Theme: Wrap Around Tailored Support for International Students

DRAFT     Mental Health and Wellbeing

 

Introduction 

Wellbeing and mental health have very different meanings for people, and our ideas about them are strongly influenced by culture. As practitioners we cannot override international students’ understandings of themselves any more than we could abandon our own understanding of ourselves. 

What we can do is plan for the range of elements that will nurture or strain international students’ wellbeing. We can also build trusting relationships with students so that they feel comfortable raising issues they experience or observe in their peers. 

Service providers and international students may have different understandings of what their health needs are, and what services provide. It is important to regularly reinforce the message that all health services, including counselling, are confidential. 

The sections below provide frameworks for understanding what mental health and wellbeing look like for international students, as well as strategies to encourage students to communicate about their challenges. This topic also provides resources for culturally-specific support that can better relate with students’ concerns. 

First, we’ll explore the holistic model used across Aotearoa to understand mental health and wellbeing, with a look at how this relates to international students’ own understandings of health.  

Te Whare Tapa Whā: Wellbeing for the whole self

Every international student brings their own wellbeing strengths and strategies to your institution, drawn from their culture, families, faiths, and experiences. Some will be outgoing and take the first steps to make new friends, others will use a ‘growth mindset’ to face academic challenges, still others have opportunities to practice their religion with their host community. 

These different types of strengths show the different forms that ‘wellbeing’ takes, which interconnect to form a whole and healthy person. Mason Durie’s Te Whare Tapa Whā model illustrates how physical, emotional, social, spiritual aspects of a student work together to support their wellness.

Te Whare Tapa Whā is useful for exploring how international students view their own wellbeing and health, because it presents an integrated view of mind and body. Every culture has practices to support wellbeing, many of which do not separate the mind from the body. Some students may observe depression or anxiety in terms of physical symptoms. This mindset can support health, since physical factors such as exercise, diet, and good sleep all have a major impact on mental health.

The whare in Durie’s model is supported by its foundation: whenua (land) that nourishes and provides stability. Onshore international students transport their whare to new grounds, resulting in some cultural shocks and shakes, as well as opportunities to gain new nutrients and foundations. This does not mean onshore students are automatically fragile, but rather that they undergo significant adaptation and change. 

Te Whare Tapa Whā also recognises that a person’s health goes beyond the individual and is connected with their communities and their spiritual beliefs. For some international students, their spiritual practices are a vital source of nourishment and connection. All students will be adjusting to the transition from their usual support networks. The process of settling in and establishing new connections will involve months of shifting, exploration, and growth. Providing international students with consistent and ongoing opportunities to ground and connect with host communities strengthens their overall wellbeing. See the upcoming Monitoring student wellbeing topic for more on how practitioners provide wider wellbeing support throughout international students’ journeys.

Use the reflection questions below to consider what holistic health looks like for yourself and the international students you support.

REFLECTION QUESTIONS

SELF What do you need in each of these areas to feel well and supported in your work? How does your institution support this aspect of your health? What needs to be improved? 
Taha tinana (physical)
Taha wairua (spiritual)
Taha hinengaro (mental & emotional)
Taha whānau (family & social)
Whenua (land, roots)
A THRIVING STUDENT Think about an international student you’ve worked with who was thriving. What strengths did that student have in each aspect of their whare?How could their whare be strengthened? How was the student able to identify the things that helped them feel well? 
Taha tinana (physical)
Taha wairua (spiritual)
Taha hinengaro (mental & emotional)
Taha whānau (family & social)
Whenua (land, roots)
A STRUGGLING STUDENT Consider an international student who seemed to constantly struggle. How did the student describe their challenges? How could their whare be strengthened?
Taha tinana (physical)
Taha wairua (spiritual)
Taha hinengaro (mental & emotional)
Taha whānau (family & social)
Whenua (land, roots)

As these questions illustrate, different factors will pressure or strengthen international students’ wellbeing. Your institution can plan and account for the impact of these factors for your students. 

