Suffering in silence?: The adequacy of Dutch mental health care provision for ethnic Chinese in the Netherlands

Abstract

Compared to other ethnic groups in the Netherlands, Chinese are less likely to use mental health care yet present more serious symptoms at the first consultation. However, the reason for these differences is unknown because of the scarcity of research. This doctoral research sets out to fill this gap in our knowledge and to shed light on mental health care utilisation among this group. It further examines the adequacy of Dutch mental health care services for them. The research embraces a range of disciplines in medical and social sciences such as psychiatry, clinical and health psychology, medical anthropology, social history and sociology. Both literature reviews and empirical studies were carried out. Literature was examined relating to the background of Chinese in the Netherlands, general issues concerning health care for migrants, health service delivery and utilisation, as well as studies of Chinese in the Netherlands and other Western countries. In the empirical research a mixed-method approach was applied to data collection and analysis. Quantitative data were collected by administering a structured questionnaire in street interviews to 102 Chinese in the Randstad (Amsterdam, The Hague, Rotterdam and Utrecht). Qualitative data were collected using 23 in-depth interviews with Chinese who were willing to relate accounts of one or more Chinese persons in their social environment whom they regarded as having (had) mental health problems (精神問題). Results show that the Chinese studied regarded Dutch health care as their primary method of managing general and mental health problems. The beliefs they expressed about mental illness did not seem to differ from those current in the West in ways that would form a major barrier to seeking help from mainstream services. Although cultural differences were observed which might create barriers to mutual understanding between health professionals and Chinese care users, they were not such as to prevent Chinese from accepting and benefiting from Dutch health care. Despite the fact that health insurance in the Netherlands is compulsory but affordable, the expectation of high costs for mental health care sometimes affected the readiness of Chinese to use such services. The results of this research suggest that the main barriers have to do with more practical factors such as low Dutch proficiency, lack of knowledge of the health system, or language and communication problems. Other barriers include lack of cultural sensitivity among professionals and the failure of the health system to take steps to overcome these problems. Because Dutch mental health services are incorporated in both primary and secondary care, the barriers to mental and general health care utilisation often overlap. The study also showed that Chinese in the Netherlands form a heterogeneous group in terms of their origins, sub-cultures, migration patterns, socio-economic status and levels of integration. Different individuals have different needs. Service providers and policy makers should take the diversity of the Chinese group into account and pay more attention to issues such as communication barriers, knowledge of the health care system, attitudes of professionals and discrimination.