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1. Considering the impact of cultural differences on student support
New Zealand’s modern society blends a number of cultural influences including Māori, Polynesian, Asian and European values among others. Cultural norms within a single society are fluid and easily overgeneralised. At the same time, anthropologists have identified cultural values that are more common among some groups than others. New Zealand European values, for instance, show an individualist orientation with an emphasis on self-reliance and initiative-taking. On the other hand, Māori and Pasifika cultural values reflect more collectivist values, which give prominence to the needs of the group such as iwi or hapu. 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’ cultures
You can learn more about your students’ heritage cultures (home country) using online cultural values websites such as the Cultural Atlas educational resource. Pick a culture that represents the largest cohort of your international students. Read the Do’s and Don’ts 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?
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
- Self-harm
- Regular drug or alcohol use impacting behaviour/studies
- Suicide ideation – plans or threats of self-harm.
INSIGHT
The key consideration here is to be mindful of intercultural dimensions that might impede international students’ 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.
Question: Which collectivist values are important to consider when offering support to this student? See a comparisons table on SIEBA’s cultural difference page that outlines differences between these values.
What do you think? Click here to see the values that might be important to the student and your possible actions:
(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:
- 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’ve spent at your institutions, e.g. ‘This experience is pointing you towards another pathway that is a better fit for you and your family’.
- If you feel they are capable of turning things around, provide support for accessing service and encourage that’s its ‘normal’ practice to do so in a NZ context
- Encourage them to discuss the situation with their family even if they’re 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.
Cultural values influence students’ 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 ‘to be outside the norm’ and wish to avoid the stigma associated with it. It’s understandable they may prefer to reach out to someone they trust, if they’re prepared to reach out at all.
“For 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.”
(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 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.
The importance of trust is a significant component in the provision of tailored support 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.
See Lena’s case:
Case Study - Lena
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: “I 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 ‘lost’ and ‘lonely’ during difficult times.”
QUICK TIP
Lena’s strong preference is to share her most deeply felt needs with someone she knows well. 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.
It may be, however, that another student is prepared to talk with someone they don’t 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’s important to communicate the professionalism of services to students.
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 Māori concept of the interconnectedness between people that embodies a shared sense of humanity. 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’ 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.
International students’ sense of connectedness to the wider institution and local community influences their appraisal of or trust in student support services. Although ENZ’s 2021 international student experience survey (Education New Zealand, 2021) showed high overall satisfaction among students, 27% of international students rated “feeling part of the community” 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’ve 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
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’s Guide to best practice in international student health (pp.7-8)
Language
Language barriers can hinder international students’ 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’ 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 CI Model (p.243).
- Encourage a careful self critique of your programme’s 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).
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).
- Encourage a careful self critique of your programme’s 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’s 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’re dealing with a significant mental health issue.
How to address stigma associated with mental health issues?
- Include conversations about mental health issues in your daily conversations to make it seem like any other topic.
- In orientation include interactive activities such as simulations and role plays to show the positivity of accessing services. Students can practice asking each other if they are okay and encourage each other to seek help.
- Demonstrate consistently positive attitudes toward mental health services, e.g. invite a friendly face (e.g. an international student who has had a positive experience with the services) to come and address students at orientation.
- Use a student ambassadors programme to encourage senior students to reach out to students that are struggling.
- Include mental health topics in the curriculum to promote information that “de-stigmatises” mental health.
- Reassure international students that addressing mental health issues does not mean they will be sent home or that their grades will be affected.
Religion and spirituality
The arrival of religious students is a reminder that we live in a predominantly religious world. Some international students are more likely to draw on their religious faith to cope with mental health issues. Indeed, studies show that religious faith can provide religious young people with a buffer for coping with stress and life’s uncertainties. However, if religious students feel alienated by a wholly secular approach to student support they may be disinclined to reach out. The report on the Royal Commission of Inquiry into the terrorist attack on Christchurch masjidain on 15 March 2019 included concerns about some educators’ lack of cultural and religious literacy in relation to ethnic minorities.
How to support religious students?
- Keep an open mind about other people’s religious beliefs, particularly if you’re used to a secular perspective on life.
- Establish and refresh contacts with local religious communities.
- Consider religious literacy as a component of intercultural competence. See the CI Model (p.241).
