Winnie Kung, Ph.D. set out to study the families of Chinese Americans who have schizophrenia. She wanted to know what particular stresses and problems these families face. Sensing a real gap in researchers’ knowledge about how this particular segment of the population deals with the issues of having a family member with schizophrenia, she designed a study to gather relevant data. The results of this study have been published in the NASW publication, Social Work Research.
A family member with schizophrenia puts great stress on the family and this stress is exacerbated in many ethnic minorities in the U.S. Dr. Kung developed a pilot specifically for Chinese Americans, based on the cultural and contextual needs of this particular immigrant population. The study involved six months of biweekly individual family treatment in which the patient diagnosed with schizophrenia and his or her caregivers were present, and a biweekly relatives’ group for caregivers only. The study took place at one of the biggest mental health agencies serving the Asian population in a northeastern city in the United States. The inclusion criteria for the patients were that they be Mandarin- or Cantonese-speaking Chinese, age 18 or over, with a schizophrenic form of disorder as diagnosed by the treating psychiatrist, and with one or more relatives willing to participate in the study. Relatives also had to be 18 or older, speak Mandarin or Cantonese, and either live with or contact the patient at least once a month. They could be parents, spouses, or siblings. Twelve families were enrolled in the study. Nine were assigned to the intervention group and three to the comparison group based mainly on their geographic distance from the agency and the caregivers’ fluency in Mandarin or Cantonese, given that they were the languages spoken in the relatives’ group. Session notes available from the nine families in intervention group alone were examined and reported in this study.
Based on the data gathered, Dr. Kung identified several tangible needs and external stressors affecting these families:
- Stress from housing: patients may be living with families, who also may be living with extended families and in crowded conditions
- Financial stress: the immigrant families often have inadequate income sources to deal with the financial strain of a family member with mental health issues
- Work and study stress: patients may have difficulty maintaining a job or getting an education, further straining family resources
- Stress and constraints in dealing with external systems: problems may arise in dealing with courts, immigration and naturalization systems, etc.
- Constraints of organizational policies: bureaucratic systems may be difficult to navigate, especially without sufficient language services
- Shortage of alternative services: the above-mentioned systems may be the only available, yet not adequate to the family’s or patient’s needs
Dr. Kung also identified several areas of strength for these families, including strong family ties and extended family assistance.
The findings have implications for social work practice. Dr. Kung highlights changes to micro, mezzo, and macro practice areas that could improve care for Chinese Americans with schizophrenia and their families. For instance, on a micro level clinicians can work to discern whether to take direct action on a client’s behalf or empower the client (or client’s family), based on situational urgency. On a mezzo level, practitioners can help families navigate systems affecting their lives, such as rehearsing for naturalization interviews, etc. On a macro level social workers can advocate for increasing bilingual vocational training and job placement services, residential care, psychosocial programs, etc.
Dr. Kung writes:
This investigation was conducted in the context of a family psychoeducation study aimed mainly at clinical interventions at the micro level addressing psychological and relational issues within the family. However, careful examination of the families’ stressors indicated the need to also intervene at the mezzo and macro levels. The intense tangible needs and external stressors in this immigrant population with [lower socio-economic status] highlight the need to address the clients’ issues in relation to the larger environment in which they reside, to bring about relief and change.
To attain the recovery movement’s ideal of increasing these individuals’ autonomy in the community, adequate social services need to be put in place—including bilingual psychosocial programs such as day treatment, job training, employment opportunities, and residential services. To assist this clientele to navigate around the systems, the clinicians’ active role in case management and advocacy is very important. Moreover, to combat the “culture of chronicity”, service providers and agency policies need to steer away from the tendency to control and micromanage, which impedes patient growth and autonomy.