SSM - Qualitative Research in Health 2 (2022) 100125

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SSM - Qualitative Research in Health

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‘I don't know where to seek for help, so I just kept my silence’: A qualitative
study on psychological help-seeking among Filipino domestic workers in the
United Kingdom
Andrea Martinez a, b, *, Chuckie Calsado c, Jennifer Lau d, June Brown d
a
Department of Psychology, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
b
Department of Behavioral Sciences, University of the Philippines Manila, Manila, 1000, Philippines
c
Department of Curriculum, Pedagogy and Assessment, University College London, London, UK
d
Department of Psychology, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, SE5 8AF, UK

1. Introduction figures are higher compared to the US general prevalence rate of

An estimated 10 million overseas Filipino workers (OFWs), or 10% of
the Philippine population, are dispersed worldwide (Oxford Business
Group, 2018). In the UK alone, roughly 250,000 Filipinos have immi-
grated since the 1980s and one-third of them are concentrated in the
Greater London area (UK Foreign and Commonwealth Office, 2014). The
majority of OFWs end up in service and domestic work, production work,
professional and technical jobs, or healthcare and nursing in different
parts of the world (Philippine Overseas Employment Agency, 2010). In
the UK, the majority of Filipino migrants are nurses, carers, or domestic
workers.
However, there are social costs of Filipino migration. The strain of
family separation among OFWs manifest in the longing for home, often
called ‘homesickness’, with accompanying sense of loss and dislocation
(McKay, 2007) (Asis, Huang, & Yeoh, 2004). Because they constitute an
ethnic minority, OFWs are also prone to racial discrimination (Wallace,
Nazroo, & B
ecares, 2016), marginalization, abuse, and exploitation
(Green & Ayalon, 2016), which are detrimental to their wellbeing.
Migration is thus associated with stress factors that affect the mental
health of migrants including vulnerability to depression, anxiety, sub-
stance abuse, schizophrenia, post-traumatic stress disorder, and suicidal
behavior (Bhugra, 2004).
In the US, 17% of Filipino Americans were reported to have a lifetime
experience of depression or anxiety (Takeuchi et al., 2007) while 23% of
Filipinos in Australia reported high psychological distress associated with
their experience of social discrimination and low social support
(Thompson, Manderson, Woelz-Stirling, Cahill, & Kelaher, 2002). These
depression and anxiety pegged at 5.9% and 6.3%, respectively, and that
of Australia which is 5.9% for depression and 7.0% for anxiety disorders
(WHO, 2017).
Among OFWs, one of the most vulnerable to psychological distress are
those who are employed as domestic workers in private households
(Mendoza, Mordeno, Latkin, & Hall, 2017) such as cleaners, chauffeurs,
butlers, cooks, nannies, and those providing personal care for the
employer. In a study of Filipino domestic workers in Hong Kong, for
instance, a staggering 25.2% has depression (Cheung, Tsoi, Wong, &
Chung, 2019), compared to 20% prevalence rate of depression among
labour migrants based on a meta-analysis of 35 studies (Lindert, von
Ehrenstein, Priebe, Mielck, & Br€ahler, 2009). Because of the precarious
nature of their jobs in living with their employers, domestic workers are
prone to loneliness and isolation, forced labour, exploitation, and traf-
ficking (Sayres, 2005). This presents as a risk to their psychological
wellbeing and mental health, compounded by mounting barriers to their
access to formal and informal help.
Unfortunately, OFWs are least likely to seek help for their psycho-
logical distress (Straiton, Melanie L., Ledesma, & Donnelly, 2018a,b)
(Abe-Kim et al., 2007) whether formal (i.e., from professional services
such as mental health specialists) or informal (i.e., from informal social
networks of family or friends) ways (Rickwood & Thomas, 2012). For
example, only 11.28% of Filipino Americans with mental health prob-
lems have sought formal help (Nguyen & Bornheimer, 2014) at a much
lower rate in comparison with 19% in the US (Mojtabai, Olfson, & Me-
chanic, 2002) and 16% in the UK (Oliver, Pearson, Coe, & Gunnell,
2005). In most cases, OFWs seek professional help only when mental

* Corresponding author. Department of Psychology, Institute of Psychiatry Psychology and Neuroscience, King's College London, Room 4.10 Addiction Sciences
Building, 1-4 Windsor Walk, Denmark Hill, London, SE5 8BB, England, UK.
E-mail addresses: andrea.martinez@kcl.ac.uk (A. Martinez), chuckie.calsado.18@ucl.ac.uk (C. Calsado), jennifer.lau@kcl.ac.uk (J. Lau), june.brown@kcl.ac.uk
(J. Brown).

https://doi.org/10.1016/j.ssmqr.2022.100125
Received 5 May 2021; Received in revised form 6 June 2022; Accepted 6 July 2022
Available online 9 July 2022
2667-3215/© 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/).
A. Martinez et al.
health problems are severe (Hermannsd
ottir & Aegisdottir, 2016)
(Thompson, Hartel, Manderson, Stirling, & Kelaher, 2002). This poses a
hindrance to any attempts at early intervention or preventive care
because Filipinos are apt to seek professional help only when the problem
manifests as severe somatic symptoms. On the other hand, identified
obstacles in accessing and utilizing mental health services for migrant
workers include stigma, sense of shame, inadequate information about
available services (Tuliao, 2014a) (David, 2010) and practical constraints
such as lack of time off work and high cost of services (Straiton, Melanie
L., Ledesma, & Donnelly, 2017) (Vahabi & Wong, 2017). Among Filipino
caregivers in Israel, a practical problem was their citizenship status
which led to reduced social rights (Bradley, 2014) similar to reported
problems on immigration status among OFWs in Iceland (Her-
mannsd
ottir & Aegisdottir, 2016). Many OFWs are also prevented from
seeking help by their sense of self-reliance, fear of becoming a burden to
others ((Hechanova, Ma, Regina, Tuliao, & Hwa, 2011), and their strong
adherence to Asian cultural values of conformity to norms which
heightens their perceived sense of shame of having a mental illness
(Shoultz, Magnussen, Manzano, Arias, & Spencer, 2010). Their beliefs
related to mental health and illness also pose a barrier to formal
help-seeking, such as OFWs in Australia who think that having depres-
sion is temporary and does not require professional help (Thompson,
Hartel, et al., 2002).
The dynamics and complexities of help-seeking among OFWs are
compounded by the healthcare systems in their host countries. Lack of
familiarity and competency on how to access health care services further
discourages OFWs from seeking help (Maneze, DiGiacomo, Salamonson,
Descallar, & Davidson, 2015). In the UK, mental health services are free
and its Improving Access to Psychological Therapies (IAPT) programme
is widely known for scaling up the evidence-based treatment of anxiety
and depression among adults (Clark, 2012, pp. 61–77). But despite the
37% treatment rates recorded in 2014 (McManus, Bebbington, Jenkins,
& Brugha, 2016), there is still a need to increase uptake and utilization of
the service among those with mental health problems to bridge these
disparities in treatment especially among ethnic minorities in the UK
(Thornicroft, 2018). However, unlike in other countries where studies on
Filipino domestic workers abound such as in Hong Kong (Chung & Mak,
2020), China (Hall, Garabiles, & Latkin, 2019), Singapore (Anjara, Nel-
lums, Bonetto, & Van Bortel, 2017) and Malta (Vassallo & Debono,
2020), data is scarce on psychological help-seeking of this migrant group
in the UK despite their growing number especially in its capital (Shield &
Meigh, 2019). Immigration statistics show that nearly 100,000 domestic
work visas were issued to Filipinos from 2010 to 2020 (UK Home Office,
2021).
Notwithstanding the availability and accessibility of mental health
services in the UK, what prevents Filipino migrants, especially those in
domestic work and service sectors, from availing of these services? Un-
derstanding the various factors that hamper or facilitate formal and
informal help-seeking among Filipino domestic workers may have im-
plications on the prevention and treatment of their mental health prob-
lems and may help improve further mental health services.
There are only a few studies that have examined the mental health
help-seeking of OFWs, let alone domestic workers in the UK. In most
cases, information about Filipino help-seeking has been included in pa-
pers about more general topics such as migration or racial discrimination
experience (e.g., (Vahabi & Wong, 2017); (Green & Ayalon, 2016).