- Be open to learning the basic tenets of your students’ religion. Through a conversation with a student advisor at a New Zealand university, a student form the UAE suddenly realised that the student advisor knew the five pillars of Islam. This provided a pleasant surprise and immediate point of connection for the student.
- Use readily available online resources for supporting international students, e.g. ENZ’s NauMai information page.
Pressure to perform
Some students are under family pressure to perform academically. This can be a significant weight especially when family or community members back home have financially supported the student and have expectations of academic achievements (Forbes-Mewett & Sawyer, 2016). International students and m. When these students are failing to perform, they can experience debilitating shame.
How to address pressures to perform?
- Explore ways to start a discussion about the pressure and offer verbal prompts that ask them about the influence of their family
- Reassure the international student that struggling is part of the learning process and that it’s not easy for their offshore family members to identify with the pressures they’re facing.
- Point students to specialised support services or hardship funds, if appropriate, and offer to advocate on behalf of the student if they are under 18.
Financial pressure
Some students face ongoing financial pressure and need to earn money while studying. Indeed, living and study costs have been cited by some students as a “negative driver” (Education New Zealand, 2018). The perceived and actual costs of accessing health care can hinder international students’ readiness to access help (Peiris-John et al, 2021).
How to support international students facing financial pressure?
- Inform international students about the financial support services available in your institution and financial advice available in the wider sector.
- Give opportunities for students to discuss the financial challenges students face either in a group setting or confidentially. If students are reluctant to discuss their own pressures, offer scenarios for them to discuss which reflect financial stressors you’re aware of. It can helpful if they’re aware other students may be in a similar situation
- Make it crystal clear which services are free.
- Provide access to up-to-date information on available work for students who can work.
- Ensure that students who can work are alerted to relevant laws.
- Provide students with budget setting exercises during orientation or early in their sojourn
- Refer students to helpful ENZ NauMai financial advice pages.
3. Addressing cultural differences and barriers to accessing care
The task of incorporating intercultural dimensions into care is not straightforward. One of the first principles is clearly communicating requisite student and health services and why they are important. This is a difficult task for newly arrived students negotiating a foreign culture and a second language. See the CI Model for strategies that enhance intercultural communication (C2) and effective interventions (C3). Another key principle is determining where the student ‘is at’ and asking questions. See one approach for doing this described below:
Miwa Yasui
Miwa Yasui, a social services specialist at University of Illinois–Chicago , has developed a clinical intervention that encourages clients to explain where they are coming from (Yasui, 2015). Her approach can be used in conversations with international students. Yasui states that culture is defined by what people do and what is important to them. She introduces the Cultural Ecogram (CE) approach that is designed to elicit the individual’s/family’s cultural experience which forms their interpretation of their presenting problem. This allows the client to bring their own personal cultural concepts to the discussion and establishes grounds for greater understanding. In her studies, Yasui found that this approach led to a stronger relationship between the questioner and clients from different cultures. The recipients of this approach felt valued for who they were as people through the effort to understand their individual selves and culture.
Tips for how might Yasui’s advice be applied
- Start the conversation with a student presenting a problem with questions relating to their cultural influences such as ‘my family’, ‘my education’, ‘my religion/spirituality’.
- Conversation starters could include the use of visual cues, e.g. an invitation to look at photos or pictures together, which explore cultural influences and encourage students to discuss cultural values that shape their thinking.
- Listen intently for responses that help you to understand their culturally formed beliefs and thoughts that may be influencing particular behaviours.
- With deeper insights into the student’s cultural instincts, you are better placed to offer tailored advice that is formed by intercultural awareness.
Applying a cultural inquiry approach
The principal proposed by Yasui suggests we should elicit from the students themselves as much of their understanding of what’s contributing to their problem.
Case Study - Bindya
Tess was a learning advisor supporting Bindya, a student who arrived from India twelve months earlier to commence her postgraduate studies. Bindya was struggling with several courses and had met with Tess once to discuss how to complete successful written reports. Tess had focused on the technical aspects during the first appointments, but Bindya appeared disengaged. So, in their second appointment, Tess decided to change tack and asked her about her life in India. This led to Bindya sharing photos from home and webpages that showed her hometown’s colourful attractions and cuisine. She then shared that she had experienced significant challenges adapting to the different culture in New Zealand. She felt socially isolated and was feeling low. This impacted her ability to focus on her studies.
