicidepreventionlifeline.org

● The National Domestic Violence Hotline1-800-799-SAFEhttp://www.thehotline.org/

● It Gets Better Project (LGBTQ)1-866-4-U-TREVORwww.itgetsbetter.org/pages/get-help

Services & Hotlines

Questions?

“International students who reported a more functional

relationship with their advisors were less likely to report having

an emotional or stress-related problem in the past year.”

(Source: Hyun, Quinn, Madon, & Lusting, 2010)