Moreover, few studies have explored in detail the dynamics of formal and
informal help-seeking. For instance, while self-reliance is often cited as a
barrier in help-seeking (Straiton, Ledesma, & Donnelly, 2018a, 2018b),
stigma and previous distress experience may also have played a role in
reinforcing self-reliance. Moreover, despite evidence that previous
experience of trauma is associated with the high level of distress among
Filipino domestic workers, it remains unexplored how coping strategies
themselves may mitigate or aggravate their vulnerability to mental
health problems and subsequent help-seeking behaviors.
The purpose of this qualitative study among Filipino domestic
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SSM - Qualitative Research in Health 2 (2022) 100125
workers in the UK was to investigate their access and utilization of
mental health services. In particular, it explored their views and expe-
rience of mental health and illness, their patterns of psychological help-
seeking and other coping strategies, their perceived barriers and facili-
tators in help-seeking, and the sense of meaning they attached to their
experience of help-seeking for mental health.
2. Method
This study draws from an interpretive research perspective which
upholds that phenomena are socially constructed reality produced by
individuals interacting with each other and influenced by their world-
views and experiences (Rehman & Alharthi, 2016). Hence, the goal is to
understand the context and subjective interpretations of research par-
ticipants of their lived experiences of mental health and help-seeking
behavior. In-depth interviews were used for data collection which
continued until data saturation was reached. Thematic analysis was done
in identifying and analysing patterns of responses (Braun & Clarke,
2006).
2.1. Recruitment and sampling
Using purposive sampling techniques, participants were recruited
through community-based Filipino organisations in London, England.
Four Filipino migrant organisations were contacted and were requested
to publicize the call for participation in the research through their social
media accounts. Selection criteria included Filipino migrants in the UK
who work in service industries such as private households and residential
care homes.
Because of the sensitive nature of the questions which may trigger
distress, individuals who recently experienced life crisis or trauma and
are still experiencing distress at the time of the interview were excluded
from participation as a preliminary safeguard measure. This was assessed
by the following screening interview questions which asked participants:
(1) whether they have a high level of distress; (2) whether they have
thoughts of self-harm; and (3) whether they have thoughts of harming
others (Draucker, Martsolf, & Poole, 2009) (Evans, John Mellor-Clark,
Frank Margison, Michael Barkham, Kerry Audin, Janice Connell,
Graeme McGrath, Chris, 2000). It was deemed that a participant is in
distress if at least one of the screening interview questions is affirmed.
One female participant was deemed high risk because she was just
rescued from human trafficking. When asked if she recently experienced
distress, she affirmed and the interview was canceled. She was then given
a referral to mental health services.
2.2. Ethical clearance
Ethics clearance was obtained from the university's Institutional Re-
view Board (Ref. No. HR-18/19–11120) which approved all communi-
cations, information sheets, consent forms, and methods used in this
research.
2.3. Interview procedure
All interviews were conducted by the first author. Participants were
contacted by telephone and social media platforms (e.g. Facebook and
Instagram) that they provided in the sign-up sheet sent to Filipino
community-based organisations. After obtaining their initial agreement
to participate, a convenient time and place for the face-to-face interview
were arranged. Participants chose the venue for the interview, which was
either in a caf
e or in their home.
They were given a written information sheet in English about the
aims of the study, their possible involvement, and rights as participants,
and other ethical considerations. The information sheet was then trans-
lated verbatim into Filipino language by the first author at the start of the
interview to ensure understanding of the participants. Written consent
A. Martinez et al.
was obtained and participants were assured of their anonymity and
confidentiality of their private information. They were asked to provide a
pseudonym that was used throughout the interview and in the reporting
of their data. They were also reminded that their participation was
voluntary and they could opt to withdraw from the study anytime. All
interviews were conducted in the Filipino language and were audio-
recorded with their consent, each approximately lasted from 45 min to
1.5 h.
Participants first completed a brief questionnaire about their socio-
demographic background and they were then administered the CORE-
10 (Clinical Outcomes in Routine Evaluation) Screening Measure. The
CORE-10 is a self-report questionnaire used to assess psychological
distress (Connell & Barkham, 2007, pp. 1–40). Using a semi-structured
interview guide which was developed from the review of literature,
participants were asked open-ended questions about their thoughts and
views on mental health and illness, the circumstances surrounding their
immigration, and experience of emotional distress in coming to the UK.
They were also asked about their coping strategies, patterns of
help-seeking and/or utilization of mental health services, and perceived
barriers and facilitators that influence their help-seeking. Finally, they
were asked about their sense of meaning related to their mental health
concerns vis- a-vis help-seeking patterns. Participants who showed
distress during the interview were asked if they want to continue, and
interviews were punctuated with a brief pause to give them time to relax
and compose themselves. Interviews ended with a brief debriefing of how
they felt about the questions and were asked if they needed further
support. They were then given a list of mental health support services
that are available.
2.4. Strategy for data analysis
All interviews were transcribed verbatim and translated into English
by the first author. This provided an opportunity for familiarisation with
the data and to develop patterns of responses. To ensure consistency in
the coding process, a codebook for the qualitative data analysis was co-
developed by the first and second authors. It was initially culled from
existing literature, theories, and research questions (DeCuir-Gunby,
Marshall, & McCulloch, 2011). A second revision of the codebook was
done after all interviews were transcribed and the first author already has
familiarity with the data. The codebook was then pilot-tested separately
by the first and second authors on two interview transcripts to generate
further codes, definitions, and sample quotes and hence underwent the
third revision. The final codebook was divided into the following topics:
(1) concept of mental health and mental illness; (2) mental health con-
cerns before and immediately after coming to the UK; (3) circumstances
and/or reasons for coming to the UK; (4) problems, challenges and dif-
ficulties encountered in living in the UK and coping strategies used; (5)
sources of informal and formal help, and types of assistance sought; (6)
reasons for seeking and/or not seeking help, and feedback (if any) on
mental health services in the UK; and (7) sense of meaning of their
experience and message they want to convey to other migrants with
similar experience.
Using thematic analysis, qualitative data analysis was done in two
stages: (1) open coding wherein the raw data from the transcripts were
chunked into small units and assigned with a descriptor or code; (2) axial
coding wherein connections among the codes were identified and
grouped into higher-level categories or themes to express the content of
each interview and to establish emerging patterns of codes in the entire
data set (Straus & Corbin, 1998). Data coding was done separately by the
two researchers using the NVivo software program and Microsoft Excel
spreadsheets. To ensure rigour and trustworthiness of the coding and
interpretation, interview transcripts were repeatedly read and reviewed
independently. Divergent opinions on codes were deliberated and
resolved after open dialogue by the researchers and no further differ-
ences on the coding were noted. Themes were analysed for each infor-
mant and were then compared and contrasted across all participants or
3
SSM - Qualitative Research in Health 2 (2022) 100125
data sets, which then served as the basis for the qualitative findings in the
research and supported by exemplar quotes that are used in the final
report.
2.5. Participants
Participants in the study consisted of 12 informants, aged 37 to 58,
two of whom were males. Eight were married or in a civil partnership,
three were single and one was a widower at the time of the interview.
Seven of them had a university degree, two reached masters level, and
three finished high school or trade school. They had lived and worked in
the UK between 2 and 19 years, with eight of them moving to London
through their employers, 2 came in as students and another 2 has
dependent visas through their spouses. Nine of them are working as
domestic helpers, cleaners, or nannies in private households and three
identified their work as carers or personal healthcare assistants. Four of
them had already obtained permanent residency status, two are on a
family visa, another two have domestic worker visa, three are undocu-
mented migrants whose visa has expired and one is on visa appeal status
as an asylum seeker due to being a victim of human trafficking. Five of
them were living with their employers, three with their family or spou-
ses, and four were flat sharing with friends. In terms of assessment of
their psychological distress based on their CORE-10 scores, three par-
ticipants scored moderate-to-severe level of distress, four had moderate
levels, one was mild, three were low and one has a healthy level.
3. Results
From the thematic analysis, the four main higher-level themes that
emerged were: (1) participants’ beliefs and concepts about mental health
and illness and their perceived causes; (2) psychosocial issues and chal-
lenges pre- and post-their migration experience and coping strategies
they used; (3) formal and informal help-seeking behavior, including
barriers and facilitators of help-seeking, sources, and types of help; and
(4) learnings and meanings attached to their experience as migrants vis-
a-vis their experience of psychological distress and help-seeking.
