Soon after graduating in 2016, Keqing Sun felt stuck. Her applied psychology degree from Heilongjiang University of Science and Technology seemed useless. In Chinese society, a career as a counselor psychologist isn’t easily attained because the topic of mental health, and treating it, is somewhat taboo.

“I told some of my relatives I would study psychology in college, and they just responded asking ‘why’ and expressing displeasure with my decision,” said Sun, now a UO international student. “People think you’re weird and want to read others’ minds. There’s just a huge stigma whenever mental health comes up in conversations.”

Internationally, the stigma surrounding mental health can become ingrained into individuals’ daily lives. This might lead to unfamiliarity with mental health and how to grapple with depressive or isolated feelings. It becomes especially problematic as non-U.S. individuals don’t communicate with family members back home, fearing ostracization.

Sun decided to take initiative and help her cohort partners, Diana Kwon and Hoda (whose surname has been removed at her request,) start International Community Voices in the winter of 2017. The Couples and Family Therapy program’s “cohort” model refers to students taking classes with peers, with one member of the group usually a year ahead in their studies. Although Kwon was the organizer, Sun took control of the group when the former graduated in the spring of 2017.

ICV at UO focuses on building a closer relationship among non-U.S. individuals through weekly group therapy while fostering a community. Workshops and discussions demystify the stigma toward mental health in international cultures, allowing non-U.S. individuals a smoother transition into society. These workshops are sometimes held at the Mills International Center in the Erb Memorial Union.


Adjusting to a new life

When she arrived in Eugene, Oregon in the summer of 2016, Sun found herself racially alienated. Aside from feeling isolated, the language and cultural barriers caused a sense of disconnection.Eugene is approximately 85 percent white, according to the U.S. Census Bureau in 2017.

“After the first few weeks, I began feeling overwhelmed and anxious because I was completely lost in my studies,” Sun said. “It’s a long process adjusting to life in the U.S., and I’m still going through that phase emotionally.”

Counseling services at universities provide an outlet where individuals impacted by these mental health concerns about academic performance seek advice and guidance. The American College Health Association reported in 2016 that 23.2 percent of college students felt anxiety to be the primary reason for doing poorly in school. In that same year, 31.8 percent of both undergraduate and graduate college students felt stress as the the primary factor affecting their performance in class.

Although there are counseling services at UO, there’s no specific support group for international students who suffer from cultural displacement and mental illnesses. At UO, more than 3,200 international students enrolled in undergraduate and graduate programs in the past academic year.

Sun’s friends offered to accompany her to the UO Counseling Center in the fall of 2016. But there was a drawback: while she discovered professors specializing in helping international students, counselors themselves kept it mostly one-on-one. Sun needed a group to relate to and counselors who could empathize with her experiences on a cultural and emotional level.

“At that point, my mom and I would talk every day on the phone or through Skype, but I would never tell her about my problems because I know she can’t help,” Sun said.


Call to action

Kwon, a former graduate student in the Couples and Family Therapy program at UO, felt passionate about addressing the emotional concerns of international students. Because she and Sun were study partners in the program, they met weekly, eventually leading to a friendship. Kwon acted as a mentor for Sun.

Hoda has identified as an “international” person since an early age. Her family immigrated from Iran to Canada, then she moved to London to study psychology. For her, ICV hits a soft spot.

“Adjusting to a new culture has always been a struggle at different phases and countries in my life,” Hoda said. “I just remember being a teenager and going to school in Canada with no coherent English, aside from only remembering to say ‘I don’t understand’ to people, which my dad taught me.”

Sun, Hoda and Kwon exchanged ideas about forming a group that would provide mental health services for newcomers to the U.S. They also considered the logistics, like funding, promotion and their overall goals. Beyond counseling and therapy, the three wanted to address the stigma toward mental illnesses within the international community.

Sun understood as a Chinese person that if she is labeled mentally ill in her country, it’s similar to discrediting and insulting another person beyond what words could describe. In Hoda’s case, Iranian culture shares a similar attitude on mental health issues. Women with mental illnesses may struggle more than men because they could be ostracized from dating or marrying.

“Generally, there’s just a contrast with the way international individuals deal with mental health and how they seek resources,” said Dr. Asha Stephen, a senior staff psychologist at the UO Counseling Center. Stephen used India’s mental health care as an example of a system where therapists are viewed as advisers, rather than in the U.S. where therapists encourage clients to find their own solution in an inclusive space.


The bigger picture

Sun, Hoda and Kwon belong to over 800,000 international students who attended U.S. universities between 2016 and 2017, with roughly 42 percent from China, according to an Open Door survey.

U.S. universities receive twice as many international students as the U.K. does; over one million were accepted in 2016. Statistics aside, when international students pursue their studies in the U.S., many arrive with a limited scope of cultural understanding, causing stress and emotional discomfort.

Besides students, ICV also wants to extend its counseling services to foreign newcomers to Lane County. ICV could serve foreigners living in the U.S. under various visa restrictions, one of which is the F-2 Dependent visa. This restricts their access to work and study opportunities, compared to F-1 Student visa holders who have more flexibility.

Sun, Hoda and Kwon all felt their personal narratives applied to a larger framework of connecting cultures. Hoda also believes the group highlights issues that domestic students are not aware of regarding their own culture to non-U.S. individuals.


Gaining administrative support

By the spring of 2017, ICV was created and began promoting its mental health services on social media, such as Facebook and WeChat. The message of the group resonated with Fei Shen, a visiting instructor and clinical supervisor at the Couples and Family Therapy program.

