Last year, an article published across New Zealand media decried how Asian New Zealanders are ‘excluded from the mental health conversation’ (Chen, 2023). This commentary is far from new. In 2006, the New Zealand Medical Journal published a paper that noted that ‘the apparent [health] policy void for Asian peoples in New Zealand is concerning’ because no clear direction existed to consider or monitor Asian peoples when undertaking health research or formulating health policy (Rasanathan et al., 2006, p. 4). Almost two decades later in 2022, a new iteration of the New Zealand public health system, Health New Zealand | Te Whatu Ora, created several strategic changes to try to improve health outcomes for different population groups. Unfortunately, they did not unveil any Asian health strategy or designate any health leadership strategy or funding. Moreover, in their scoping review, Chiang et al. (2022) highlighted a paucity of Asian mental health research, concluding that Asians are simply not recognised as a priority. This ‘void’ is still present.

As projected by Statistics New Zealand (2022), Asians will account for around one-quarter of the Aotearoa New Zealand population in 2043, of which Chinese people will make up a substantial proportion. Despite being the largest Asian ethnic grouping, Chinese remain strikingly absent in mental health research, initiatives and policy. However, recent data from Asian Family Services showed that young Asians (aged 18–30 years) reported high rates of depressive and anxiety symptoms (Zhu, 2020, 2021). The COVID-19 pandemic lockdowns exacerbated this (Every-Palmer et al., 2020), especially against the backdrop of increased racism and discrimination (Zhu, 2021).

As a young New Zealand-born, Taiwanese clinical psychology trainee, I often question why Chinese mental health in New Zealand is neglected. My doctoral research is a qualitative interview study on how Chinese university students conceptualise mental health. Chinese students are likely to be a high-risk group for mental health issues as in addition to the stressors common to most students, they must contend with language barriers, acculturative stress and reportedly higher academic expectations from their families (R. C. Chung et al., 1997; Ho et al., 2003). This article draws upon research literature and my conversations with research participants to challenge five misconceptions about Chinese mental health.

1. Assuming Lack of Use Equals a Lack of Need

A common explanation for the dearth of Chinese representation in mental health research, teaching and policy is that because Chinese under-utilise mental health services relative to non-Chinese, there is no apparent need to provide these services (Chow & Mulder, 2017). However, this argument rests on the assumption that Chinese New Zealanders do not need help simply because they do not present to services with a ‘need’. In fact, Chung et al. (2022) argued that the reason that Chinese do not present in the first place is because mental health provision in New Zealand for Chinese is inadequate. They argued that barriers to Chinese people using mental health services included the absence of culturally responsive care and language services (D. W. K. Chung et al., 2022), as well as discrimination from health professionals (Peiris-John et al., 2022).

Although my research participants were aware of mental health services broadly, they echoed a sentiment that young Chinese are reluctant to engage with these services, despite acknowledging having mental health difficulties. Our inherently Eurocentric health system means that young people may be offered advice that does not take cultural considerations into account. For example, one participant who had used a mental health service spoke about how they had disclosed relational difficulties with their family and were advised to ‘move out of home’. They explained how this recommendation completely dismissed the familial and collectivist obligations inherent in Chinese culture. Unsurprisingly in this case, the participant felt their needs were not met, which confirmed their expectations that mental health services were not helpful to them, and they did not return. If cultural needs are not met, then no wonder there is scant presentation to services.

2. Overfocus on Stigma

International and local data document that mental health issues can be heavily stigmatised in Chinese families (Peiris-John et al., 2016; Zhang et al., 2020), which may lead to reduced dialogue and help-seeking behaviour (D. W. K. Chung et al., 2022). Researchers have described how cultural norms regarding ‘keeping face’, upkeeping of social harmony and fear of failure or of bringing ‘shame’ on one’s family can result in an internalised expectation that mental health issues must be kept ‘in the family’ (Chan & Parker, 2004; Shea & Yeh, 2008), preventing professional help from being sought.

However, although cultural stigma surrounding mental health does exist, professionals should not assume that this is always the case, especially for young Chinese in New Zealand whom other cultural values have influenced. The young people I interviewed were forthcoming about their own experiences with mental health and expressed a desire to increase dialogue about mental health experiences with their family. By over-focusing on stigma, we may inadvertently dismiss the possibility that young Chinese are aware of and want to talk about mental health with honesty and authenticity.

