Chinese Immigrants Suffering from Mental Illness at Risk

Xiang Li (left) helping in the kitchen at the Chinese Continuing Day Treatment Program. (Photo via Sing Tao Daily)

[The following is a condensed version of a story that appeared in Sing Tao Daily by Rong Xiaoqing on the only program in New York City to exclusively serve Cantonese speakers with mental illness, which is at risk of being shut down.]

Sandwiched between a Buddhist temple and a Sichuan restaurant, 46 East Broadway is an inconspicuous seven-story building. The dark gray facade looks dilapidated, the narrow gate only allows one person to go through at a time, and the birdcage elevator allows at most three people to squeeze in.

The Chinese Continuing Day Treatment Program is located on the second floor. The members are all Cantonese speakers who have been diagnosed with severe mental illnesses and hospitalized numerous times before. Medications are key to preventing them from doing harm to others or to themselves. And a class taught in their own language may be the only way to persuade them to take medications. That’s why they were sent here, the only continuing day treatment program in the city catering exclusively to Cantonese-speaking mentally ill patients.

Director Margaret Lai, a social worker from Hong Kong, has been with the program for 33 years. In the space of 400 square feet, she learned every detail of the patients’ lives and is familiar with all their family members, and she helped them go through rough patches and gave them hope.

“Mental illness is a blind spot of the Chinese culture. When their family members show symptoms, many Chinese would pray to Buddha or force the patient to swallow incense ashes as a cure,” said Lai, who joined the program right after she received her master’s degree in social work from Hunter College. “If you can help the patients rediscover their value, it is very fulfilling.”

But now Lai is a little anxious as the accumulation of debts over the years has pushed the program to the brink of being shut down. “If we close, I cannot imagine what would happen to the members,” said Lai with tears in her eyes. “The progress they made during all these years could wind back overnight.”

Members taking a class. (Photo via Sing Tao Daily)

Founded in 1982 amid the deinstitutionalization wave in mental illness treatment, the program now serves 17 patients who come here five days a week to take classes – such as maintaining a healthy lifestyle, and anger management – socializing with one another in their own way, and occasionally going on organized field trips to Central Park or the Bronx Zoo. Other than the two social workers, there is also a cook who makes lunch and a part-time psychiatrist comes once a week to serve their medical needs. Every month, there is a support meeting attended by family members where they can learn how to take care of mentally ill people.

What the patients and their family members learn at the program is not only the textbook tips all such programs offer but also the traditional Chinese culture of filial piety and “the doctrine of the mean” coined by Confucius to help them establish smooth family relationships and avoid going to the extreme, a pathway to relapse. To many families, the program has become an indispensable pillar of their life.

Among all the members, Xiang Li is the one who has been with the program for the longest time – almost 30 years.

At age 24, he moved to the U.S. with his parents and siblings in 1980. Years later, he started a family but with the pressure of trying to make ends meet, he began arguing and fighting with colleagues in the restaurant where he worked as a cook and was even arrested for beating up his father. He also attempted suicide.

Xiang was diagnosed with schizoaffective disorder and was frequently hospitalized. When he was not in the hospital, he spent his time wandering on the street in tattered clothing and threatening pedestrians. In the early days when he was referred to the program by a hospital, Xiang couldn’t help shouting and screaming at the staff all the time.

But eventually, through the program, his condition started improving.

“Sometimes he said he was angry and wanted to beat people up,” said his mother, known as Granny Li. “Sometimes when he didn’t want to get up in the morning to come to the program, I would awake him and prompt him to go. I told him ‘Without this program, you could have died a long time ago and our family would’ve been broken.”

The program, which receives no government funding, relies completely on Medicaid reimbursement from the members’ insurance. In 2009, the New York State Office of Mental Health changed the billing methodology of the continuing day treatment (CDT) programs. The reform resulted in fewer billable CDT claims and on average, a 5 percent decrease in reimbursement to providers.

Meanwhile, the number of uninsured members of the program has jumped to six now. It has been running on increasing deficits in the recent years. Last year, the deficit hit $175,000.

Lai was still hopeful. “There are so many kind people who have the means in the Chinese community. We only need to raise $150,000 to $170,000 to survive,” she said. “Is it really not possible?”

The names of the patients and their family members were changed to protect their privacy.

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