Protective factors to address common pressures

[PRACTICE EXAMPLE] When it comes to strategies for supporting students’ mental health, the common thread is to be prepared to listen and look for opportunities to encourage conversation. Generally, when a student discloses a need they are looking for assistance, and often one can provide that – sometimes that has been hardship applications, sometimes a visit to a counsellor, and sometimes simply getting them to engage in activity that relieves their anxieties (International education practitioner). 

This practice example illustrates the different types of wellbeing needs we explored above, as well as the different ways practitioners offer support. Sometimes support addresses a material need, sometimes it involves a referral to a specialist, and sometimes just encouraging the student to boost their existing wellbeing strategies is enough to remind students that they are supported and capable. 

Remember how we ourselves can overlook our typical habits for good health when we are stressed. Prompting students to reflect on good health habits that they know work for them may feel easier to adopt and more empowering: 

[PRACTICE EXAMPLE] “I was supporting a Japanese student who was feeling very stressed and anxious. I asked her, ‘What would you normally do back home when you were feeling this way?’ She said that she would often meditate back home but stopped doing it when she came to New Zealand. I encouraged her to start meditating again, and some weeks later she reported back that using this practice again had really helped her” (Health promotion lead of service provider). 

Encouraging students to reflect on their protective skills is a key strategy for working through the pressures that can arise. NauMai NZ also contains advice from international students for international students about how to support their Personal wellbeing. These practices to recharge students’ wellbeing will help them to navigate through the pressures they face. 

Common pressures

While we cannot predict the specific highs and lows in students’ wellbeing, there are certain pressures that commonly arise for onshore international students: 

  • Accommodation – Difficulties finding accommodation, cost, issues with homestay family, etc.)
  • Financial – International study involves significant costs with limited opportunities to for work or social support
  • Pressure to meet expectations of family back home to succeed
  • Difficulty feeling understood across language and cultural differences 
  • Discrimination and/or disconnection from host communities

As illustrated with Te Whāre Tapa Wha, mental health and wellbeing are connected with these social and lifestyle pressures. Practitioners cannot fix social issues, but we can take practical steps to boost students’ wellbeing by relieving some of these pressures. This can include: 

  • Accommodation support (see Providing tailored accommodation support topic)
  • Connecting students with financial hardship support
  • Culturally relevant support from staff and/or peers
  • Staff training to improve inclusive policies and practices

Providing needs-based support to students through their challenges can do wonders to relieve the pressure that students feel. Yet as we explore next, it is particularly important to develop staff capacity to deliver an inclusive student experience. 

Protective action

The most significant predictor of a flourishing environment for international students is how well your institution embraces and includes your students’ diverse identities.

Psychologist Colleen Ward studies the key factors for international students’ mental health and wellbeing in New Zealand. Her decades of work have found that the biggest boost to international students’ wellbeing is to create belongingness and trust with their host institution and communities (Bethel, Ward, & Fetvadjiev, 2020). In particular, a key predictor of international students’ psychological wellbeing is a sense of connectedness with their local peers.  

Your institution can support these connections through: 1) valuing diversity, 2) providing regular opportunities for students from different backgrounds to interact, and 3) implementing strong diversity and inclusion policies (Ward & Kim, 2020). 

Ward’s research has found that where institutions success in these areas: 

  • the greater international students’ sense of belonging in their educational environment,
  • the more they trusted people in their educational institution,
  • the less discrimination they experienced,
  • the lower their levels of stress, anxiety, depression and negative mood, and
  • the greater their experience of flourishing, life satisfaction and positive emotions.

 

See upcoming topic Fostering international student inclusion topic for more.  

In the next sections, we explore in more detail how to develop the trust that Ward identifies as key to international students’ wellbeing. The foundation for this trust is shared understanding of confidentiality.