3.1. Concept of mental health and illness
For most Filipino domestic workers, mental health and illness are
intertwined. Mental health is believed to mean ‘soundness of mind,’
‘rational thinking’ or having a ‘clear understanding’ or appropriate
perception of reality. On the other hand, mental illness is equated with a
sense of distress and dysfunction such as feeling ‘useless and worthless’,
subjective discomforting ‘sadness,’ ‘emotional pain’ and ‘stress’, and
having a ‘troubled mind’ and negative view of things:
“A person has mental illness when he is always alone and sad … if he
always wanted to be isolated.” – Valery, 49
“It is our experience of emotional pain.” –Levy, 39
Both mental health and mental illness are also construed as having a
derogatory meaning, such as being ‘crazy’, ‘insane,’ or ‘nutcase’:
“When we talk about mental health, the first thing that comes to mind is
‘mentally ill,’ ‘crazy person.’” – Valery, 49
When asked about their beliefs on the causes of mental illness, most
participants point to negative personal experiences, stress, and trauma as
culprits. These experiences are those they described as ‘painful,’ ‘diffi-
cult,’ ‘challenging,’ or ‘unbearable’ that usually relate to family prob-
lems, relationship issues, upbringing and childhood trauma,
disappointments, and frustrations in life.
“Mental illness is due to too difficult problems that people couldn’t bear
and their mind just gave up.” –Maria, 54
A. Martinez et al.
“Mental illness is caused by painful experiences in life.” –Ann, 39
3.2. Psychosocial issues pre- and post-migration
Before leaving the Philippines, Filipino domestic workers were
experiencing family and financial problems as their main concerns,
which also served as their driving force to migration. Among family
problems they cited were the separation of parents, death of a spouse,
problems with extra-marital affairs, and having children at an early age.
Many of them were also born to poverty, economic deprivation, or had
difficult childhood experiences.
“It was so painful for me because when I was young, I promised myself that
when I have a family, I won’t leave my children behind … I didn’t expe-
rience having a mother because my parents are separated … I didn’t want
to be left with my father because I wanted to be with my mother, I was so
hurt when she left and my mom said, ‘I cannot bring you up, you have to
live with your father.’ This is what I experienced while growing up, so I
promised myself that when I have my own children, I will never leave them.
But it didn’t happen coz I have to go abroad.” –Ann, 39
“My husband died and left me with our four children. I was only 32 years
old at that time and I was at the peak of my career … Everything just falls
apart because all the burdens are left with me … So at the time I was asking
myself what shall I do?” –Cel, 58
As such, the primary reason they went abroad was due to financial
burdens especially their need to support their children.
“I decided to go abroad because there was no job in the Philippines. My
husband has no work. I had no work. Then we had three children.”
–Helen, 51
“Life was difficult in the Philippines, there is no decent job, the salary was
very low, so I was thinking that to support my children, I had to go
abroad.” –Maria, 54
For most of them, UK was often not their first destination. They were
brought by their previous employers from another country and several of
them became victims of human trafficking from whom they attempted to
escape. Others came to the UK for family reunification.
“Before coming here, I was in Hong Kong for 11 years … My employer
needed to transfer here. Then they brought me here.” –Helen, 51
“I thought that in coming here, my cousin promised that she would help me
find a job … It was already too late when I realized that her real purpose of
bringing me here was to help them take care of their child so she and her
husband can work full-time.” –Gigi, 43
Most of the participants work in private households, and many of
them live with their employers. This makes them vulnerable to issues of
work-related abuse, exploitation, and forced labour. Some of them even
experienced verbal, physical, and emotional abuse and sexual
harassment.
“My workload was also heavy. Aside from domestic chores, I take care of
the twin children of my employer. I do the laundry and ironing of clothes
and even the dishwashing and cleaning up of the house. I need to do all of
them so I could avoid being scolded, cursed, or even called names such as
‘stupid,’ ‘no brain,’ or ‘animal’. I have to do everything even when my job
contract says that I’m just a nanny to one child.” –Ann, 39
“The way we were treated by our employer is like we were just maids, like
we were their slaves. We are considered their property because they bought
us from the agency so we don’t have any right at all.” –Maria, 54
“One night, I woke up and my male employer was in front of me just
wearing a robe. That time I was sleeping on the floor while the baby I was
caring for was sleeping on the bed. I was so scared and then he covered my
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SSM - Qualitative Research in Health 2 (2022) 100125
mouth. I tried to break free … I was thinking come what may, I could kill
him. The following morning I told his wife because I thought she could help
me if I tell her what happened. But I was dead wrong, she even slapped me
in the face. She said words like ‘yahimara,’ which I learned later on means
‘you’re an animal.’ We weren’t speaking after that.” –Daniela, 53
The precarity of their work conditions, especially for those who are
undocumented or without legal papers, also prevents them from going
home and visiting their families. Some of them have been in the UK for
about ten years and have not gone back to the Philippines even for a short
family visit. As such, many of them suffered from homesickness,
depression, and anxiety.
“I think that was my depression stage, I was starting to question myself why
am I here, what am I doing here. I felt so hopeless at that time.” –Gigi, 43
“I nearly killed myself at that time. I jumped off the train track. There was
an oncoming train. I jumped off. I didn’t know. And then I just saw myself
there on the train track. And then I blocked out.” – Levy, 39
“I think I'm having depression. I feel so lethargic like I've lost the drive to
work. Then I don’t see any purpose in doing things. I feel sorry for myself. I
did experience that, feeling sorry, feeling down every day. I just burst into
cries. When no one is around, I just cry. I felt I no longer have some purpose
of living.” –Seti, 48
Being in a new environment and different culture, many of them also
experienced acculturation and adjustment concerns such as difficulty
adapting to new ways of life, experiencing culture shock, or having a
language problem.
The effect of weather is worse on me so I told my employer, ‘Sir, let me go
home.’ We came here in January and it was very cold then and the rain was
heavy. And then it was already dark around 3:00 p.m.? So I asked myself,
‘what kind of weather is this?’” –Helen, 51
“One of the struggles here is the language barrier. They have a different
English from the English we know in the Philippines. So at first, it was
difficult to understand what they are saying.” –Maria, 54
“I was crying because I was thinking that when I was in the Philippines
somebody was doing this kind of work for me, now I have to do them by
myself.” –Cel, 58
3.3. Coping strategies for psychological difficulties
In coping with all of these issues and challenges, Filipino domestic
workers utilized several coping strategies. The most prominent coping
strategy used is cognitive reframing in which they perceive their stressor
as a challenge instead of a threat and hence cultivating a sense of
optimism.
“I need to swallow the hurtful words of my employer while I’m swelling up
with tears because I’m in a foreign country. I am here to get a good life yet I
ended up being miserable. But I repeatedly tell myself that I need to sac-
rifice for the sake of my children.” –Ann, 39
“Even if I think hard about it or I get worried, I always remind myself that I
cannot do anything else. I’m just doing it for my children and my family.”
–Cel, 58
“I was just thinking that someday, at the right time, karma will take its
course on my employer. I was thinking about my family in the Philippines
that’s why I had to endure everything. Of course, I have dreams for them, I
want to fulfill that dream so I had to bear everything.” –Liza, 37
Religious coping such as praying for guidance and strength, going to
church, attending other church-related activities is also repeatedly used
as a coping strategy.
A. Martinez et al.
“All I did was to go to church and pray. Every time I get so lonely, my
mother would say over the phone ‘just pray hard and trust the Lord.’”
–Annie, 51
“I pray strongly. That’s my belief, that if you pray hard, your worries will
disappear. That’s true for me, after I pray my worries are gone, my inner
burden is lifted.” –Cel, 58
“What is God's plan for me? What is God's challenge for me that these
things are happening? My faith and beliefs helped me cope because I was
not only given strength but also hope. It was like I was given the strength to
cope for whatever difficulties I have to endure.” –Seti, 48
Distracting or keeping oneself busy or doing something else to take
their mind off from a stressor is also employed as a coping mechanism.
Others create a diversion either through working hard or engaging in
community activities and use avoidance coping.
