Number 5, December 2008 BO AI SHE a volunteer peer support organisation empowering chinese mental health service users Whilst one depends on one s parents at home, one should rely on friends when venturing outside Chinese proverb at a glance What: Bo Ai She is a volunteer Chinese mental health peer support organisation. Why: To provide a culturally appropriate mental health support and to empower Chinese service users. How: Groups are facilitated and run by volunteers, and involve physical exercise, recovery work, and educational sessions. Target: Mental health care users of Chinese ethnicity living in the community. Where: Four locations in Auckland: North Shore, Panmure, Howick and Mount Roskill. the profile Bo Ai She is a volunteer organisation that provides group support to Chinese mental health service users and their families. It operates from four Auckland locations. The organisation is managed by a committee with two mental health professionals (from Chinese Mental Health Consultation Services) and five members of Bo Ai She elected among all members. Bo Ai She currently has 90 service user members. Bo Ai She offers physical fitness and recreational activities; opportunities to share recovery experiences; educational workshops on general topics such as English classes; and workshops on recovery skills and techniques. The organisation also helps its members to set up a personal recovery plan. Many members progress to become facilitators/trainers of the activities and leaders (board members) of the organisation. Bo Ai She also provides educational opportunities for mental health care workers and is actively involved in networking and cooperation with other organisations, as well as various mental health research projects. The 1000 mile journey starts with one step Chinese proverb the beginnings Bo Ai She was initiated in 2001 by Wenli Zhang, then a community support worker, along with graduates of the Wellness Recovery Action Planning (WRAP) programme, provided by Te Korowai Aroha, a training and education institute. Wenli identified that a specific service, built on the WRAP model would be a better way to accommodate the increasing needs of Chinese service users. This service would also overcome workforce shortage, address isolation and stigma experienced by Chinese service users, and improve and maintain their wellness. - 1 -
Chinese people who experience mental illness have unique needs that may not be effectively dealt with within mainstream services. Often they feel scared of their condition, have concerns about possible relapse, and feel upset that their families will not understand them or provide adequate support. Additionally Chinese service users have doubts about the degree to which New Zealand medical professionals understand their condition. Bo Ai She has become a place where Chinese service users can offload their concerns and share their personal experiences with likeminded individuals. The group progressed from an informal to a formal structure and was registered as a Society in 2003. Initially the WRAP was interpreted orally from English to Chinese and then Wenli, the Director of Bo Ai She, translated it into written Chinese to help service users develop personal recovery plans. Members of the organisation decided that WRAP forms the basis for their programme and activities, and all new members would complete an eight week WRAP course as the foundation for their wellness. Developing the Bo Ai She support group required strong consideration of Chinese culture and traditions. The name reflects Chinese culture and incorporates a few layers of meaning Bo (universal and also a personal effort) Ai (love) She (community, home). Initially the group s idea was to encourage access to mainstream services (with a provision of cultural perspective of how these could be made more effective for Chinese service users) but the language barrier was a serious obstacle. Recovery can only happen when relying on self, not on others. Bo Ai She member and service user The group encountered challenges balancing the benefits that could be achieved by publicising and actively advertising the organisation versus the importance of maintaining individual needs of privacy and support. There were also cultural tensions between relating to people of authority and collective decision making. Over time the group has strengthened through collective effort and structural changes. Structural changes have included the introduction of a committee board of two mental health professionals and five committee members selected from members of Bo Ai She, which has led to strengthening the group and establishing a successful working model. The target group of Bo Ai She includes Chinese mental health service users living in greater Auckland; new and older migrants with diverse cultural backgrounds from urban or rural Mainland China, Hong Kong, Malaysia, Singapore, Indonesia; and New Zealand born Chinese. The languages among the service users are Mandarin, Cantonese and English. The age of participants ranges from 18 to 82. Bo Ai She group activities involve working with service users and their families. the process Bo Ai She is a peer support group that promotes the mental health of Chinese service users and facilitates healthy living by providing a supportive and educational environment for the members. This vision is achieved by creating and promoting an anti-discriminatory attitude against the stigma of mental illness, maintaining and fostering the rights of the Chinese mental health service users and brining hope and promoting the strengths and potential of each individual. Service users find out about the Bo Ai She through community mental health centres, medical professionals, and word of mouth. The group gathers every fortnight in four locations: North Shore, Panmure, Howick and Mount Roskill. Chinese service users are invited to visit the groups and are encouraged to become members. The activities are mainly run by volunteers, often members of Bo Ai She. The group sessions are held bi-weekly for two hours and have three key elements: physical exercise (such as Tai Chi), wellness and recovery action planning (provided by trained facilitators), and education (with the help of either members of Bo Ai She or guest speakers). Project coordinators are responsible for setting up the group sessions. Bo Ai She also organises two-monthly and yearly gatherings for the service users and their families to celebrate events such as Christmas, Chinese New Year and Chinese Moon Festival. Service users may also meet and provide additional support to each other outside the programme. For example, they may visit each other in hospital, and regularly contact each other by phone or in person. - 2 -