Confidentiality is key

[QUOTE] “We emphasise that student’s parents, schools, husbands or wives cannot be given any information about the appointment as this is often a concern. Recently, we had a student that was hesitant to meet a psychologist because he didn’t want his university in his home country to get the information as it would impact on his ability to find employment later on” (English Australia, 2018, p. 16).

Confidentiality is critical for students to disclose the issues they are facing. We may assume that students understand the information you provide about how confidentiality protects them. However, this message needs to be reinforced often and modelled by all staff. As in the quote above, we cannot assume that students know how we communicate with others about their concerns. 

International students in NZ are often very concerned that accessing any mental health care will be reported back to Immigration and potentially affect their visa status. Some students actively avoid disclosing mental health issues because of this belief. International students undergo extensive health examinations as part of their student visa approval process, so unlinking that experience from the confidential care they are entitled to requires ongoing and clear messages about confidentiality. 

Making sure that international students know these conversations are confidential is the first step to opening communication about mental health issues and growing trust. Let’s look further at some key strategies for supporting international students to communicate about their mental health.

Developing trust and communicating about mental health 

[PRACTICE EXAMPLE] The students know me from the time they start with us, and I support them with other issues so they know they can come to me. I am from the same culture and can speak their native language. So they can express to me what’s happening and I can refer the student to appropriate support. Our team took a mental health first aid course. We also have a solid mental health referral system within our institute (International education practitioner). 

The above reflection illustrates the importance of developing your relationships with students over time. This practitioner also recognises how sharing language and culture enables a deeper relationship. Asian students often seek help from friends and family rather than health professionals due to shared cultural understanding and trust (Ling & Tran, 2015). The practitioner here also highlights how solid referral systems and training support their practice. You may wish to identify a colleague to make proactive contact with a student first. 

Whatever your existing points of connection with an international student, there are key strategies that enable trust and communication to open. 

Normalise, don’t stigmatise

[QUOTE] “For an international student to approach mental health services, is a leap, a decision reached after overcoming a chasm of hesitations”- international student Varsha Ravi (Nott, 2021).

Students may avoid discussing mental health struggles due to feelings of shame or stigma. The best thing that you can do to act as their support person is to reassure the student that their struggles are normal, and that seeking help is a common thing to do: 

[QUOTE] “We explain that if you feel sad and lonely or are not sleeping well or feel very homesick you can speak to a counsellor. We compare it to being sick (e.g. having the flu) and seeing a doctor and explain that in Australia seeing someone for mental health difficulties is normal and very common – and importantly – completely confidential” (English Australia, 2018, p. 16).

Avoid labelling the issue in conversations with the student, e.g. “you’re depressed”. This may increase feelings of stigma, shame, or helplessness. Moreover, practitioners without mental health qualifications should not make judgments about whether a student’s mental health issue is genuine or attempt to diagnose them. Rather, having a trusted person to listen, support, and empathise can make all the difference for a struggling student. 

It can be difficult for the student themselves to express the issue, especially if they cannot do so in their mother language. Ask the student how they would describe their feelings – tired? stressed? scared? 

See upcoming Effectively engage with international students topic and Understand intercultural models for educational contexts topics for more

Online resources for students

Online resources are great starting points for encouraging students to explore mental health in their own time and in language that they can relate with. 

  • Nau Mai NZ provides up to date resources and links on personal wellbeing tailored to the international student experience.
  • Asian Family Services provides comprehensive and culturally-specific support services nationwide. They also offer a suite of online resources to support international students and regularly host workshops and webinars on wellbeing.  
  • The Mental Wealth interactive site is designed to normalise mental health issues for young people. Its Māori and Pacific viewpoint presents a plain language, community-centric approach that international students may relate with better than official Ministry of Health information.

You may feel unsure whether a student needs gentle encouragement, professional support, or more serious intervention. Your institution should provide regular training and clear procedures for escalating concerns. See the upcoming Intercultural dimensions of care topic for more.