“I call up boys. These are men who want to meet up with me. They
entertain me. They talk to me over the phone. I like to hear things that
please me. It makes me think that there is someone who cares for me … But
sometimes, to be honest, I use my physical body to have fun with someone
and to entertain myself. You know what I mean by “fun”. So I could forget
my stress. So I could relax and sleep.” –Levy, 39
I joined a migrant's organization, and every Sunday I was busy with it. At
first, I just did volunteer work, eventually, I became its president. That helps me
keep my mind off my worries.” –Daniela, 53
“As long as I could help others, I’m happy because this has been my kind of
work in the Philippines. Then I met other Filipino community organisations
here doing the same thing. My homesickness was diverted into helping other
people.” – Valery, 49
“My mindset is, if I cannot control it, I should not think too much about it.”
–Cel, 58
3.4. Psychological help-seeking
3.4.1. Seeking informal help
Remarkably, all participants have used help-seeking from friends and
family when they were experiencing an emotional crisis. This includes
securing social support or asking for assistance from others such as
friends, family, partners, and community organisations.
“The idea that someone like my aunt was helping me has eased my
burden.” –Liza, 37
“I share my problems with (a) few friends. Sometimes I disclose them to my
children.” – Helen, 51
“I become okay when I talk to friends whom I regarded as family.”
–Patricia, 44
“At the moment, my preferred source of help is my best friend and my
partner. They are the ones I always contact, especially when I feel that I
wasn’t treated right by another person or when I’m about to breakdown.”
–Levy, 39
“I also get strength for the Filipino community here. They help me, they
provide some emotional support.” – Valery, 49
“Members of the organisations of Filipino domestic workers said, ‘Don’t
worry, you can stay with one of our members. So when I escaped from my
abusive employer, I lived with them for two months. They referred me to
other charity organisations that help trafficked victims like me. Since then,
I got all the help I needed from them.” –Ann, 39
The majority of participants cited trust and confidence in their social
networks as the primary reason for seeking informal help. They feel more
at ease and comfortable disclosing their problems to them. Moreover,
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SSM - Qualitative Research in Health 2 (2022) 100125
they are encouraged to seek help when friends are openly talking about
issues related to mental health. Their friends also encouraged them to
seek services from charity organisations.
“I'm even closer to my friends here than with my siblings because we've
been together longer. And some friends are okay, I feel very at ease and
comfortable with them because they understand me. That's why I tend to be
selective sometimes with whom to open up and share my problems with … I
do not open up to my family especially my siblings, I did not grow up with
them so I’m not close with them.” –Helen, 51
“We do not openly talk about mental health issues. But when our friends
do, it encourages us to discuss them openly.“—Maria, 54
“I wanted to escape from my abusive employer so I talked to my friends in
the church. They said they would refer me to this organization of Filipino
domestic workers.” –Ann, 39
However, they were still selective on whom to disclose their problems
to or whom to ask for help from their social networks, citing fear of
becoming a burden, especially to their family as the main reason.
“But in everything that happened to me, I didn’t want my family to know. I
didn’t want them to worry.” –Ann, 39
“I didn’t tell my husband because that’s how much I love him. I don’t want
him to feel that I’m weak. At the same time, I don’t want to burden him, I
don’t want him to worry about me.” –Patricia, 44
“I was ashamed of what my family would think because they’ve been very
supportive in everything I do then I’d be adding another problem to them if I
tell them about my depression. I didn’t want them to worry about me that
much.” – Valery, 49
Both social and self-stigma were also cited as barriers in seeking
informal support from their family and friends. They fear being
discriminated against, excluded, judged negatively, or given derogatory
labels. Others have internalised devaluation and disempowerment with
accompanying feelings of shame, embarrassment, sense of being a
disgrace, loss of self-esteem, engaging in self-blame, or having self-belief
of being weak so they would rather keep their problems to themselves.
“I have to always show them the best of me. They’ve known me as the one
who stands up to problems and issues. I’m the one who does not cry and
break down easily. So my family thinks I’m the strongest among my sib-
lings. I project myself that way even if I felt I was already crumbling inside,
even if I felt like dying inside, I still haven’t told them.” –Daniela, 53
“I have such high pride in myself that I could help other people with their
problems but then I got my own problems and I felt like giving up and was
about to commit suicide. I was ashamed of what my family would think of
me if I told them.” – Valery, 49
“How could I even tell my friends when some of them won’t even help.
They would even pull me down, mock me and make fun of me by saying,
‘Ah, because she’s crazy.’ ‘Leave her alone. That’s how she is, she’s
crazy.” –Levy, 39
Perceived self-reliance and personality traits were also cited as top
barriers to seeking informal help. As migrants and having the will to
leave their family to try their luck abroad, Filipino domestic workers
believe that they are responsible for themselves and can overcome their
problems so they tend to rely on themselves. The belief that they have
already experienced and overcome the most challenging and difficult
situations abroad, coupled with their perceived disposition of being
strong and resilient reinforced this notion and leads to self-expectations
of being self-reliant.
“I know I can find ways to solve my problem. I was their strength. So I had
to endure it on my own. I kept it to myself because I feel I can bear it and I
can overcome it.” –Patricia, 44
A. Martinez et al.
“I felt I was so depressed at that time when I was having problems with my
husband but I didn’t tell anyone because I thought I can get through it. I
have always been this way.” – Maria, 54
“I have this mindset that when I’ve gone through a problem, I’d be able to
overcome the next hurdle even if its' more difficult. That’s how I was
brought up. I was brought up to think that hardships in life are part of our
destiny. We are so used to the idea that we need to go through our problems
because that is supposed to make us stronger.” –Helen, 51
3.4.2. Seeking formal help
Four of the participants reported having sought formal help from
general practitioners (GP), while six have sought services of mental
health professionals such as a psychiatrist, psychologist, guidance
counselor, and social worker either through the referral of a charity or-
ganization or social networks of friends. The four participants who went
to the GP had sought help for somatic complaints such as sleep or eating
problems and other physical health problems, and they were given
medications but only one was given a referral to a specialist mental
health service, which she did not use. For those who sought the services
of a mental health specialist, two used the service through phone coun-
seling, only one had undergone a series of face-to-face individual coun-
seling, and another one went through support group sessions. Two others
have sought assistance with a mental health specialist in the Philippines
through referral of friends and community-based organisations.
“I went through counseling. It took several months, I had 6 sessions. I was
seeing the counselor fortnightly.” –Liza, 37
“I only had one session over the phone. We talked for about half an hour,
and she asked me how I felt that time, what help can she offer. I was
encouraged to do a one-on-one session but I didn’t want to.” –Ann, 39
“When the GP gave me a landline to call, I called up the number because I
felt I needed someone to talk to. But I felt it was not a talk. Almost every
day I called them up. I was at work but I wasn’t doing my job. I would go to
the room of my client, I will change his nappy. Then while changing his
nappy, I was already on the phone talking to them.” –Levy, 39
“I sought the help of a psychiatrist who was doing volunteer work in the
charity. I did not want to talk to him initially but I was encouraged by
people who worked in the charity.” –Valery, 49
Filipino domestic workers reported that perceived problem severity is
the main facilitator in accessing professional services. Their awareness of
their mental health needs due to the high level of distress that severely
affected their daily living prompted them to seek treatment.
“I went to the doctor for a medical check-up because I was having palpi-
tations and I couldn’t work, I couldn’t eat, I didn’t want to get out of bed.
But I still haven’t told my GP that I was having bouts of anxiety and
depression. I just want to get well physically.” –Daniela, 53
“I needed professional assistance because I think I was getting worse. I
jumped on the train track twice. I was brought to an ambulance and the
paramedics asked how I was. But I was never brought to the hospital”
–Levy, 39
“I still couldn’t eat so I went back to the GP for the second time in a month.
I felt so down. I cannot take in food. But the GP said it was still not
depression. I told her I just want to get well. I told her I need meds because I
don’t want to think about negative things that happened in my life. I want
to work in a normal way. But I wasn’t given medication. I also didn’t get a
referral to a mental health specialist.” – Maria, 54
Whilst some sought professional help because of the perceived
severity of their mental health needs, others wanted to prevent their
problems from getting worse.
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SSM - Qualitative Research in Health 2 (2022) 100125
“Because I don’t want my depression to get worse so I went back to my GP.
I want it to be treated immediately because I don’t want it to come to the
point that I would lose my mind, or I may not be able to cope with life
anymore.” – Maria, 54
Those who were victims of human trafficking and employer abuse
sought formal help because charity organisations gave them accessible
assistance, while others were encouraged by their friends to seek pro-
fessional help.