Bindya went on to explain that families play an important role in India. Extended family members such as uncles, aunts and grandparents are all involved in most stages of a child’s development. Families are seen as one unit and include friends of parents and siblings. It is common to live with your own parents as an adult. Your parents and even the wider family are often involved in life decisions, such as your choice of profession or partner. Neighbours know each other well and are informed about visitors and their relationships within the family.
What did Tess learn from inviting Bindya to discuss her cross-border experience?
Bindya’s description of her experience highlighted the intercultural challenges some international students experience when they are away from their community networks. These students have to make decisions and face problems without the support of their families. Tess realised that these cross-border dynamics were a significant stressor for Bindya. She realised that there was value in getting to know her students and offering cues that allowed students to talk freely about their cultural perspective and lived experience in a foreign country. She was also aware of several extra curricula programmes at her university that were popular with international students, and she arranged for Bindya to meet with one of the programme coordinators.
Mei’s experience of counselling
Mei is a year 13 student from China. She is in her second year at a New Zealand school. She began to feel isolated and started to develop anxiety and depression, but was reluctant to talk to anyone about it. Mei realised that she needed help after a long time trying to solve the problem herself. However, after finally speaking with another international student, she made an appointment with the school counsellor. Mei found the experience to be only partially helpful: "It really felt like I was engaging with a Western person. Family is really important to me - but they couldn't really understand," she said.
Tips for a cultural inquiry approach that supports Mei
- Ask Mei about her experience since she arrived from China. What does she miss?
- Invite her to share photos or stories that relate to her life at home.
- Give her time to discuss her own perspective on why she’s feeling low and whether she thinks it's due to her cross-cultural experience.
- Ask her whether she’d like a family member to participate remotely in the discussion.
- Ask the student if they want to bring a friend to the next conversation.
4. The intercultural dimensions of care: A health professional reflects
For a long time Patrick Au was the Asian Mental Health Coordinator at Auckland District Health Board. Patrick is a registered psychiatric nurse and a counsellor. He lived in Hong Kong before he arrived in New Zealand. In our interview (Nov 2021), Patrick discussed the cultural dimensions of care in relation to Chinese-background students.
Patrick explained that in China there is generally not the same emphasis on mental health issues. People are encouraged to privately deal with their emotions from a young age, especially men. Sharing emotions openly is not as common and there are relatively few words in the Chinese language to describe feelings. Instead, Chinese people can talk a lot about their behaviour and physical health when they are not well. When working with international students, health professionals and pastoral care staff need to consider how Chinese students describe their symptoms in order to get to the root of the problem.
Think about what possible physical health symptoms or behaviours might indicate mental health challenges.
For example, it might be useful to ask Chinese-heritage students about their appetite, sleep or physical symptoms such as headaches, chest pain, tummy ache to find out more about their wellbeing. In addition, changes in behaviour such as swearing, physical aggression, inattentiveness, tiredness and not engaging with friends can be indicators of mental health problems. When talking with Chinese students, Patrick recommends exercising curiosity, asking simple questions and being ready to read between the lines. If you are in doubt, refer the student to a qualified professional.
INTERESTING FACT
Expressing our feelings with physical symptoms is reflected in many idioms in multiple languages. See some examples in English:
‘a heavy heart’, ‘a lump in my throat’, ‘getting cold feet’
5. Developing a care strategy that recognise intercultural dimensions
Patrick Au’s reflections on Chinese students critiqued the culture-specific needs of these students, which is a principle that extends to all international students. In this topic we have investigated other potential barriers to providing tailored support for students and considered a number of variables for improving access to care, including professional support when it is needed. Below is a number of tips that offer advice for providing culturally responsive care:
Practical tips for drafting a strategy to support international students
- Spend time to understand where they are at, e.g. use visual or verbal cues to encourage them to talk about themselves and their personal challenges.
- Communicate a genuine interest in listening to the student’s perspective.
- Talk about accessing mental health care as a part of life in New Zealand and share information in a way that “de-stigmatises” mental health as much as possible.
- Become familiar with online resources that provide useful information about cultural values, particularly in relation to help-seeking.
- Describe in plain English or translated texts straight-forward ways to access health services. Work on plain English and don't rely on translated texts.
- Offer to be a support person for a student who needs to see a health professional or invite them to bring a trusted friend to accompany or support them.
- Highlight the respective benefits of different services (e.g. counselling, medical centres vs hospitals, Healthline) and the normalcy of using them.
