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)