“The counseling service was provided by the charity organisation that was
helping me in my case.” –Liza, 37
“I was referred by my friends to the charity. The charity then helps me in
my trafficking case. And if it’s not for the charity organization that was
helping me in my trafficking case, I wouldn’t have talked to a psycholo-
gist.” –Ann, 39
“I have this friend who went to a GP and said that she was referred to a
psychiatrist. She said I should also go to the GP to get a referral to the
psychiatrist.” –Levy, 39
However, participants cited different barriers in their access to mental
health services, primarily the lack of awareness on available services,
including lack of familiarity with the structure of the service. They also
said that since it is not part of routine medical check-ups, they did not
know that they can ask for a referral from their GP, and if they did, they
were not given access to services.
“I do not know how to request counseling from the GP. I do not know the
mental health services here. I don’t have an idea whom to ask for help,
whom to go. So I just kept my silence. I was also so scared. And when I went
to the GP, like for urinalysis, blood test, or things like that, I wasn’t asked
about my mental health.” –Annie, 51
“I requested the GP to refer me to a transgender psychiatrist but until now I
haven’t received a referral yet.” – Levy, 39
“Perhaps one of the reasons why Filipinos do not avail those kinds of
services is that they don't know about them, they are ignorant of the ser-
vices. The problem with the NHS is the consistency in which they offer their
services because not everyone is offered with the same service.” –Seti, 48
Similar to the reasons for their reluctance to seek informal help,
Filipino domestic workers also reported that fear of being stigmatized
prevent them from seeking professional assistance for their mental health
concern.
“I went to the GP but I came home immediately. I was just seeking
consultation for my physical illness. I had a blood test. I did not tell my GP
that I have depression and drug use problems because I don’t want to have
a record. I was thinking that it will not be good to have mental health issues
in my medical records. Aside from that, I’d be a disgrace to my family
because I’ll be the first to have a mental health problem.” –Daniela, 53
“Most of the Filipinos here in the UK are scared. They are scared to be
labeled. There is this mentality until now among Filipinos working abroad
or those who are immigrants, they always think that when you say you
have a mental problem, the first thing that comes to mind is you’re crazy.
For us Filipinos, there’s a stigma when you say someone crazy. These are
things that they still couldn’t fully accept.” – Levy, 39
“I think it's because of the stigma. Even I, myself, would probably be scared
and embarrassed to attend a direct one-on-one therapy session. People
might say I'm crazy. Yeah, it’s shameful. For us Filipinos, once you use the
word 'therapy' it's scary for people, it's 'uncool'.” –Seti, 48
Participants also reported having a lack of confidence in professionals
to help them in their distress, hence they did not seek help.
A. Martinez et al.
“I was recommended by the GP for counseling. I rejected it because I said,
‘will they be able to do anything?’ None, whatsoever. They couldn’t help
me with my problems.” –Patricia, 44
“The GP said, ‘we have a hotline, I’ll give you the number, talk to them.’
But I didn’t call the hotline because they don’t know about my life. I was
thinking that they couldn’t help me so I didn’t call. I didn’t believe in the
hotline because I couldn’t see the person, so I think he couldn’t help me
because he doesn’t know my whole story. He couldn’t see how sadly I look
because we will just be talking over the phone. He will just hear me whining,
crying. What I want is someone who could hold my hand and tell me I’ll be
okay.” – Maria, 54
“How can I trust him (psychiatrist) if he’s White? He was dismissive of my
issues. I keep on telling him I have depression, I’m suicidal and I needed
medications. But he just said, “Okay, come back to me after a week and
let’s see if you’re still depressed.” –Levy, 39
Another highly cited barrier to getting professional help is the sense
of self-reliance, using one's way of coping with the situation, managing
their own emotions, and taking self-responsibility over their problems.
Having gone through difficult times before made them think that they
could overcome their emotional crisis. Others feel that they have the
necessary preparation and training to handle their problems.
“I was thinking since I’m a carer, I could take care of myself so I could bear
it. I just need to be strong. And in my experience, I just have to firm and
strong, I just have to think about my family. That's the only thing that
makes me strong. Even when situations are distressing, I still need to
persevere. So it was just self-motivation.” – Annie, 51
“There was a time I was so depressed but I didn’t tell anyone because I
thought I can get through it. Because usually I just resolve my problem on
my own.” – Maria, 54
“I think I'm just too proud that I can overcome this on my own without
help. I didn’t avail of the counseling services coz I was thinking I can do it
on my own. I can rely on myself and I can handle it. I felt I can do it on my
own because you know, I have a degree in counseling. So why should I need
it? I was able to overcome it I had sort of a plan how to go about it.” – Seti,
48
Because of the nature of their work, time constraints also prevent
them from seeking professional services. As domestic workers, they left
their families in the Philippines to work hard in a foreign country and
they think that going to a professional will take their precious time away
from the opportunity to earn money.
“Especially that I’m working, it’s a waste of time. First and foremost, you
need time to go there, you have to devote your time, but if you are a do-
mestic worker here, you work the whole day, sometimes even on Sundays.”
–Gigi, 43
“Here, if you do not work, you’ll die. There are a lot of bills to pay for
housing rent, transportation, utilities. That’s why it’s difficult to squeeze in
a schedule for a doctor’s appointment. It’s like, ‘I can’t be bothered. I need
to work hard.” –Patricia, 44
For those who sought professional services, Filipino domestic workers
were generally unhappy with the services of mental health specialists but
were satisfied with the GP.
“I couldn’t feel his attachment or concern for me. I couldn’t feel that there
was care. He was just listening to me and saying, ‘Okay’ in everything I
say.” – Levy, 39
“If I would rate it in 1-10, I’ll give it a 5 perhaps because whilst counseling
helped me in some ways, we were just talking about the problem all the
time. So instead of calming me down, we just talked about it often so I felt I
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SSM - Qualitative Research in Health 2 (2022) 100125
was just stuck in that situation and I didn’t know how to move on.” – Liza,
37
3.5. Learning from experience
3.5.1. Advising other migrants experiencing problems
When asked about the advice they would give to other migrants who
experience psychological distress but were reluctant to seek help, all of
them are urging others to be proactive in seeking help, whether formal or
informal. They cited the need for awareness on when, how, and where to
get help and handle their problems. Despite a lack of confidence in
professional help, they still recognized that mental health specialists are
knowledgeable and could impart ideas that could help individuals who
are experiencing psychological distress. They also encouraged other
migrants about the need for self-care and to reduce the stigma associated
with mental health.
“What I can advise them is that they need to let it out. They should have
somebody with whom they can confide and help ease their burden.
Whatever they are feeling, they need to tell others and let it out because if
they keep it to themselves, it would explode, and that would give them a
much bigger problem. Anything that you try to keep inside, it would pile up
and eventually explode.” – Cel, 58
“Perhaps they need to be aware when they need help. Most of the time, they
are in denial. They do not recognize that they have a problem, or they don’t
admit to themselves that they have depression.” Maria, 54
“Be brave to face the truth that you need help. That’s the first step. We
need to accept in ourselves that if we have depression, there is a mental
health problem that needs to be addressed with the help of someone who
has professional training and skill, like a psychiatrist or psychologist. Most
importantly, talk to someone you trust and knows how to help resolve the
problem.” – Valery, 48
3.5.2. Specific emigrant experience
Filipino domestic workers have a various sense of meanings attached
to their experience as migrants. The sense of meanings they created is
mostly related to their social bonds and sense of community in which
they recognize the importance of their connections with friends and
family with a corresponding change in their outlook towards those in
their social networks. Others recognized the importance of engaging in
community activities and providing support to others especially those
who are marginalized and have experienced abuse and exploitation.
“One will not fully understand the hardships of being a Filipino migrant
unless you have experienced leaving the country and being away from your
family and loved ones.” – Gigi, 43
“We also need to understand that even just the act of leaving behind your
children in the Philippines to work abroad is already an emotional baggage
for migrant workers and yet they still experience different forms of abuse.
That’s quite a difficult experience they have to endure for the sake of their
loved ones.” – Valery, 48
In being migrants, they also recognized their strengths and weak-
nesses especially when they were experiencing distress, emphasizing the
need for ‘determination,’ ‘perseverance’, ‘hard work’, and ‘resilience’.