During Kwon’s time at UO, she worked as an assistant in the Office of International Affairs. She helped spread information about ICV. With Shen’s assistance, she reached out to Zhaohui Chen, an international student advisor at the office.

“The idea of forming a group like ICV has been on UO’s agenda for a long time,” Chen said. “What we lacked beforehand was resources, whether it be finances or faculty personnel.”

Around 2016, Chen, Shen and some UO professors noticed how deeply affected some international students are by mental health. Shen studied as a former graduate student in the Couples and Family Therapy program, before becoming a faculty member and supervisor of ICV. Like Sun, she recalls feeling isolated during the early stages of living in the U.S. Coming from China, the stigma toward mental illnesses was all too familiar for Shen.

When Chen heard about ICV in the winter of 2017, he immediately advocated for the group. Since then, according to Chen, the Office of International Affairs considered taking steps in addressing the mental health concerns of international students.

Programs like ExplOregon that are geared toward connecting international and domestic students through trips around Oregon have not produced the results the Office of International Affairs expected. Chen notes the challenging aspects, faced by all U.S. universities, of integrating domestic and international student bodies. Although ExlpOregon doesn’t directly address mental health, its purpose shows the need for forming a system to help international students acclimate to campus life.

Although they recieve resources from the Office of International Affairs and the Couples and Family Therapy program, the group requires new clients to pay a $15 service fee each session. Shen stresses the fee can be waived, but it’s another factor affecting enrollment.

After more than nine months, ICV still meets at the HEDCO education building every Friday afternoon. They run cultural workshops or group discussions of personal issues that clients bring up.

“I see it as we’re opening a door for them and a chance to tell their story,” Shen said.

Aside from Shen, Stephen also visualized an “open door” when she took the leadership role of International Women’s Support Group a few years ago, a separate group to that of ICV in strictly connecting with female international students experiencing emotional troubles adjusting to U.S. society. The group is in partnership with the UO Counseling Center and the Women’s Center.

Stephen stresses International Women’s Support Group promotes a different model of addressing mental health concerns of newcomers to the U.S. Her group doesn’t require weekly attendance in meetings and has a drop-in environment, so those who attend don’t feel required to show up every time.

“We do want clients coming in weekly because in that way, we track changes in their development and ultimately see if a group setting works for them,” Shen said. “If one person comes one week, skips the next three weeks, then returns, the individual already ruined the group dynamic among other clients.”

She notes that support groups, such as ICV, act as a bridge in helping international students “feel accepted and not be ignorant regarding certain topics” when interacting with U.S. students.

Furthermore, U.S. students also gain “invaluable perspectives and new cultural information.” The hope rests on wider integration of the international and domestic student bodies, and greater engagement on both sides.


Moving forward

Shen views the limited attendance of ICV at its weekly group meetings as a normal aspect of growth in any support group a few months into offering its services. Addressing mental health applies to a broader framework of adjusting to American culture. This includes distance from family, being immersed in an unfamiliar environment and basically “starting from scratch,” according to Stephen.

Stephen said that an international presence on U.S campuses not only helps non-U.S. individuals fit in, but brings about cultural insight for domestic students who may have grown up in a sheltered environment.

Stephen said that if universities allocated more resources for funding integration programs between the domestic and international student bodies, the responsibility of assimilating would extend to both groups.

“A lot of international students don’t know what to say, what to do and what to ask,” Stephen said. She said that fewer attendees at recent International Women Support Group meetings offers two takeaways: lack of promotion because of insufficient funding, and stigmatization that convinces non-U.S. individuals not to seek help.

The same problem persists for ICV. While Shen doesn’t attend every weekly group meeting, it’s usually Sun and Hoda conversing directly with clients. Both of them said there are inconsistencies with the number of clients per term.

Early steps for any group, according to both Sun and Stephen, require time for branching out its presence within campus so a large part of the international community becomes aware of it. Connections function as a key component in spreading awareness of ICV, and also an aspect Sun expanded on when promoting the group on social media apps popular with non-U.S. individuals, such as WeChat, LINE and KaKaoTalk.

Regardless, she and Hoda continue holding weekly group meetings with clients enrolled since the beginning of winter 2018. It’s important to note that ICV never disclosed the exact number of clients enrolled in its program due to patient confidentiality agreements.

Both Sun and Hoda developed their own process of handling the stress, isolation and depression caused by feeling out of place through facilitating the weekly group meetings. The experience of providing therapy to another person allows them to incorporate practical skills learned in their studies and apply them in the field. After all, one of the primary reasons Sun flew over 7,000 miles from northeast China to Eugene was the level of professionalism and insight she would never gain back home about counseling psychology.

“In China, the stress and competition in school and when finding a job is increasing for our generation,” Sun said. “There’s a huge demand for therapists, but I don’t know when I will ever go back there and work.”

Sun sees herself traveling back to China one day, however not after graduation. She views her experience at UO as more than getting a diploma. Sun plans on pursuing a state licensure in counseling psychology after finishing the Couples and Family Therapy program.

“All the studies and research in China on psychology are purely based on white, American people,” Sun notes. “If I return, what will be difficult is applying my skills and what I learned in a Chinese cultural setting.”

What matters most to Sun is assisting newcomers to the U.S., especially from her home country, to comfortably transition into American culture.

“If I can’t help Chinese people back home, at least I can assist them at UO,” Sun said.