- Encourage international students to use the same health professional, where possible, in their institution or local community (e.g. school counsellor, GP).
Experienced international student advisors will tell you they’re always learning. In addition to the tips listed above, the attitude that one brings to the care of international students is critical. In her Process Model for Intercultural Competence Darla Deardorff stresses the need for respect, openness, and curiosity as attributes one needs to bring to intercultural competence, and they are attributes that assist us in understanding intercultural dimensions of care.
6. Conclusion
The acculturation and adjustment to the academic and everyday life in another country might be challenging for international students and makes them a vulnerable student population. Therefore, these students require careful guidance, advice and support. They respond to manaaki and benefit when institutional culture emphasises whanaunga. All staff need to be aware of, and have an understanding of, the stressors and issues associated with the demands of being an international student. They need to be aware of ways in which they can minimise risk and direct students to appropriate services when needed. When services are accessed, international students may face challenges in expressing their mental health issues. These challenges may be caused by language barriers, fear of stigma or pressure to perform. Services need to be sensitive to these challenges and to cultural differences. Support is particularly critical during the adjustment period and during early assessments and exam periods. The use of peers, including both local students and foreign students who have succeeded in the acculturation process, will benefit new foreign students.
Culturally responsive organisations, links and services
The following services and organisations may have useful information to refer to to help your care of international students.
7. References
Au, Patrick. (2021). Personal communication. November 2021.
Beard, C. (2020). Introducing the CI model for intercultural contact. Journal of Transient Migration, 4 (2) 235-247.
Chen, Y., & VanderWeele, T. J. (2018). Associations of Religious Upbringing With Subsequent Health and Well-Being From Adolescence to Young Adulthood: An Outcome-Wide Analysis. American Journal of Epidemiology, 187, (11), 2355–2364, https://doi.org/10.1093/aje/kwy142
Collings, S., Mckenzie, S., Dowell, A. C., Currey, N., Gandar, P., & Rees, D. (2010). Toolkit for primary mental health care development: report. Wellington: University of Otago and Synergia Ltd.
Education New Zealand Manapou ki te Ao. (2018). Understanding the international student experience in New Zealand. Wellington: Kantar TNS
Education New Zealand Manapou ki te Ao, (2021), International Student Experience Survey 2021, Wellington, ENZ, https://intellilab.enz.govt.nz/document/682-international-student-experience-survey-2021-final-report-v2. Accessed 17 January 2022.
English Australia (2018). The guide to best practice in international student mental health. https://www.englishaustralia.com.au/documents/item/493. Accessed 22 February 2022.
Fleming, L., & Kitchen, M. (2018). Most of the time I can’t understand: Lessons from Chinese international students at risk of not achieving. Teaching and Learning, 2 (2), 10-17. https://doi.org/10.18296/set.0105
Forbes-Mewett, H., Sawyer, A. M. (2016). International students and mental health. Journal of International Students, 6(3), 661-677.
Hofstede Insights (2022). What do we mean by culture? https://news.hofstede-insights.com/news/what-do-we-mean-by-culture
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.
RNZ, (2019). Lack of support in NZ risks international students’ lives-heath services, Wellington, RNZ, https://www.rnz.co.nz/news/icymi/398238/lack-of-support-in-nz-risks-international-students-lives-health-services. Accessed 17 January 2022.
RNZ, (2019). Big rise in number of Asians seeking mental help in Auckland, Wellington, RNZ, https://www.rnz.co.nz/news/national/405561/big-rise-in-number-of-asians-seeking-mental-health-help-in-auckland. Accessed 17 January 2022.
Schools International Education Business Association, (2021). Cultural Differences, Wellington, SIEBA, https://www.sieba.nz/cultural-differences. Accessed 17 January 2022.
Wixon, K.,(2021). Global Citizenship, Te Ao Whānui He tirohanga Māori, A Māori perspective, Wellington, ENZ.
Yasui, M. (2015). The cultural ecogram: A tool for enhancing culturally anchored shared understanding in the treatment of ethnic minority families. Journal of Ethnic and Cultural Diversity in Social Work, 24(2), 89-108.
Zhu, A., (2021). New Zealand Asian Wellbeing & Mental Health Report 2021, Wellington, Asian Family Services, https://www.asianfamilyservices.nz/resources/resource-items/new-zealand-asian-wellbeing-mental-health-report-2021/. Accessed 17 Januar 2022.