A coordinator manages the communication among the four Bo Ai She centres where projects are run. All members of the organisation participate in the Annual General Meeting. The committee group (a rotating group of two mental health professionals and five members of Bo Ai She) meets once a month. Bo Ai She is a school for people to learn and grow Wenli Zhang, Bo Ai She Service Director Step by Step 1. Service users can be referred by a medical professional, social worker, family member, or can be selfreferred. 2. The service users ring the service and leave a message on the answer phone with their contact details. The group coordinator contacts them and clarifies which group location would be most convenient for them. Mental health service users are contacted by a Mandarin or Cantonese speaking coordinator depending on the language of the particular service user. 3. Before becoming a member of Bo Ai She, service users can attend one or two sessions so they can make an informed decision about whether the group being suitable for them or not. This attendance can be facilitated and supported (organising transport and social support) by the mental health practitioner involved in the care for the future member. 4. Service users need to register and become members of Bo Ai She to participate fully in the organisation. New members complete WRAP training and develop their personal recovery plan during the first year of their membership. 5. During each 3 hour group session, participants take part in 15 minutes of physical activity (such as Tai Chi), followed by two different types of educational activities. This could be a WRAP group, English or art classes, networking and peer support, or guest speakers on different topics such as green prescription, drug and alcohol use, Chinese medicine for mental illness, or occupational therapy. 6. Activities are scheduled to be run in blocks of eight weeks and can be repeated in different locations. the unique approach Chinese service users not only participate in the organisation but also drive its development. All decisions are made collectively, there is no vertical hierarchy in the decision making process. Existing group members and particularly board members are trained to lead smaller groups. Trained service users take turns in running the groups. Bo Ai She members participate in the board on a rotation basis. The Chairperson rotates after a one year term and each person may only stand for one term. The committee members take their roles seriously. This raises their self-esteem, positively influences their recovery and leads to development of advocacy skills. the results Since 2003, the group has expanded from 15 registered members to 90. Growing membership has resulted in changes to the organisational structure and the agreed protocols. A formal evaluation of Bo Ai She is yet to be undertaken but some evaluation work has been carried out. Bo Ai She took part in research conducted in collaboration with Massey University to examine the acceptability, applicability and the effectiveness of the Western style of mental health recovery including wellness recovery action planning (WRAP) for improving recovery. A paper presented by Wenli Zhang and Suet Yi Wong at the 2006 Asian health and well-being conference in Auckland, outlined the advantages and benefits of participating in such an ethnic peer-support group. A number of benefits of Bo Ai She have been noted in the existing research along with anecdotal evidence from mental health care professionals and Bo Ai She members. Taking part in activities where everybody getting together contributes to learning new skills, and learning how to communicate with each other. Being with Bo Ai She helped me to understand the importance to be independent and to stand up for yourself Bo Ai She member and service user - 3 -
Increased understanding about the nature of mental illness and help managing psychological problems by developing and maintaining a WRAP (Wellness and recovery action plan). Service users become more comfortable with themselves, more accepting of who they are, and become socially more active and adept. An apparent decrease in the number of hospital admissions of the Bo Ai She members was noted. Learning new skills helps service users to adjust to the New Zealand culture. Service users develop a sense of personal pride, independency and the ability to stand up for themselves. Participating in the group becomes a bridge toward becoming leaders within Bo Ai She, leading to further engagement in voluntary or paid community involvement. About ten people have been trained as WRAP educators enabling them to monitor their own personal wellbeing and to facilitate WRAP groups. For the purpose of training and delivery of the WRAP programme the training manual was translated from English to Chinese. Service users learn how to express themselves and to share their experiences. Ten members of Bo Ai She have been trained by the Speak your Mind speaking bureau so they can share their experiences with the wider community. Members continue their relationships outside of the group environment and visit each other at home or in the hospital, if in need. For some service users, Bo Ai She has been their first contact with mental health care and contributes to a better understanding of mental health system. Those who work with Bo Ai She identified the organisation as a home for service users and professionals alike and report that the contact with service user adds to their professional development. Coming to Bo Ai She helps me to learn, it gives me sense of security and belonging Bo Ai She member and service user the lessons learnt Recovery requires participation and leadership. Ethnic and cultural differences have to be considered in order to achieve positive group outcomes. Having one permanent professional in the committee supports sustainability of the organisation. Recovery can only happen when people are relying on selfmotivation and working to overcome their own self-stigmatisation, and are not expecting others to fix them. Responsibility for personal well-being is a recovery tool. The location and duration of meetings play a major role in achieving positive outcomes. Administrative and management frameworks (gaining external help to write funding applications, including professionals in the committee, rotation of committee members) provide a framework for success. Formal evaluation is needed to evaluate existing information, draw relevant conclusions, and suggest appropriate measures for improving the service provided to Chinese mental health service users. Mental illness is not like catching a cold; you can t understand when your health is better and when it s worse Bo Ai She member and service user more information Contact Wenli Zhang at wenli.zhang@pgfnz.org.nz Website Bo Ai She website (www.freewebs.com/boaishe/) Documents/links Bo Ai She leaflet, available by visiting stories of change at www.tepou.co.nz/knowledgeexchange An innovative group approach: Bo Ai She- a Chinese mental health service user peer support group challenges and future directions. A paper by Zhang, W. & Wong, S. Yi and presented at the 2nd Asian Health and Well- - 4 -
being Conference in Auckland, New Zealand, 2006, available by visiting stories of change at www.tepou.co.nz/knowledgeexchange The effectiveness of the mental health recovery (including Wellness Recovery Action Planning) programme with Chinese service users, a research paper by Zhang, W., Li, Y., Yeh, H.-S., Wong, S. Yi, & Zhao, Y. (n.d.). available by visiting stories of change at www.tepou.co.nz/knowledgeexchange Video Bo Ai She produced by Asia Downunder in 2006 available by visiting stories of change at www.tepou.co.nz/knowledgeexchange (duration: 6 minutes) Sue Wong, Executive Chairperson and Wenli Zhang, Service Director - 5 -