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Abstract

Acceptance and Commitment Therapy (ACT) is an empirically supported psychotherapy that offers promise for the mental health of minoritised ethnic populations. Given the diversity of those presenting to inner-city services and barriers to accessing appropriate mental healthcare, we sought to develop a culturally syntonic ACT intervention for UK Vietnamese refugee communities in a practice-based partnership project between a National Health Service and local third-sector service in East London. The aim was to explore the feasibility, acceptability and impact of the adapted intervention to inform culturally inclusive clinical practice and future research. We outline key aspects of Vietnamese belief systems and culture, and consider how these might influence the optimisation of group-based ACT. We then present a mixed-method evaluation of the seven-session adapted ACT group for 11 participants (9 male and 5 female, aged between 44 and 73 years). Individual-level change analyses indicated clinically significant improvements in psychological flexibility for the minority of participants and a mixed pattern for impact on well-being. A thematic analysis and descriptive approach examined acceptability, feasibility and narratives of impact. Participants reported positive feedback on group experience, relevance and usefulness, and emergent themes indicate that the group facilitated key acceptance, commitment and behaviour-change processes, promoted social connections and increased engagement in meaningful life activities in relation to new perspectives and values-based action. Limitations are outlined, but overall, findings suggest preliminary support for the potential beneficial effect of the adapted ACT group as a feasible, culturally acceptable therapeutic approach for UK Vietnamese communities that is worthy of further investigation.

Keywords: ACT; UK Vietnamese; co-production; community consultation; cultural adaptation; third-sector partnerships.

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Conflict of interest statement

Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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Suu | Global Licensed Psychologist JP/EN

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'I would assume this person is crazy' encapsulates the stigma surrounding mental health in Malaysia's multi-ethnic society. My MSc dissertation examines how social and cultural frameworks shape perceptions and management of mental health among the three predominant ethnic groups: Malays, Chinese, and Indians. Using a semiotic prism approach, the dissertation reveals the coexistence of traditional and modern views, underscoring the need for social and culturally sensitive strategies to enhance mental health literacy and access to care, writes Khairin Amin

_______________________________________________

Why do we react this way to mental illness? In recent years, mental health issues have become a growing concern in Malaysia, with increasing cases of depression, anxiety, and other psychological conditions. Despite these troubling trends, mental health remains a sensitive and often taboo subject, especially within traditional communities. In such an environment, mental health conversations were either avoided or quickly dismissed. When people did talk about it, they often misunderstood the complexities of mental illness, labelling those who behaved differently as 'crazy'-a term that not only oversimplifies the issue but perpetuates fear and ostracism. The question of why we react in this manner drove me to explore how cultural, religious, and social factors shape perceptions of mental health in Malaysia. Do these perceptions differ across the country's diverse ethnic communities? And what are the barriers preventing people from seeking help?
The Reality of Mental Health in Malaysia
Mental health knowledge in Malaysia has traditionally been passed down through family, friends, and local communities, with mental illness often stigmatised as 'crazy'. According to the Malaysian Ministry of Health, nearly 29% of adults experience mental health issues-a threefold increase since 1996. Despite government initiatives like the "Minda Sihat" programme, aimed at promoting awareness, and the "Mentari" strategy, which extends psychiatric services into communities, mental health stigma remains pervasive.

The persistence of stigma highlights that current strategies may not be addressing culturally embedded beliefs in real depth. With its rich tapestry of ethnicities and religions, Malaysia's diversity plays a crucial role in shaping perceptions of mental illness, which directly impacts the effectiveness of interventions. This raises important questions: How do Malaysia's different ethnic groups perceive mental health? How do they reconcile these views with their social and cultural beliefs?
Mental Health Across Malaysia's Multi-Ethnic Landscape
My research explored how Malaysia's major ethnic groups (Malay, Chinese, and Indian) perceive and manage mental health within their social and cultural contexts. Through in-depth interviews with 30 participants and discussions with organisations like NYAWA, Thrive Well, and Mental Illness Awareness & Support Association (MIASA), I sought to understand these diverse representations of mental health.

While some commonalities emerged, significant differences were observed between the communities. Among the Chinese, mental illness is often stigmatised within families, due to a cultural emphasis on emotional restraint and maintaining family harmony. This dynamic makes it difficult for individuals to express mental health struggles openly. For the Indian community, family pressure, particularly the need to uphold the family's reputation, leads to denial or suppression of mental health issues. Individuals often avoid acknowledging their conditions out of fear that it will tarnish the family's image. As for the Malays, they are heavily influenced by religious beliefs, attributing mental illness to spiritual or supernatural causes. Instead of seeking psychiatric help, people frequently turn to religious leaders for guidance. While faith can provide solace, it often delays professional treatment.

These social and cultural factors demonstrate the need for interventions that goes beyond general awareness and address community-specific beliefs and practices. Understanding these differences is key to designing effective mental health strategies in Malaysia.
Self-Stigma and the Fear of Professional Help
The societal stigma surrounding mental health inevitably leads to self-stigmatization, wherein individuals internalize negative beliefs about mental illness and feel ashamed to seek professional help. In Malaysia's collectivist society, preserving the family's reputation is a priority, and admitting to mental health struggles is seen as bringing shame upon the family. This is particularly evident in severe cases of mental illness, where being admitted to a psychiatric facility is considered an irreversible sign of failure and proof that one is 'beyond help'.