Others admitted having lost their sense of self-confidence and recognized
the limits in which they could deal with their problems on their own with
the pervading sense of giving up. However, in trying to understand why
they experience such difficult challenges, they reported having achieved
transcendent experience in which they feel that such adversities were
part and parcel of their migration experience that helped strengthen their
resolve in life.
A. Martinez et al.
4. Discussion
4.1. Framing of mental health and illness
In this study, Filipino domestic workers' perception of mental health
and illness is focused more on a dichotomous illness perspective rather
than seeing mental health as a spectrum of mental wellbeing ranging
from good to poor mental health (England, 2017). This has an implica-
tion on the way they frame the causes of mental illness with associated
stigma and consequently affecting their help-seeking behavior. For Fili-
pino domestic workers, having good mental health is seen as the ratio-
nality of thinking and the absence of any mental illness, rather than
looking at it in a holistic perspective that includes the ability to cope with
stress, the realization of one's potential, and social and occupational
productivity (World Health Organization, 2005). Because mental illness
is seen as a result of psychosocial factors such as difficult family problems
and painful emotional experiences, biological factors are ignored. An
interesting finding is that they did not hold the cultural view of under-
standing mental illness due to supernatural causes or God's will. This is in
contrast to findings by Tan (Tan & Tan, 2008) who studied local Fili-
pinos, and Tuliao (Tuliao, 2014a,b) who studied local and overseas Fil-
ipinos and concluded that the Filipino basis of psychological disorders is
supernatural and religious.
Participants also held the notion that toughness in character and
resilience were core traits that can buffer the experience of mental illness.
This highlights the important role of resilience in mediating the experi-
ence of distress (Gloria & Steinhardt, 2016) and as protective factors
against migration-related stressors (Cardoso & Thompson, 2010) and
trauma exposure among migrants (Gatt et al., 2020). However, for Fili-
pino domestic workers, the inability to cope with psychological problems
is seen as unacceptable and a sign of weak character. This is linked to
their stigmatized view of mental illness which they usually equated with
derogatory labels of being ‘crazy’, ‘insane’, or a ‘nutcase’. This finding is
consistent with the external shame attitude towards mental disorders
among Asian students in UK universities where they held beliefs that
society has negative views towards persons with mental illness (Gilbert
et al., 2007). Thus, having a mental illness is seen as a social disgrace
because of self-expectations as migrants of being strong in character and
not succumbing to emotional difficulty.
4.2. Resilience and self-reliance amidst migration-related distress
The economic difficulties in the Philippines drive Filipino migrants to
go abroad. Among Filipino domestic workers, the burden of providing for
the needs of the family gives them the impetus to work in foreign
countries even if it would mean being away from their families for long
periods. Many of them hold the notion that they are the strongest, most
resourceful, and independent in the family. As such, they tend to
downplay their immigration-related concerns like adjustment and
acculturation problems, homesickness, depression, and anxiety despite
reports of mild to moderate psychological distress in their CORE-10
assessment. Moreover, their traumatic experience of work-related
abuse, violence, and exploitation especially among undocumented mi-
grants are seen as challenges that they have to cope with on their own.
This is similar to the experiences of Congolese women who migrated to
the US and learned to “stand on their own” (Wachter & Gulbas, 2018), to
cultivate their sense of self-reliance amidst adversities.
In this study, they said they needed to develop and use different
coping methods to demonstrate their self-reliance and sense of resilience.
One is the use of positive reframing as a cognitive coping strategy
(Khawaja, White, Schweitzer, & Greenslade, 2008). By reframing their
psychological distress as a test of their inner strength and constantly
reminding themselves that the emotional labour of working overseas is a
personal sacrifice for their family, they can cope with distress and facil-
itate adaptation. Emotion-focused is another commonly used coping
strategy by distracting oneself and keeping oneself busy at work as forms
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SSM - Qualitative Research in Health 2 (2022) 100125
of diversion from stress. However, this kind of avoidant emotional coping
may be maladaptive in the long run as it involves denial of the problem
(Cobb, Xie, & Sanders, 2016).
4.3. Preference for informal help vs formal help
In this study, the participants much preferred sharing their feeling
informally with other Filipino friends. The framing of mental illness as
caused by painful experiences may help explain Filipino migrants' pref-
erence for informal sources of help, rather than consulting with a mental
health specialist (Hechanova, M. R. M., Tuliao, Teh, Alianan, & Acosta,
2013). Because it is considered a psychological problem that can be
addressed with adequate social support by ‘letting it out’ to a trusted
friend, professional assistance is seen both as unnecessary and imprac-
tical. This is consistent with how Filipino migrants in Australia
(Thompson, Manderson, et al., 2002) and Norway (Straiton, M. L.,
Ledesma, & Donnelly, 2018a,b) are seeking help and coping with their
distress and even with the preference for lay sources of help among
people in the UK with minor mental health problems (Oliver et al., 2005).
In this group, participants said this could help them cope with their
immediate problems, such as homesickness, but may not help their more
major mental health problems such as depression. They often still went to
their GPs, or their friends and charity organisations may encourage them
to seek professional help.
However, despite their claim that they are close to their families and
their primary motivation for working abroad is to sustain the needs of
children, siblings, spouses, or parents, Filipino domestic workers tried to
avoid burdening their family with their emotional problems and instead
seek informal help and social support from friends. This cultural value
also places mental illness as a stigmatized condition for fear of being
shamed, discriminated or excluded from one's relative position in the
family and the community (Tuliao, 2014b). This also reinforces the
self-expectation of being tough, adaptive, and self-reliant and the
concomitant fear of being perceived as weak, thus the tendency to either
keep their problems to themselves or be selective of friends that they can
disclose their problems with. Participants in this study take full re-
sponsibility for their mental health and believe that self-management of
their psychological problems will be sufficient to help them get through
and overcome the crisis.
As such, professional help was rarely sought by domestic workers.
This may happen when they are experiencing somatic symptoms such as
sleep disturbance or eating problems, or when certain dysfunctions are
already evident like the inability to work and cope in their daily activ-
ities. This suggests that problem severity is the main motivation for uti-
lizing healthcare services (Vahabi & Wong, 2017). Such formal
help-seeking is also mediated by assistance from friends and charity or-
ganisations that refer them to these services. On the other hand, those
who availed of professional services reported general dissatisfaction due
to failed expectations of how their problems should be dealt with while
those who were satisfied with their GP services did not push through with
specialist care.
The lack of awareness and lack of familiarity with the healthcare
system also contributes to their underutilization of mental health services
(Maneze et al., 2015). This might be due to the isolated nature of their
work in private households (Anderson, 2007) which reduces their access
to information and lessens their opportunity to engage with others in an
open dialogue about mental health. The expectations and demands of
their work such as caring for children, the elderly, or those with a
disability also pose constraints in accessing mental health services. It also
prevents them from discussing their mental health problems for fear that
they would be branded as ‘unfit for the job (Vahabi & Wong, 2017),
hence losing their employment opportunity. In addition, the precarious
immigration status of undocumented migrants serves as a barrier to their
help-seeking for fear of deportation (Bloch, Sigona, Zetter, & Sigona,
2014). This indicates their willingness to compromise their mental health
as a necessary sacrifice for the sake of providing for their family.
A. Martinez et al.
4.4. A three-stage approach to help-seeking
The preference for informal sources of help before considering pro-
fessional services seem to suggest a three-stage approach in which Fili-
pino domestic workers in the UK are seeking help: (1) informal help from
friends who referred them to charities; (2) charity organisations that offer
psychosocial assistance and referred them to GPs or specialist services
when needed; and (3) GPs and mental health services that provide pro-
fessional care.
The pattern of help-seeking among Filipino domestic workers in-
dicates that the initial act of help-seeking is towards social networks of
friends and relatives because they can be trusted. This is entrenched in
the Filipino cultural trait of shared identity called ‘kapwa’ (Pe-Pua &
Protacio-Marcelino, 2000) in which those who are ‘insiders’ such as
friends as can be trusted while ‘outsiders’ of the culture like GPs and
mental health specialists are dealt with extreme caution and sometimes
even distrust and lack of confidence. Because Filipinos cultivate re-
lationships in their social interactions (Mujtaba & Balboa, 2009) built-in
trust and confidence, Filipino domestic workers will not readily disclose
their problems to someone they just met since the process entails a highly
interpersonal experience of seeking help in which they would have to feel
comfortable expressing their problems to someone they trust. This is
consistent with the conceptualization of Rickwood and Thomas (2012) of
help-seeking as a social transaction whereby an intensely personal
domain of psychological distress becomes an interpersonal process of
willingness to seek help. In this social transaction, gatekeepers such as
friends, relatives, community members, and charity organisations who
are in a position to assist people with distress become an important
mediating factor to access mental health services.
