Management of a Mental Health Crisis in an International High School Exchange Student: A Case Study

Objectives: Acculturative stress is a significant problem for International exchange students in the US, and has been associated with a variety of psychiatric symptoms and psychosocial impairment. In this article we focus on the mental health issues of exchange students from East Asia, who typically are dealing with differences in culture as well as high expectations for academic success. Methods: We review the literature on the acculturation of foreign exchange students and suicide in East Asian populations. We then present a case study of an East Asian high school student who attempted suicide during his exchange program in the United States and give a cultural formulation. We discuss the systems of care that were involved in treating the student in an inpatient psychiatry setting and returning him home. Results: Suicide, suicidal ideation and suicidal behaviors are common problems among adolescents and adults in East Asia, with academic stress and family conflict being the most common precipitants. Those who come to the US have the added stress of adapting to a different culture. It can be difficult for treatment providers to distinguish between personality features unique to the patient and those that are culturally determined. Conclusions: Treatment in this case involved a significant interaction between health care, legal, cultural, and educational concerns. Enhancement of the patient's sense of efficacy and control was an important goal of treatment. It is important that child and adolescent mental health care providers become familiar with this population.