This fear of social ostracism and the perception of seeking professional treatment as a sign of personal weakness further complicates help-seeking behaviour. Consequently, many Malaysians view mental illness as a character flaw rather than a legitimate health condition requiring medical attention, perpetuating the cycle of silence and shame.
Navigating Mental Health: The Self-Other-Object Prism Model
How do Malaysians navigate traditional beliefs about mental illness with personal experiences and new knowledge? Self-Other-Object Prism Model (figure 1) developed by Zittoun (2014) provides valuable insight into this process, illustrating how individuals navigate between 'received knowledge'-inherited from family, community, or media-and 'elaborated knowledge', which involves their interpretation and sense-making of that information.

In Malaysia, this dynamic is particularly evident among younger generations who are challenging traditional views on mental health through social media platforms like Instagram and TikTok. These platforms have become spaces where taboo topics are openly discussed, reshaping public perceptions and encouraging a more progressive dialogue on mental health. The ability of youth to negotiate between inherited beliefs and personal experiences reflects a shift in how mental health is understood in modern Malaysia.
Cognitive Polyphasia and Mental Health
One of the key concepts that helps explain Malaysia's mental health landscape is cognitive polyphasia, which refers to the coexistence of multiple, sometimes contradictory, forms of knowledge within an individual or community. This concept is especially relevant in Malaysia, where many people simultaneously hold traditional and modern views on mental illness. While some may consult psychiatrists, they also seek help from traditional healers, such as shamans, religious leaders, or monks for spiritual remedies.

In my research, participants frequently reported blending psychiatric care with traditional healing practices. One participant shared how they sought treatment from both a psychiatrist for anxiety and a traditional healer when modern medicine seemed insufficient. This dual approach demonstrates how Malaysians navigate between different forms of knowledge when dealing with mental health issues, influenced by their cultural and religious backgrounds.
Barriers to Professional Mental Health Services
Despite the increasing availability of professional mental health services in Malaysia, significant barriers remain, especially in rural areas. These barriers include limited accessibility, high costs, and entrenched societal stigma. This study shows that Malaysians continue to rely on traditional or religious healing methods because of these obstacles, reflecting a broader rural-urban divide. While urban Malaysians have relatively better access to mental health care, the costs of services can still be prohibitive.

Although the Malaysian government has introduced mental health awareness campaigns and hotlines, these efforts are still in their early stages and face challenges in reaching the country's most vulnerable populations. The National Mental Health Strategic Plan aims to improve mental health services, but its impact remains limited, especially in rural areas where mental health concepts are less familiar.
The Path Forward: Towards an Open and Inclusive Future
The future of mental health in Malaysia depends on dismantling long-standing cultural stigmas and ensuring equitable access to professional services. While younger generations are already advocating a more open approach to mental health, systemic barriers persist, particularly in rural areas. To create a more inclusive society, continued efforts in education, advocacy, and policy reform are essential.

A path forward involves addressing the rural-urban divide in access to mental health services and fostering greater cultural sensitivity in interventions. Future research could focus on evaluating the effectiveness of government-led mental health programs or exploring how traditional healing methods can complement modern psychiatric care. By understanding the complex factors that contribute to mental health stigma and incorporating them into public health strategies, Malaysia can move towards a future where mental illness is treated with the care and respect it deserves, free from stigma.

______________________________________________

*Banner Picture by Roszie from Pixabay.com

*About the research: This blog is based on the Author's dissertation for her LSE MSc Social and Cultural Psychology, for which the Author was awarded SEAC's Dissertation Fieldwork Grant.
*The views expressed in the blog are those of the authors alone. They do not reflect the position of the Saw Swee Hock Southeast Asia Centre, nor that of the London School of Economics and Political Science.
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Apply directly through the university website for:

Application Tips

Michelle: Be reflective. Everyone will have varying clinical, research and leadership experiences. The way you reflect on your experiences will help you stand out from other applicants.

Nicole: Tell a cohesive story! You can have a variety of (possibly non-psychology) experiences as long as you can link how they come together - preferably linked to your wider aspirations for psychology.

Saiyuri: Apply critical thinking skills - analyse your experiences, evaluate how the program aligns with your goals & interests, structure your application so it flows, reflect on why you are an ideal candidate and your motivation for applying. Tailor your application for each program if you are applying via the individual website.

Funding

$12,000 one-off for studying in the university

Scholarships are given out once a year, and successful applicants may re-apply yearly

Possible scholarships:

3. Individual/specific circumstances

4. Others

Pathways - UK or SG?

Degree Level

Ability to work globally

Diversity of clinical experiences

Focus on research at Doctorate level

Optional additional accreditations

Accreditation/Recognition

Job Prospects

No NHS bond following completion of DClinPsy/DCounsPsy

3-year graduate visa available after DClinPsy/DCounsPsy

2-year graduate visa available for undergrad & masters level psychology qualification

There is demand for psychologists in both Singapore and UK.
Things to consider:
The International Student Experience

The number of international students in your course can significantly impact your experience.
General
Resources
DClinPsy YouTube Channels
Saiyuri's website : https://internationalpsychuk.my.canva.site/

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