In the UK, charities and community-based organisations can also offer
informal help in support groups which can form an additional level of
help between informal help from friends and formal professional help.
Filipino domestic workers are more apt to utilize mental health services
when they are referred to them by their support groups in charity orga-
nisations. Whilst evidence shows that intervention through support
groups is not substantially equivalent nor more effective than profes-
sional help, people with chronic mental health problems still benefit from
mutual-help groups (Pistrang, Barker, & Humphreys, 2008).
Similar to the findings in other studies (e.g., (Oliver et al., 2005);
(D'Avanzo et al., 2012), professional help is the last resort for Filipino
domestic workers. Quite often, utilizing specialist mental health services
is made through referrals or assistance from friends and charity organi-
sations. Remarkably, despite their general reluctance to seek psycho-
logical help, Filipino domestic workers are encouraging their compatriots
to seek mental health specialists when they experience psychological
distress, believing that professionals are more equipped to deal with their
problems. There seems to be a disconnect between their actual formal
help-seeking behavior and their attitude towards formal help-seeking as
evident through the advice they give to others, thus contradicting the
notion that attitude predicts behavior (Bohon, Cotter, Kravitz, Cello, &
Fernandez y Garcia, 2016).
Implications of the findings of this study suggest that intervention
programmes may target behavior change and reinforce a positive attitude
towards help-seeking. The emphasis that Filipino domestic workers
placed on the importance of social bonds in helping overcome migration-
related distress experience also indicates the core Filipino value of shared
identity and hence their choice of informal help over formal sources. It is
thus crucial that interventions tap their social networks to encourage
them to access mental health services. Whilst self-reliance and resilience
may serve as barriers to seeking professional help, they could also be seen
as important psychological resources of Filipino domestic workers that
may buffer their experience of distress or even mental illness, and hence
it may be beneficial to enhance their resilience while minimizing stigma
attached to mental health.
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5. Conclusion
Filipino domestic workers in the UK view mental ill-health as a stig-
matized condition caused by difficult experiences in life which require
the use of various coping strategies such as positive reframing and
seeking informal help from friends, selected family members, or charity
organisations. Professional assistance is sought only as a last resort when
problems have physical manifestations and are disrupting their work.
Their patterns of help-seeking reveal a three-stage approach in which
help is initially sought from informal networks of friends who then refer
them to charity or community-based organisations that provide them
with psychosocial assistance. Before they are referred to a GP or a mental
health specialist. The most notable barriers from seeking specialist ser-
vices are stigma, lack of familiarity with the structure of the services, and
a sense of self-reliance. General dissatisfaction with mental health ser-
vices was also noted.
Ethical statement
Ethics clearance was obtained from the university's Institutional Re-
view Board (Ref. No. HR-18/19–11120) which approved all communi-
cations, information sheets, consent forms, and methods used in this
research.
Declaration of competing interest
None.
References
Abe-Kim, J., Takeuchi, D. T., Hong, S., Zane, N., Sue, S., Spencer, M. S., et al. (2007). Use
of mental health–related services among immigrant and US-born Asian Americans:
Results from the national latino and Asian American study. American Journal of Public
Health, 97(1), 91–98.
Anderson, B. (2007). A very private business: Exploring the demand for migrant domestic
workers. European Journal of Women's Studies, 14(3), 247–264.
Anjara, S. G., Nellums, L. B., Bonetto, C., & Van Bortel, T. (2017). Stress, health and
quality of life of female migrant domestic workers in Singapore: A cross-sectional
study. BMC Women's Health, 17(1), 1–13.
Asis, M. M. B., Huang, S., & Yeoh, B. S. (2004). When the light of the home is abroad:
Unskilled female migration and the Filipino family. Singapore Journal of Tropical
Geography, 25(2), 198–215.
Bhugra, D. (2004). Migration and mental health. Acta Psychiatrica Scandinavica, 109(4),
243–258.
Bloch, A., Sigona, N., Zetter, R., & Sigona, N. (2014). Sans papiers: The social and economic
lives of young undocumented migrants. Pluto Press London.
Bohon, L. M., Cotter, K. A., Kravitz, R. L., Cello, P. C., Jr., & Fernandez y Garcia, E. (2016).
The Theory of Planned Behavior as it predicts potential intention to seek mental
health services for depression among college students. Journal of American College
Health, 64(8), 593–603.
Bradley, L. (2014). Health, well-being, and rights: Mapping the boundaries of belonging for
Filipino caregivers in Israel.
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Null, 3(2), 77–101.
https://doi.org/10.1191/1478088706qp063oa
Business Group, O. (2018). Development plans seek to build upon the Philippines' diverse
culture and geography. Retrieved from https://oxfordbusinessgroup.com/overview/is
land-nation-diverse-people-geography-and-culture.
Cardoso, J. B., & Thompson, S. J. (2010). Common themes of resilience among latino
immigrant families: A systematic review of the literature. Families in Society, 91(3),
257–265.
Cheung, J. T. K., Tsoi, V. W. Y., Wong, K. H. K., & Chung, R. Y. (2019). Abuse and
depression among Filipino foreign domestic helpers. A cross-sectional survey in Hong
Kong. Public Health, 166, 121–127. https://doi.org/10.1016/j.puhe.2018.09.020
Chung, R. Y., & Mak, J. K. (2020). Physical and mental health of live-in female migrant
domestic workers: A randomly sampled survey in Hong Kong. American Behavioral
Scientist, 64(6), 802–822.
Clark, D. M. (2012). The English improving access to psychological therapies (IAPT) program.
Dissemination and Implementation of Evidence-Based Psychological Interventions.
Cobb, C. L., Xie, D., & Sanders, G. L. (2016). Coping styles and depression among
undocumented Hispanic immigrants. Journal of Immigrant and Minority Health, 18(4),
864–870.
Connell, J., & Barkham, M. (2007). CORE-10 user manual, version 1.1. CORE System Trust
& CORE Information Management Systems Ltd.
D'Avanzo, B., Barbato, A., Erzegovesi, S., Lampertico, L., Rapisarda, F., & Valsecchi, L.
(2012). Formal and informal help-seeking for mental health problems. A survey of
preferences of Italian students. Clinical Practice and Epidemiology in Mental Health: CP
& EMH, 8, 47.
A. Martinez et al.
David, E. (2010). Cultural mistrust and mental health help-seeking attitudes among
Filipino Americans. Asian American Journal of Psychology, 1(1), 57.
DeCuir-Gunby, J. T., Marshall, P. L., & McCulloch, A. W. (2011). Developing and using a
codebook for the analysis of interview data: An example from a professional
development research project. Field Methods, 23(2), 136–155.
Draucker, C. B., Martsolf, D. S., & Poole, C. (2009). Developing distress protocols for
research on sensitive topics. Archives of Psychiatric Nursing, 23(5), 343–350.
England, M. (2017). Mental Health First Aid England.
Evans, J. M.-C., Frank, M., Barkham, M., Audin, K., Connell, J., McGrath, G., et al. (2000).
Core: Clinical outcomes in routine evaluation. Journal of Mental Health, 9(3),
247–255.
Gatt, J. M., Alexander, R., Emond, A., Foster, K., Hadfield, K., Mason-Jones, A., et al.
(2020). Trauma, resilience, and mental health in migrant and non-migrant youth: An
international cross-sectional study across six countries. Frontiers in Psychiatry, 10,
997.
Gilbert, P., Bhundia, R., Mitra, R., McEwan, K., Irons, C., & Sanghera, J. (2007). Cultural
differences in shame-focused attitudes towards mental health problems in Asian and
non-Asian student women. Mental Health, Religion & Culture, 10(2), 127–141.
Gloria, C. T., & Steinhardt, M. A. (2016). Relationships among positive emotions, coping,
resilience and mental health. Stress and Health, 32(2), 145–156.
