Work is a key feature of successful rehabilitation from mental illness (Morris & Lloyd, 2004) and according to Moll, Huff, and Detwiler, (2003) the majority of people with mental illness want to work, preferably in open employment. The idea of work is of particular importance within Asian communities, and especially within immigrant Asian communities (Mei, Ngai, Latimer, Yee, & Cheung, 2001). This article examines the complex relationships between immigration, mental health and employment. It reviews national and international literature on vocational rehabilitation and Asian mental health. Adding a vocational focus to aspects of Asian mental health services is discussed with a particular attention to Asian people's work culture and their experiences as immigrants. From this we contend that occupational therapists have a significant role to play in providing vocational rehabilitation services for Asian people with our expertise in enabling occupation, including work-related activities. We identify some of the specific considerations occupational therapist will need to address in doing this within new or existing services.
Asian mental health
There has been a significant increase in the Asian population of New Zealand over the last decade. In the 2006 census, Asian ethnic groups increased by almost 50 percent to make up 9.1% of the population (Statistics New Zealand, 2006). Over half of the Asian population are immigrants, who have lived here for less than ten years. Asian people are extremely heterogeneous in terms of culture, language, and immigration status, with Chinese being the biggest sub ethnic group followed by Indian and Korean. The majority live in urban areas, with 63% residing in the Auckland region (Statistics New Zealand, 2001).
The prevalence of mental illness in Asian populations in New Zealand is estimated to be similar to that of the general population. However, a number of factors associated with immigration can make them more vulnerable to mental health problems. These include language difficulties, employment problems, changes in socio-economic status following migration, disruption of family support networks, traumatic experiences prior to migration, unfriendly receptions in the host country, and adolescence or senior age at time of migration. Recent Asian immigrants have been a focus in mental health research, involving two key themes, immigration adaptation and barriers to accessing mental health services (Ho, Au, Bedford, & Cooper, 2002).
The links between employment problems and mental health in migrant health have been well documented. Akhavan (2004) found reciprocal influences among health, work, and migration. Migration may cause poor health (resulting in unemployment and sick leave), and can disadvantage migrants in the labour market, which impacts individuals' health. Ho et al. (2002) summarized Asian employment problems (unemployment and under-employment) as more likely to affect recent immigrants. Unemployment is usually associated with low socio-economic status, loss of self-esteem and constrained social contacts, which negatively affects the person's psychological well-being and adaptation to the new country. Under-employment refers to employment of workers with higher skill levels in low-wage jobs that do not require the full use their abilities. This is associated with real or perceived loss of status, contributing to both personal frustration and family stress. Under-employment in Asian people is consistent with the argument that "it is not so much employment, but the quality of employment itself that is crucial to well-being" (Mental Health Commission, 1999, p.9). Abbott, Wand, Williams, Au, and Young (1999) suggested that unemployment is a predictor of minor mental disorders in Chinese migrants' resident here for less than two years. Similarly in Canada, Tang, Oatley and Toner (2007) found that employment related difficulties are the most frequent negative life events experienced by recent female Chinese immigrants. …