These key principles from SIEBA are also a useful reminder for deciding how to classify a concern: 

PRINCIPLES FOR RESPONDING TO CONCERNS (adapted from SIEBA)

Level 1: GATHER MORE INFORMATION

You have noticed minor changes that are out of character. E.g., the student might be less talkative than usual, might turn up late, or might appear more tired than usual.

 Speak to the student, caregivers, or teachers. Continue to monitor and check in with others.

Level 2: PROVIDE ASSISTANCE

Advise appropriate staff, support the student, and refer for additional support if:

  you notice multiple changes, e.g. not attending class, falling grades, problems with friends, tearful  

  you notice changes in multiple settings, such as home, school and sports practice

  the symptoms have continued for a while and aren’t improving

  problems are occurring frequently

  problems are causing difficulties in the student’s relationships, schoolwork and usual activities.

Level 3: ACT IMMEDIATELY

Alert appropriate staff and seek immediate mental health or emergency support for alarming   observations, such as:

  risk to self (suicidal or self-harm ideas)

  odd, bizarre or extreme behaviour; not making sense

  risk to others, such as the student threatening to harm someone, they think is trying to harm them.

 

If you believe an international student would benefit from counselling, English Australia (2018) provides some key Do’s and Don’ts for having a supportive and productive conversation with your student:

[CHECKLIST] – How to suggest counselling 

  • Set a time to talk privately
  • Communicate your concern
  • Ask and listen
  • Bring up idea of counselling as resource
  • Avoid a power struggle
  • Don’t diagnose or be judgmental
  • Remain calm
  • Normalise counselling
  • Stress confidentiality
  • Describe the counselling service or nominated student counsellor at the institution and how to access, in detail
  • Recommend a specific counsellor
  • Look for leverage e.g. career or health focus
  • Check back with the student; allow some time

 

[CHECKLIST] – What to avoid

  • Overreacting: magnification of issues and involving too many people
  • Under-reacting: missing the seriousness of the issue
  • Downplaying: “pull your socks up; you’ll get over it”
  • Fearful responses: reacting to unusual or eccentric behaviour by amplifying your own anxiety
  • Super Rescuer: believing it is your role to “fix the issue”
  • Personalising: “this is what worked for me, so it will work for you”

Remember that being an empathetic support person is more than enough to help your student connect with services and take care of their wellbeing. You will also need to take good care of your own wellbeing through challenging times and manage your professional boundaries

Rather than attempting to resolve the issues on your own, your student will be best supported by a good referral system, as well as connections to culturally-specific support. 

Connecting students with culturally specific support 

Experiences of discrimination can be a significant barrier to the trust and understanding that international students need to feel in order to share their inner struggles with services. A 2022 study of Asian adolescents in New Zealand found that experiences of racism were a significant barrier to health care: 

[QUOTE]“Students who experienced discrimination by healthcare professionals and unfair treatment by teachers were more likely to forgo healthcare… East Asian students were especially likely to forgo healthcare when they came from poor communities or were bullied in school” (Xia, 2022).  

As noted above, increased training for cultural awareness and better inclusion is essential for all education practitioners and health professionals. Mainstream mental health services may not always be equipped to support international students due to language and cultural differences. Being able to express complex and intimate emotional issues in your own language makes a big difference for making sense of things. There are also cultural factors at play in students’ lives that mainstream services may not always understand. Therefore, it is helpful to be aware of culturally-aware services that may be better equipped to support your students. 

Take a look at this quick reference guide to building your network of culturally-specific support: 

 Build your directory – Culturally specific wellbeing support

Summary

This topic provides holistic and practical strategies for supporting international students’ mental health and wellbeing. This support can address various aspects of wellbeing that may strain or support a student’s overall mental health, as illustrated by the interconnected dimensions of Mason Durie’s Te Whare Tapa Whā model. 