3. Buying into Stereotypic Myths

Chinese migrants in Aotearoa New Zealand are subject to socially constructed stereotypic myths that are unhelpful and dismissive (Tan, 2023). Popular myths include the model minority (i.e. Asians are seen as more successful than other minority groups), and the ‘grateful’ and ‘healthy immigrant’ (i.e. a perception of Asians as obeisant, subservient and hardworking who often have minimal burden on social or health services). Such stereotypes can minimise opportunities for Chinese migrants to express their struggles with issues related to acculturation and migrant stress. For those Chinese who have migrated to New Zealand, the process of acculturation can engender elevated mental health symptoms because of social isolation, discrimination, unemployment and inaccessibility to healthcare or housing during this acculturation period (Bhugra & Becker, 2005).Given that Chinese youth experience considerable academic pressure to succeed (R. C. Chung et al., 1997; J. P. H. Huang et al., 2009) and to care and give back as part of their familial responsibility, we may not acknowledge that beneath migrant myths are very real and painful difficulties. Many of the participants in my study were fully aware of their family’s intergenerational pressures and sacrifices, and how this played into their own academic pressure.

Moreover, Chinese are still subject to racial discrimination in New Zealand; this became pronounced throughout the COVID-19 pandemic (Liu et al., 2022), with young Chinese students experiencing a higher prevalence of racism than other Asian ethnicities (Jaung et al., 2022; Nielsen, 2021). Buying into stereotypical myths can shut down how Chinese youth not only bear the brunt of parental and societal expectations, but are also subject to marginalisation that is detrimental to their mental health.

4. Ignoring Cultural Hybridity

Chinese youth in New Zealand commonly contend with and negotiate hybrid identities described as a position of ambiguity or limbo, where an individual may feel stuck ‘in-between’ cultures (Bartley, 2010; Bartley & Spoonlety, 2008). These identities can be difficult to navigate amid academic study, familial obligations and general life stressors. Dong (2016) described that mental health issues may be exacerbated for Chinese New Zealanders because they feel trapped between the traditional Chinese beliefs and values of their family and their acculturated Western values. Several participants were acutely aware of how they straddled multiple identities, and how their mental health was affected by the stress of navigating these cultural nuances across multiple spaces. Wong et al. (2015) stressed the need for health approaches to be cognisant of the cultural, contextual and intergenerational aspects that affect young Asians. We must not assume homogeneity and appreciate that mental health difficulties for some Chinese are multi-faceted, with added layers of complexity around identity and belonging.

5. Chinese are Not Mental Health ‘Literate’

Chinese people have been described as lacking ‘mental health literacy’ (D. Huang et al., 2019; D. F. K. Wong et al., 2017). While knowledge of discrete Western mental health conditions may be low, this view is at odds with indigenous philosophies such as Taoist, Confucianist and Buddhist thinking instilled in the culture for centuries (Joshanloo, 2014; Wang et al., 2016). These existed long before the inception of Western psychology and are grounded in modern psychological techniques taught today (e.g. mindfulness). Indeed, my participants were explicit in their awareness and understanding of how they care for their mental health that drew upon non-Western frameworks. Wu et al. (2021) challenged the idea that Chinese people are lacking in mental health literacy and argued that the Western conception of mental health literacy is not culturally congruent with Chinese values. The unreflective application of a Eurocentric lens of mental health means we may construe Chinese as ‘illiterate’ of mental health when instead we should be more mindful of how Chinese understand mental health, and their networks of healing.

Conclusion

It is widely acknowledged that the true rates of problems are not always known. This is true of sexual abuse, family violence and rates of youth mental health problems more broadly. In the field of criminology, the number of crimes not reported to the authorities has been described as a ‘dark figure’ (Biderman & Reis, 1967). This same issue may reflect the apparently low rates of mental health problems among Asian people in Aotearoa New Zealand. Psychologists are increasingly attuned to cultural responsivity and safety for tangata whenua, and other cultural groupings in New Zealand. It is imperative that we use our knowledge and awareness to advocate towards a better understanding of Chinese mental health needs. Chinese youth are aware of their mental health, and their own modes of healing. They are having conversations about this, so why aren’t we?

Acknowledgements

The author would like to express his heartfelt gratitude to his academic supervisors, Professor Kerry Gibson and Professor Ian Lambie, who provided feedback on this article and continuously supported him in his research and passion for this topic.