Pathways to Patienthood: An Interpretative Phenomenological Analysis of the Initiation of Help-Seeking among Hong Kong Chinese with Chronic Mental Illness

Mental health service utilization in Hong Kong has often been the last resort for many affected individuals, considered only after an individual has sought help from informal networks, such as family members and friends, then formal non-mental health networks, such as general practitioners, and other medical specialists and social workers, which often results in long treatment delay. Treatment delay has a negative effect on long-term prognosis, increases costs to families and society through prolonged psychiatric and psychological intervention and results in a protracted rehabilitation process. This study set out to investigate patients' pathways into the mental health system and the characteristics and other culture-specific components along this pathway to determine ways of facilitating earlier treatment for individuals with chronic mental health issues in Hong Kong. A qualitative approach was used to learn about 36 individuals with chronic mental illness from community mental health service facilities. Individual interviews were administered about participants' experience along the pathways to patienthood. Three key findings were identified. The first was a two-stage model of professional help-seeking: Stage 1 involved the identification of problems that were not yet defined within psychiatric categories and Stage 2 involved the identification of an acute and often serious crisis (e.g., psychosis) that brought the participants into contact with the mental health system where they received their first psychiatric diagnosis. The time between onset and seeking mental health services ranged from a few months to 20 years. The second key finding was participants' experience with alternative treatment, in particular Chinese traditional spiritual healing, which was often sought at the insistence of family members. The participants themselves were ambivalent about these treatments, but they tolerated them due to family obligation. The third key finding was misinformation about mental illness and diagnosis among participants. Most participants thought they had an emotional illness rather than a mental illness, which they perceived as two different kinds of illnesses. In addition, the diagnosis of "early psychosis" was preferred to "schizophrenia," as early psychosis carries fewer stigmas and appears to be more treatable. Some patients were never told their diagnosis or were given an inaccurate diagnosis in order to reduce anxiety or stigma. The findings were discussed with respect to existing research on mental help seeking in Hong Kong and among Chinese immigrant populations in other countries. The results suggest that the identification of early symptoms of mental illness by social workers and general practitioners is particularly important when these early symptoms often bear little resemblance to sufferers and their family members as a diagnosable disorder that requires psychiatric treatment.