Developing trusting relationships and good communication channels with students supports their sense of connection and belonging, and encourages them to communicate when issues arise for themselves or their peers. Regularly reinforcing the confidentiality of all sensitive conversations and linking students with culturally-specific support make all the difference in encouraging students to overcome the hesitations they may have about seeking support. 

Mental health and wellbeing issues can be very complex and are connected with wider social factors that students and practitioners regularly encounter. Being an empathetic support person for students, normalising their experiences, refraining from labelling the issues, and connecting them with appropriate support make a big impact on international students’ capacity to feel supported, connected, and able to keep nurturing their own wellbeing.  

 

REFERENCES

Asian Family Services. (2020). New Zealand Asian Mental Health & Wellbeing Report 2020. Retrieved from https://www.asianfamilyservices.nz/resources/resource-items/nz-asian-mental-health-wellbeing-report-2020/

Bethel, A., Ward, C., & Fetvadjiev, V. H. (2020). Cross-Cultural Transition and Psychological Adaptation of International Students: The Mediating Role of Host National Connectedness. Frontiers in Education, 5. Open access: https://doi.org/10.3389/feduc.2020.539950

Durie, M. H. (1985). A Maori perspective of health. Social Science & Medicine, 20(5), 483-486. https://doi.org/10.1016/0277-9536(85)90363-6

English Australia. (2018). Guide to best practice in international student mental health. Retrieved from https://www.englishaustralia.com.au/professional-development/best-practice-guides

Forbes-Mewett, H. (2019).  Mental health and international students: Issues, challenges, & effective practice. Open access: http://dx.doi.org/10.13140/RG.2.2.19923.94243

Le Va. (2019). The Mental Wealth Project. https://www.mentalwealth.nz/

Ling, C. & Tran, L. T. (2015). Chinese international students in Australia: An insight into their help and information seeking manners. International Education Journal: Comparative Perspectives, 14(1), 42–56. Open access at: https://dro.deakin.edu.au/view/DU:30074166

Minutillo, S., Cleary, M., Hills, A. P., & Visentin, D. (2020). Mental health considerations for international students. Issues in Mental Health Nursing, 41(6), 494–499, https://doi.org/10.1080/01612840.2020.1716123

Nielson IQ. (2021). International student experience survey 2021. Retrieved from https://intellilab.enz.govt.nz/document/682-international-student-experience-survey-2021-final-report-v2

Nott, W. (2021, October 15). Students fear NZ visa issues if they report poor mental health. The PIE News. Retrieved from https://thepienews.com/news/nz-students-fear-visa-issues-if-they-report-mental-health-problems/?mc_cid=7e6e8cef77&mc_eid=e90006ca87

Peiris-John, R., Kang, K., Bavin, L., Dizon, L., Singh, N., Clark, T., Fleming, T., & Ameratunga, S. (2021). East Asian, South Asian, Chinese and Indian Students in Aotearoa: A Youth19 Report. Auckland: The University of Auckland. Retrieved from: https://static1.squarespace.com/static/5bdbb75ccef37259122e59aa/t/60d3a4202b2d4a2ddd6b7708/1624482883718/Youth19+Report+on+South+Asian%2C+East+Asian%2C+Chinese+and+Indian+student.pdf

Ward, C. & Kim, I. (2020). Does diversity-receptiveness in educational institutions predict international students’ psychological and social well-being? Unpublished report to Oakley Mental Health Foundation. https://docs.google.com/document/d/1Oto9lv0On7peeT1OJIxAvNNcms61YQXr/edit?usp=sharing&ouid=115546995389104053809&rtpof=true&sd=true

Xia, L. (2022, February 2). Racism preventing young Asian Kiwis from seeking health services, study shows. Retrieved from https://www.stuff.co.nz/national/health/127671211/racism-preventing-young-asian-kiwis-from-seeking-health-services-study-shows

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