Green, O., & Ayalon, L. (2016). Whom do migrant home care workers contact in the case
of work-related abuse? An exploratory study of help-seeking behaviors. Journal of
Interpersonal Violence, 31(19), 3236–3256.
Hall, B. J., Garabiles, M. R., & Latkin, C. A. (2019). Work life, relationship, and policy
determinants of health and well-being among Filipino domestic workers in China: A
qualitative study. BMC Public Health, 19(1), 1–14.
Hechanova, M., Regina, A., Tuliao, A. P., & Hwa, A. P. (2011). If you build it, will they
come? Media Asia, 38(1).
Hechanova, M. R. M., Tuliao, A. P., Teh, L. A., Alianan, A. S., & Acosta, A. (2013).
Problem severity, technology adoption, and intent to seek online counseling among
overseas Filipino workers. Cyberpsychology, Behavior, and Social Networking, 16(8),
613–617. https://doi.org/10.1089/cyber.2012.0648
Hermannsd
ottir, B. S., & Aegisdottir, S. (2016). Spirituality, connectedness, and beliefs
about psychological services among Filipino immigrants in Iceland. The Counseling
Psychologist, 44(4), 546–572.
Khawaja, N. G., White, K. M., Schweitzer, R., & Greenslade, J. (2008). Difficulties and
coping strategies of Sudanese refugees: A qualitative approach. Transcultural
Psychiatry, 45(3), 489–512.
Lindert, J., von Ehrenstein, O. S., Priebe, S., Mielck, A., & Br€ahler, E. (2009). Depression
and anxiety in labor migrants and refugees–a systematic review and meta-analysis.
Social Science & Medicine, 69(2), 246–257.
Maneze, D., DiGiacomo, M., Salamonson, Y., Descallar, J., & Davidson, P. M. (2015).
Facilitators and barriers to health-seeking behaviours among Filipino migrants:
Inductive analysis to inform health promotion, 2015 BioMed Research International,
2015, 1–9.
McKay, D. (2007). ‘Sending dollars shows feeling’–emotions and economies in Filipino
migration. Mobilities, 2(2), 175–194.
McManus, S., Bebbington, P., Jenkins, R., & Brugha, T. (2016). Mental health and wellbeing
in England: Adult psychiatric morbidity survey 2014. A survey carried out for NHS digital
by NatCen social research and the. Department of Health Sciences, University of
Leicester.
Mendoza, N. B., Mordeno, I. G., Latkin, C. A., & Hall, B. J. (2017). Evidence of the
paradoxical effect of social network support: A study among Filipino domestic
workers in China. Psychiatry Research, 255, 263–271.
Mojtabai, R., Olfson, M., & Mechanic, D. (2002). Perceived need and help-seeking in
adults with mood, anxiety, or substance use disorders. Archives of General Psychiatry,
59(1), 77–84.
Mujtaba, B. G., & Balboa, A. (2009). Comparing Filipino and American task and relationship
orientations. Taylor & Francis Ltd.
Nguyen, D., & Bornheimer, L. A. (2014). Mental health service use types among Asian
Americans with a psychiatric disorder: Considerations of culture and need. The
Journal of Behavioral Health Services & Research, 41(4), 520–528.
Oliver, M. I., Pearson, N., Coe, N., & Gunnell, D. (2005). Help-seeking behaviour in men
and women with common mental health problems: Cross-sectional study. The British
Journal of Psychiatry, 186(4), 297–301.
10
SSM - Qualitative Research in Health 2 (2022) 100125
Pe-Pua, R., & Protacio-Marcelino, E. A. (2000). Sikolohiyang pilipino (Filipino
psychology): A legacy of virgilio G. Enriquez. Asian Journal of Social Psychology, 3(1),
49–71.
Philippine Overseas Employment Agency. (2010). OFW statistics. Retrieved from http
://www.poea.gov.ph/ofwstat/ofwstat.html.
Pistrang, N., Barker, C., & Humphreys, K. (2008). Mutual help groups for mental health
problems: A review of effectiveness studies. American Journal of Community
Psychology, 42(1–2), 110–121.
Rehman, A. A., & Alharthi, K. (2016). An introduction to research paradigms. Int J
Educational Invest, 3(8), 51–59.
Rickwood, D., & Thomas, K. (2012). Conceptual measurement framework for help-
seeking for mental health problems. Psychology Research and Behavior Management, 5,
173.
Sayres, N. J. (2005). An analysis of the situation of Filipino domestic workers ILO-Sub-regional
Office.
Shield, A., & Meigh, A. (2019). The victimisation of Filipino domestic workers in the United
Kingdom and Singapore.
Shoultz, J., Magnussen, L., Manzano, H., Arias, C., & Spencer, C. (2010). Listening to
Filipina women: Perceptions, responses and needs regarding intimate partner
violence. Issues in Mental Health Nursing, 31(1), 54–61.
Straiton, M. L., Ledesma, H. M. L., & Donnelly, T. T. (2017). A qualitative study of filipina
immigrants' stress, distress and coping: The impact of their multiple, transnational
roles as women. BMC Women's Health, 17(1), 72.
Straiton, M. L., Ledesma, H. M. L., & Donnelly, T. T. (2018a). It has not occurred to me to
see a doctor for that kind of feeling": A qualitative study of filipina immigrants'
perceptions of help seeking for mental health problems. BMC Women's Health, 18(1).
https://doi.org/10.1186/s12905-018-0561-9
Straiton, M. L., Ledesma, H. M. L., & Donnelly, T. T. (2018b). It has not occurred to me to
see a doctor for that kind of feeling”: A qualitative study of filipina immigrants'
perceptions of help seeking for mental health problems. BMC Women's Health, 18(1),
73.
Straus, A., & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for
developing grounded theory.
Takeuchi, D. T., Zane, N., Hong, S., Chae, D. H., Gong, F., Gee, G. C., et al. (2007).
Immigration-related factors and mental disorders among Asian Americans. American
Journal of Public Health, 97(1), 84–90.
Tan, M. L., & Tan, M. T. (2008). Revisiting usog, pasma. kulam UP Press.
Thompson, S., Hartel, G., Manderson, L., Stirling, N., & Kelaher, M. (2002). The mental
health status of Filipinas in Queensland. Australian and New Zealand Journal of
Psychiatry, 36(5), 674–680.
Thompson, S., Manderson, L., Woelz-Stirling, N., Cahill, A., & Kelaher, M. (2002). The
social and cultural context of the mental health of Filipinas in Queensland. Australian
and New Zealand Journal of Psychiatry, 36(5), 681–687.
Thornicroft, G. (2018). Improving access to psychological therapies in England. The
Lancet, 391(10121), 636–637.
Tuliao, A. P. (2014a). Mental health help seeking among Filipinos: A review of the
literature. Asia Pacific Journal of Counselling and Psychotherapy, 5(2), 124–136.
Tuliao, A. P. (2014b). Mental health help seeking among Filipinos: A review of the
literature. Asia Pacific Journal of Counselling and Psychotherapy, 5(2), 124–136.
UK Foreign and Commonwealth Office. (2014). The South-East Asia Diaspora in the UK,
2021. In Immigration statistics. London: UK Home Office.
Vahabi, M., & Wong, J. P. (2017). Caught between a rock and a hard place: Mental health
of migrant live-in caregivers in Canada. BMC Public Health, 17(1), 498.
Vassallo, M. T., & Debono, M. (2020). Labouring behind closed doors: The working and living
conditions of Filipino live-in care workers in Malta. Uncertainty and Challenges in
contemporary economic behaviour. Emerald Publishing Limited.
Wachter, K., & Gulbas, L. E. (2018). Social support under siege: An analysis of forced
migration among women from the Democratic Republic of Congo. Social Science &
Medicine, 208, 107–116.
Wallace, S., Nazroo, J., & B
ecares, L. (2016). Cumulative effect of racial discrimination on
the mental health of ethnic minorities in the United Kingdom. American Journal of
Public Health, 106(7), 1294–1300.
Who. (2017). Mental health atlas 2017 (Geneva).
World Health Organization. (2005). Promoting mental health: Concepts, emerging evidence,
practice: A report of the world health organization. Foundation and the University of
Melbourne World Health Organization. Department of Mental Health and Substance
Abuse in collaboration with the Victorian Health Promotion.