NZ Korean healthcare workers Aram Kim and Rebekah Jaung on efforts to understand the suicide problem in the Asian population.

“Even one suicide in any ethnic or population group is one too many.”

— Understanding deaths by suicide in the Asian population of Aotearoa New Zealand | Te whakamārama i ngā mate whakamomori i te taupori Āhia i Aotearoa

Earlier this month, a relatively hidden aspect of our national mental health crisis was finally brought into the light. The Suicide Mortality Review Committee released a report highlighting the increasing rate of suicide in the Asian community. Over the last decade, between 10 and 41 people of Asian ethnicity have died by suicide in Aotearoa every year, and rates are trending upwards. With the Asian population of Aotearoa projected to grow, and in the absence of central government strategies to address Asian mental health, the committee stated that it was concerned that the rate of suicide may rise.

We approach the report as healthcare workers and two members of the Korean community with personal and professional experiences of the way that mental distress and suicide have touched the community. We acknowledge that “Asian” is a commonly used identifier but its utility is limited when speaking of specific cultural and individual experiences. Even so, we hope that this report initiates safe and empowering conversations about Asian mental health, and catalyses governmental and societal action for suicide prevention. 

Mental health is a complex issue which extends beyond the health of an individual to the community and social context in which they live. When we contemplate the wellbeing of the diverse Asian communities of Aotearoa, we need to consider unique migration histories and cultures as well as underlying vulnerabilities such as loss of connection, role, status, and sense of belonging – all of which can become exacerbated further with stress caused by racism and xenophobia. Societal and familial expectations to assimilate and succeed can create additional pressures for subsequent generations whilst also clashing with expectations from within the community to maintain cultural identity and familiarity.

The role of culture

Cultural beliefs around health are powerful and shape every facet of experiencing illness. Although it is difficult to generalise, people with Asian cultural beliefs will often turn to their families and communities to understand and access support for their wellbeing. This can be a source of strength and resilience but can also impact on their access to mainstream health services, especially when combined with stigma around mental health, linguistic and cultural barriers, and the limitations of western models of health.

The role of the healthcare system

Some studies have shown that people of Asian ethnicity are less likely to be asked about mental health issues, leading to under-detection, under-diagnosis and under-treatment. This may be driven by health professionals’ bias, but may also indicate the limited capacity for cultural safety of the health system as a whole. Without cultural safety, differences in perceptions effects quality of care, a vicious cycle that can reduce trust in healthcare services and result in further harm.

Priya* repeatedly presented to the Emergency Department with medically unexplained symptoms. The treating team struggled to understand her needs, found her “difficult”, and had formed an opinion that she had a prescription drug addiction. What she was actually experiencing was undiagnosed and untreated depression which was manifesting in worsening physical symptoms.

The report acknowledges work that has already been done by local researchers, frontline healthcare workers and affected communities to increase the knowledge base around Asian community mental health, and it described the lack of responsiveness by policymakers as “unethical”. Strengthening the capacity of mental health services to provide culturally safe and linguistically appropriate care was highlighted as a priority, and it is important that this message is heard during this time of transformation within the sector.

The social and structural determinants of wellbeing

Looking beyond healthcare, to a whole-of-society approach is critical for addressing the social determinants of wellbeing for Asian communities.

The threat of compromising employment and visa status when accessing any health service is a barrier to wellbeing for migrant and refugee communities. Migrants and international students may be forced to return to their home country to access appropriate mental health care, or due to fear of cost or their visa not being extended further as a result of their mental health issues.

Ji-Young* presented to an Emergency Department following a suicide attempt but refused to engage with mental health professionals. Later it was found that she was ashamed of her depression and suicide attempt but also fearful of having a mental health record which may negatively impact on her employment and residency status.

Sometimes it is the interaction of multiple agencies which cause harm.

Li* was a young mother whose children were nearly uplifted by Oranga Tamariki due to the perception that she was not prioritising them over her abusive partner. Li* loved her children dearly and tried to protect them but was reluctant to leave due to strong cultural beliefs around the importance of maintaining her marriage, and a sense of shame about her home situation which was leading to further social isolation, as well as fear of losing her children due to her negative experience with social agencies and lack of familiarity with local legal and child protection agencies.

The role of racism

Asian people living in New Zealand report the highest levels of discrimination in their daily lives, and anti-Asian hate crimes are a consistent feature within the limited data that we have. Both the visible, violent, slur-wielding racism, and the more insidious kind which is “carried out by otherwise well-meaning people and almost impossible to name,” are barriers to our right to be healthy.

One concern when highlighting health issues within an ethnic minority community is the backlash. Comments made in response to news articles about the report cover all of the usual tropes: questioning why resources are being used for looking at health issues in Asian communities at all, blaming migrants for failing to assimilate, comparing the findings to other groups (as if some suicides are more important than others) and simply, “Go home then.”

Although the right to health held by tangata whenua is often framed as being in competition with the needs of ethnic minority communities, we need to be clear in our thinking that eliminating suicide in the Asian community should not be used as a diversion from our obligations to honouring te Tiriti. In fact, “entry by Treaty”’ is a powerful counter-narrative to those which seek to marginalise both Māori and Asian communities. In other words, “The principles of the Treaty give us rules of engagement; if we accede to them, we will access our right to be different.”

Where do we go from here?

The most important outcome of the report is that it was written at all. Naming suicide in Asian communities as a national concern  is more support than we have had in the past. When it comes to talking about suicide prevention, instead of comparing “who is worse off” or “who needs more resource”, we need to affirm that all of our communities should feel that their lives are equally valued and that they have a right to the same quality of life as any other New Zealander.

If “Zero Suicide” is our goal for Aotearoa, then it is also our responsibility to ensure that everyone who calls these islands home has what they need to be part of that vision.

*Names and details have been changed