Chinese immigrants less likely to access mental health care
A study of how B.C.’s Chinese-speaking doctors help Chinese immigrants to receive care shows that immigrants who visit these doctors are less likely to receive diagnoses of mental disorders, and have a lower rate of mental health consultations than those who visit non-Chinese-speaking doctors.
Because Chinese immigrants are more likely to visit Chinese-speaking doctors for care, the finding challenges the assumption that doctors who speak the same language as patients will facilitate access to mental health care.
SFU health sciences researcher Alice Chen and colleagues reviewed the health records of more than 270,000 B.C. residents who visited 886 Chinese-speaking doctors and psychiatrists between 1992 and 2001.
Earlier research showed that Chinese immigrants had only 10 to 20 per cent as many mental health consultations as a control group of people matched for age, sex and local area of residence.
Chen says one explanation may be that Chinese-speaking primary care doctors have different patterns of practice. They may also be under-diagnosing mental disorders.
The study, published this week in the medical journal, Open Medicine, was undertaken to evaluate whether the recruitment of health-care practitioners who speak the same language as immigrant patients would ease access to mental health care.
Chen says the study doesn’t dispute that doctors speaking the same language will improve access, but shows there are “nuances” in that access.
Chen is an adjunct professor and associate director of the Children’s Health Policy Centre in the faculty of Health Sciences.
The paper is available online at http://www.openmedicine.ca/.
Steve Bowell
The wording of the article implies that Ms. Chen and her colleagues suspect that Chinese-Canadian doctors are diagnostically short-changing their patients by failing to diagnose mental disorders. The only concession they make to the idea that something else might be involved is a vague reference to "different patterns of practice."
I suspect that something more basic is involved. Thanks to cultural studies, we now know that health itself is a social, a cultural, construction. Every culture has different notions of what the body is, what the mind is, where the boundaries are between body and mind, and what sort of things can go wrong with either. (Jonathan Miller, in his book and TV show The Body In Question, talked about the French people's obsession with "le foie," and the Germans' with "the circulation.")
One could say that in cultures where the concept of mental illness is unheard of, there is no such thing. I know that in my own Anglo-Saxon culture, two or three generations ago, there was no such thing as "depression;" there was only unhappiness, and the cure was to stop thinking about it and do some useful work. It is not at all self-evident whether that cure was any less effective in my grandparents' day than the current fashionable cures for "depression," especially the pharmaceutical ones.
My uninformed guess about these Chinese doctors, which risks crossing the line into racism, is that they are telling their patients something like, "Your Yin and your Yang are out of balance; drink a tea made with these herbs twice a day, or do two hours of Tai Chi." The only questions worth investigating are, a) do these prescriptions "work," that is, clear up the patient's unpleasant symptoms, and, b) do they work for some objective reason that would apply to everyone, or only to patients who accept the Chinese Yin-Yang model of health (if that is indeed the model)?
Cultural anthropologists have done a useful thing in making us aware of these cultural differences. But the radical "deconstructionist