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Intercultural dimensions of care

Manaakitanga: A M膩ori saying: 鈥楰o au ko koe, ko koe ko au鈥, I am you and you are me!

We are all kin and this drives a duty of care for each other reflected in cultural practices of welcome.听

Providing tailored support for international students includes considering the intercultural dimensions of care. Culture has been defined as The programming of the human mind by which one group of people distinguishes itself from another group. (Hofstede Insights, 2022)

Cultural differences need to be considered when dealing with mental health issues and critical incidents. The M膩ori values of manaakitanga (hospitality and kindness), mana orite (a balancing of mana)听 and听 aroha (love) provide a firm grounding for relating to international learners as our guests who are a long way from home. It helps us to keep in mind each student's cultural background, values and beliefs when providing support.听

It is important to develop strategies that consider the cultural values and beliefs of international students when dealing with mental health and welfare issues. Having an awareness of the importance of cultural differences in relation to mental health is essential for developing a more culturally responsive practice.听听

This topic will consider the impact of cultural differences on student support, highlight potential cultural barriers to effective care, offer strategies for addressing these potential barriers, share an experienced mental health nurse鈥檚 reflections and outline practical tips for tailoring support services for international students.听听

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    1. Considering the impact of cultural differences on student support

    New Zealand鈥檚 modern society blends a number of cultural influences including M膩ori, Polynesian, Asian and European values among others. Cultural norms within a single society are fluid and easily听 overgeneralised. At the same time, anthropologists have identified cultural values that are more common among some groups than others.听 New Zealand European values, for instance, show an individualist orientation听 with an emphasis on self-reliance and initiative-taking. On the other hand, M膩ori and Pasifika cultural values reflect more collectivist values,听 which give prominence to the needs of the group such as iwi or hapu.听 If student services are contingent on individuals taking the initiative, this may lead to a disconnect with students from collectivist cultures who prefer group-based decision-making.

    Learning about your international students鈥 cultures听

    You can learn more about your students鈥 heritage cultures (home country) using online cultural values websites such as the educational resource. Pick a culture that represents the largest cohort of your international students. Read the 顿辞鈥檚 and 顿辞苍鈥檛蝉 page. How might this information inform your approach to these students in terms of the way you approach orientation, communicate health and safety information, approach students individually and provide follow-up support?听

    Health professionals provide clinical support for at-risk students, and a fundamental principle in student support work is referring a student to health services when the student presents with problems requiring professional or clinical intervention. The more acute examples include:

    • Marked changes in behaviour
    • Impulsiveness or aggressive behaviour
    • Eating disorders
    • High levels of pessimism or neuroticism
    • High levels of stress and / or anxiety
    • Increased symptoms of depression听
    • Self-harm
    • Regular drug or alcohol use impacting behaviour/studies
    • Suicide ideation 鈥 plans or threats of self-harm.

    INSIGHT

    The key consideration here is to be mindful of intercultural dimensions that might impede international students鈥 readiness to discuss their problems or make access to professional health care more difficult for them.

    Consider the scenario below:

    ACTIVITY

    Imagine the majority of your students come from collectivist cultures and your staff are more individualist in outlook. You are dealing with a student who is failing half their subjects. It is clear the student is not coping, regularly absent and in danger of failing to meet the conditions of their student permit.听

    Question: Which collectivist values are important to consider when offering support to this student? See a comparisons on SIEBA鈥檚 cultural difference page that outlines differences between these values.听

    What do you think? 听Click here to see the values that might be important to the student and your possible actions:听

    (i) Maintaining a sense of belonging; (ii) Avoiding behaviours outside the norm bring shame; (iii) Working together for the success of the group

    Possible actions to address these:听

    • If the student is simply not going to successfully complete their studies, be honest with them.
    • Offer face-saving alternatives for the student, and highlight the benefits of the time they鈥檝e spent at your institutions, e.g. 鈥楾his experience is pointing you towards another pathway that is a better fit for you and your family鈥.
    • If you feel they are capable of turning things around, provide support for accessing service and encourage that鈥檚 its 鈥榥ormal鈥 practice to do so in a NZ context听听
    • Encourage them to discuss the situation with their family even if they鈥檙e reluctant to do so.

    The Impact of identity and culture on mental health

    Our cultural values affect how we perceive and experience mental health issues and what support works for us.听

    Cultural values influence students鈥 help-seeking strategies

    A student's attitude towards mental health and help-seeking can be shaped by their cultural instincts. As mentioned, some cultures have a strong sense of shame in acknowledging mental health issues and the need to seek help. And friends and family are often the first port of call for international students rather than student support services or health professionals (Forbes-Mewett & Sawyer, 2016) In some cases, they may perceive their health problem 鈥榯o be outside the norm鈥 and wish to avoid the听 stigma associated with it. It鈥檚 understandable they may prefer to reach out to someone they trust, if they鈥檙e prepared to reach out at all.听

    鈥淔or a lot of international students, mental health is never talked about where they come from. Emotional wellbeing is pretty ignored and neglected probably. People are expected to be tough and get on with their life.鈥澨
    (Kelly Feng, National Director, Asian Family Services)

