Book review: Recovery, Mental Health and Inequality: Chinese Ethnic Minorities as Mental Health Service Users

NSUN member Vanessa Yim reviews Lynn Tang’s latest book ‘Recovery, Mental Health and Inequality: Chinese Ethnic Minorities as Mental Health Service Users’

Recovery, Mental Health and Inequality: Chinese Ethnic Minorities as Mental Health Service UsersBy Lynn TangPublished by Routledge. ISBN 20170706.

This book was adapted from the author’s PhD thesis, where she examined mental health recovery in Chinese service users in the UK. Using the biographical method with interviewees’ life history as the primary data, 22 Chinese service users with diverse backgrounds in terms of received diagnoses, gender, age, place of birth and class status living in Birmingham, Manchester and London were interviewed between 2009-2010.

The author sought to answer three questions:(1) What do people recover from?(2) What do they recover to?(3) What and how social and structural factors influence the process of recovery?

Tang argues for a community development approach of recovery. In her view, the dominant narrative of recovery is individualistic which does not often promote the service user’s capacity to make choices for themselves (due to factors such as funding cuts in community centres/charities, benefit cuts, and health professionals deciding their treatment options etc.).

She also argues that the social determinants of mental ill health and the intersectionality of race, gender, class, sexuality are not addressed adequately for them to recover into.

As someone working in mental health research and also ethnically Chinese, this book caught my attention on a personal level.

It touched upon several controversial issues around mental health, such as diagnosis (& labelling), compulsory hospitalisation, and intersectionality.

However, in this review I will focus on the specific social factors covered in the book. Research has shown that there is an under-representation of Chinese people in mental health services (Kwok, 2013; cited in Tang, 2017). Is it because Chinese people are the “model ethnic minority” who are high-achieving and self-contained?

This book debunks a number of stereotypes the public may hold about Chinese people. Firstly, it is not certain whether the under-representation of Chinese in mental health services is due to a lower prevalence, different conceptualisations of illness, stigma, or the presence of institutional barriers.

Moreover, the rate of compulsory admission (67%) was found to be higher than average (47%) for Chinese mental health service users.

This counters the stereotype of the Chinese being a “model ethnic group” in this regard. Rather, this invisibility adds a layer of difficulty for policy makers to design services that meet their needs. For example, one participant complained about her intestinal pain.

It was later found that the symptom was not caused by any physical illness.

The pain was relieved after administering a combination of Chinese herbal medicine and antidepressants in her place of origin.

What’s more, as demonstrated by the participant demographics in this study, although all of them were of Chinese ethnicity, they originated from different regions, such as China, Hong Kong, Taiwan, Malaysia, Singapore, and Vietnam, which all have fundamentally different healthcare systems.

Therefore, the author cautions that sending service users to their “home” countries should not be an assumed option.
Instead, their agency and preference should be respected, as many participants noted, (1) the option of travelling “home” is for people who are financially privileged, (2) this may not apply to second generation Chinese who regard the UK as their homes, or (3) “home” is the place they try to escape from (i.e. “Recover from”).

Many of the participants’ stories illustrated how the stereotype of the Chinese community as a harmonious and close-knit community may not always be true. Some women migrants were overseas brides (women who got married and migrated overseas), who arrived in the UK in the 60s-70s. Apart from their English language proficiency and stress of migration, extra stressors included social isolation as they often had to do domestic work at home.

Hence, they are often trapped in “gendered roles” and are dependent on their husbands. Furthermore, they may experience a culture gap with their children, as British-born Chinese may not fully identify with Chinese culture. These negatively contribute to mental ill health and become what they need to “recover from”.

However, the lack of financial freedom, gender inequality and adjustment problems associated with migration hinder the process of recovery, especially if marriages break down and are no longer seen as a safe and secure haven.
As for the catering business, poor working conditions were indicated by some participants as something they need to recover from. Chau and Yu (2001, cited in Tang, 2017) suggested the “double social exclusion” among Chinese people from the British and other Chinese, as the Chinese catering business is geographically dispersed to minimise competition.

This self-sustaining economy seems to overshadow the issues of poor working conditions and the lack of choices for this group of marginalised people in the mainstream labour market. In other words, the author notes that this situation can be seen as colluding with the exploitation and limiting their capabilities.

These phenomena seem to be culturally-specific to Chinese people with regards to the social and historical contexts of migration yet haven’t been well-addressed by service providers. I would like to see further research on other Chinese migrant groups such as the international student community, and the recent Chinese immigrants who settle in the UK for career opportunities.

The research method used was unique. I was particularly struck by the author’s honest and thoughtful account of her own experiences as a Chinese migrant and a service user in Hong Kong and in the UK. She reflected on her own privileges as someone with high educational attainments and her strengths that made her the right person to research on this topic.

As opposed to hiding her identity, her service user expertise was seen as a positive to this research and her motivation to explore this field. She even included her own story as part of the dataset, as she believed this would enrich its diversity, despite this being unusual for this type of research.

But she was aware of the emotional intensity and sought support from a mentor in this process.

As I am currently working on a randomised controlled trial, I sometimes lose sight of the importance of one’s choice for treatment and the rich narrative drawn from qualitative research. Unlike other research where participants’ identity is randomised, one participant wished to use his real name as he felt more empowered that way and did not feel ashamed of his experiences.

Overall the tone of the book is academic and not a light bed-time read. However, this unique research adds to the limited evidence-base on the important issues of mental health service provision in the UK, not only to the Chinese people, but all minority groups alike.

Book review by Vanessa Yim Chau, R. C., & Yu, S. W. (2001). Social exclusion of Chinese people in Britain. Critical Social Policy, 21(1), 103-125.
Kwok, J. (2013). Factors that influence the diagnoses of Asian Americans in mental health: an exploration. Perspectives in psychiatric care, 49(4), 288-292. Click here for abstract