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Article Excerpt
Studies on the help-seeking pathways of different cultural groups have consistently revealed that Chinese people with mental illness often experience a much longer delay in help seeking than other ethnic groups (Ryder, Bean, & Dion, 2000; Skeate, Jackson, Birchwood, & Jones, 2002), and the duration of untreated psychosis can be as long as one to two years. Although findings have indicated that people with a longer duration of untreated psychosis are likely to be less responsive to treatment and require more long-term intensive intervention (McGorry & Edwards, 2002), a growing body of clinical evidence has revealed that early detection and intervention in young people with schizophrenia may result in a substantial reduction in morbidity and in better quality of life for these people and their families (Black et al., 2001). It has been suggested that recovery from psychosis is greatest at the early stage of the development of the illness (Drake, Haley, Akhtar, & Lewis, 2000).
Rogler and Cortes (1993) maintain that the help-seeking process usually involves a network of people, from the intimate and informal confines of the nuclear family, through successfully more select, distant, and authoritative laymen, until the professional is reached. Bhugra and colleagues (1999) argued that the nature and duration of the help-seeking pathways of a particular cultural group are determined by the interaction among three levels of factors: individual level, cultural level, and the social institution. On the individual level, the person's recognition and acceptance of illness and the degree of personal stigma influence his or her readiness to seek help. On the cultural level, factors such as cultural beliefs about mental illness and the influence of the informal network shape the help-seeking pathways of the people involved. Last, "social institution" refers to the perceived availability of, access to, and delivery of health services, such as the availability of ethnic mental health workers. Thus, the extent to which social institution is perceived and is able to provide access for individuals to obtain formal psychiatric services affects individuals' motivation to seek help.
Various studies have explored the interactions among these three sets of factors in shaping the help-seeking pathways of different cultural groups in societies. One study found that although the presence of family physicians (a social institutional factor) enhanced the help-seeking processes, socioeconomic factors such as social deprivation, unemployment, and social isolation led to delays in help seeking among the ethnic minority groups in a multiethnic population in Britain (Burnett et al., 1999). Other studies revealed the importance of family influences in shaping the help-seeking pathways of the individuals concerned. For example, Carpentier and colleagues (1999) discovered that despite the presence of different trajectories, family members invariably played an important role in the trajectories by initiating the help-seeking process for relatives suffering from early psychosis. Although this study highlighted the importance of cultural factors (that is, influence of the informal networks), it also showed the interaction of cultural and individual factors (that is, recognition of psychiatric symptoms) in shaping the help-seeking pathways of families with relatives suffering from mental illness.
Studies on the help-seeking pathways of Chinese people appear to suggest that the informal networks play an even greater role in influencing the help-seeking pathways. Kramer and colleagues (2002) revealed that Chinese people usually count on the support of the extended family members and friends or villagers. Lin and Lin (1981) also mentioned that Chinese people in Canada do not seek external help until the conditions of their ill relatives have reached a crisis point. Individual factors such as personal and family stigma may also play an important role in discouraging the family members from initiating help from others. As Kramer and colleagues asserted, although psychiatric stigma exists in many cultures, mental illness is stigmatizing in Asian cultures, including Hong Kong. Last, evidence suggests that Chinese people in Hong Kong have insufficient knowledge of mental illness and psychiatric services (for example, Wong, Tsui, Pearson, Chen, & Chiu, 2004). Because of the lack of empirical data to explicate how the three levels of factors influence the help-seeking pathways of Chinese people in Hong Kong, this study attempted to examine these underlying factors and the roles played by different individuals in the help-seeking pathways of Chinese caregivers with relatives suffering from early psychosis in Hong Kong.
In this study, the main research questions were "Who are the crucial individuals facilitating a Chinese caregiver to approach formal psychiatric services for help in Hong Kong?" "What are the functions performed by these crucial individuals that influence the help-seeking of a Chinese caregiver?" and "What are the possible factors shaping the Chinese caregivers' pathways to care?" Answers to these questions might help us develop strategies to educate and train these different key people to recognize the occurrence of mental illness and thus reduce the delay in help seeking among Chinese caregivers.
OBJECTIVES
There were two objectives of this study:
1. to identify the roles and functions played by the key individuals in the help-seeking pathway of Chinese caregivers with relatives suffering from...
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