    The importance of trust

    The importance of trust is a significant component in the provision of tailored support听 in many cultures. While we need to be aware of subtle or significant cultural differences on the one hand, experienced practitioners report that the establishment of trust can make a difference for students from a variety of backgrounds. The practice of manaaki - kindness towards others - helps to engender this trust.听

    The importance of trust is a significant component in the provision of tailored support听 in many cultures. While we need to be aware of subtle or significant cultural differences on the one hand, experienced practitioners report that the establishment of trust can make a difference for students from a variety of backgrounds. The practice of manaaki - kindness towards others - helps to engender this trust.听

    See Lena鈥檚 case:

    Case Study - Lena听

    Lena is a German-heritage student from Switzerland who has studied for three years in New Zealand. She explains what it needs for Swiss people to open up about their issues: 鈥淚 only talk about my problems with very good friends, with someone I can trust. Establishing these relationships takes time and can be more complicated with people from different cultural backgrounds. In addition, it is very difficult to talk about your feelings in a different language even if your language knowledge is well established. Therefore, I may end up feeling really 鈥榣ost鈥 and 鈥榣onely鈥 during difficult times.鈥

    woman sitting on wooden dock by the sea

    QUICK TIP

    Lena鈥檚 strong preference is to share her听 most deeply felt needs with someone she knows well.听 To support a student like Lena it is important to communicate the usefulness, availability and friendliness of student services to the whole student body. And it is quite possible that Lena befriends a student who has had a positive experience of student services.听听

    It may be, however, that another student is prepared to talk with someone they don鈥檛 know in a professional setting. For them they may prefer a professional, independent voice. In this case, the student needs to trust the integrity, competence and confidentiality of the service, and so it鈥檚 important to communicate the professionalism of services to students.听听

    Whanaunga: Working on interpersonal connections to build trust

    An important component in your care of international students is nurturing the relationship they have with you and encouraging their friendships with other students. At the heart of this principle is whanaunga, the M膩ori concept of the interconnectedness between people that embodies a shared sense of humanity.听 Student services staff and educators need to create occasions where they can engage personally with international students and learn more about their lived experiences. Or they can encourage student allies, e.g. senior students who have participated in leadership programmes, to support new students鈥 social connections. Though there will still be cultural differences to negotiate, it is more likely that students will be ready to open up if they feel they belong.听听

    International students鈥 sense of connectedness to the wider institution and local community influences their appraisal of or trust in student support services. Although ENZ鈥檚 2021 international student experience survey (Education New Zealand, 2021) showed high overall satisfaction among students, 27% of international students rated 鈥渇eeling part of the community鈥 as adequate or poor. 12% of the students did not have someone in New Zealand to rely upon. In these circumstances, the needs of some international students may potentially pass under the radar, and we鈥檝e already noted that many students prefer to talk to a friend first when seeking help (Forbes-Mewett & Sawyer, 2016). If, however, they experience an institution that emphasizes the welfare of students and encounter staff who appear to have time to listen, they may be prepared to talk with them.

    2. Potential barriers to offering tailored support and care听

    International students can be vulnerable for a range of reasons. Take a look at some potential barriers to students seeking help and consider strategies that can be used to overcome these barriers. The challenges listed below reflect some of the international student vulnerabilities identified by English Australia鈥檚 (pp.7-8)听

    Language

    Language barriers can hinder international students鈥 capacity to express their needs and feelings (Fleming & Kitchen, 2018). Added to this, some international students may not be encouraged to confidently express an opinion in their home countries鈥 classrooms.

    How to address language barriers?

    • For entry-level English students, provide early opportunities for them to interact with students in similar circumstances, e.g. English as Additional Language (EAL) students from other countries.
    • Create buddy systems where an international student is buddied up with a native English speaker. This gives students an opportunity to learn informally about the new language and academic culture.
    • Work on optimal spacing of key information, e.g. health and safety advice sufficiently spaced/separated from accommodation advice, to give EAL learners time to digest information. See the (p.243).听
    • Encourage a careful self critique of your programme鈥檚 language use when working with EAL students, e.g. are you using colloquialisms, information dumps or low-frequency words unnecessarily? See the (p.241).

    How to address language barriers?

    • For entry-level English students, provide early opportunities for them to interact with students in similar circumstances, e.g. English as Additional Language (EAL) students from other countries.
    • Create buddy systems where an international student is buddied up with a native English speaker. This gives students an opportunity to learn informally about the new language and academic culture.
    • Work on optimal spacing of key information, e.g. health and safety advice sufficiently spaced/separated from accommodation advice, to give EAL learners time to digest information. See the CI Model (p.243).听
    • Encourage a careful self critique of your programme鈥檚 language use when working with EAL students, e.g. are you using colloquialisms, information dumps or low-frequency words unnecessarily? See the CI Model (p.241).

    Stigma

    Many international students can be hesitant to seek assistance because of the stigma associated with mental health issues. These attitudes can originate from the student鈥檚 cultural background and beliefs. For example, the collectivist inclination to avoid behaving outside the norm. Some students may want to preserve family honour by keeping the issue within the family or simply not want to make a fuss about their problems. The risk here is by delaying intervention, mental health issues may escalate if they鈥檙e dealing with a significant mental health issue.

    How to address stigma associated with mental health issues?

    • Include conversations about