Public Policy Bulletin (9th Issue - June 2024)

2 • What is the state of MHL among ethnic minorities in Hong Kong? • What barriers to and facilitators of access to mental health services for ethnic minorities exist? • What shapes the MHL and help-seeking behavior of ethnic minorities? • What are the study’s policy-making implications? Study Methodology This bulletin summarizes a qualitative study conducted in Hong Kong between December 2023 and March 2024, employing a descriptive–qualitative approach to explore MHL and help-seeking behavior among EM groups based on Laura and Ana’s cross-cultural model. Purposive sampling was used to recruit participants from Indian, Nepali, and Pakistani communities in Hong Kong, with a focus on elders—a high-risk population for mental health issues. Twenty-eight participants sat for in-depth interviews. The participants comprised 23 elderly individuals and 5 caregivers, including 8 elders of Pakistani descent, 8 elders of Indian descent, and 7 elders of Nepalese descent. The semi-structured interviews incorporated concepts from previous studies of MHL. Topics covered included participants’ knowledge and beliefs about mental health— risk factors, causes, health-seeking behaviors, access to professional services, and preferred mental health services—as well as their assessments of healthcare systems and policies in Hong Kong. Findings and Analysis The study revealed that cultural beliefs and contextual factors influence ethnic minorities’ MHL and help-seeking behaviors. These perceptions are consistently shaped by deficiencies in the public health system. The interplay between ethnicity and the support offered by or barriers to the system shape Hong Kong EMs’ MHL and help-seeking behavior. Six themes describe EMs’ beliefs and understanding of mental health and help-seeking: (1) biased recognition and stigmatization of mental health problems; (2) social and cultural attributions associated with mental health problems; (3) a “family first” responsibility pattern; (4) openness to professional care, with doubts; (5) barriers in accessing and receiving services; (6) opportunities to promote mental health services. The findings highlight the relative lack of relevant knowledge among EMs. Additionally, these individuals often lack awareness of available resources. While the participants seemed generally open to formal mental healthcare services, barriers within the public health system discourage them from accessing and utilizing those services. Figure 1 Biased Recognition and Stigmatization of Mental Health Problems Many participants lacked understanding of mental health problems, considering them less serious than physical conditions and associating them with cognitive dysfunction. Participants believed that mental health issues were rare. Stigma was concerning, discouraging many participants from sharing their struggles with others. Social and Cultural Attributions of Mental Health Problems Participants attributed mental health problems to socioeconomic factors. They also relied on spiritual beliefs to explain symptoms, viewing them as manifestations of God’s will or dark magic. Employment disparities and workplace discrimination are also contributing factors, as is inadequate support offered by and cultural insensitivity within public services. Conceptualizing Mental Health Literacy and Help-Seeking of Ethnic Minorities in Hong Kong Promoting Mental Health Equity: Enhancing Ethnic Minority Mental Health Literacy and Help-Seeking in Hong Kong Public Policy BULLETIN