Mental Health Care in AAPI Communities: Overcoming Language, Stigma, and Other Barriers
Mental health does not discriminate. It impacts one in five individuals at any given time. But people of Asian American and Pacific Islander (AAPI) descent rank last among all ethnic groups in seeking care, a fact that is particularly disconcerting in this time of racism, hate crimes, and bias incidents against AAPI Americans and communities.
“Even before the pandemic Asian American and Pacific Islanders were the lowest help-seeking group. There was already under treatment of mental health conditions,” says Columbia psychiatrist Warren Ng, MD. To illustrate the scope of the challenge, he notes that AAPI as a group is not a monolith and represents over 30 ethnicities and 50 languages.
The pandemic highlighted what many already knew: There are gaps in how we provide care in the United States. Like other groups, Asian Americans and Pacific Islanders have traditionally been overlooked. Ng attributes this in part to systemic racism including the "model minority" myth. The term refers to a group perceived as successful, hardworking, and resourceful, in spite of obstacles other groups do not face. As a result, they receive fewer resources and services.
“'Crazy Rich Asians' and other stereotypes make everyone else, especially the bottom 10%, invisible,” says Ng. “Thirteen percent of Asian Americans in New York City do not have health insurance and 24% live in poverty. They don't know how to access health insurance, and this is largely a language and cultural barrier.”
Language is particularly significant when it comes to mental health. And language communicates more than words. Language lets a person know how they will be heard, seen, and understood.
Beyond literal signs in the appropriate language (sign up for health insurance here; free mental health help here), there are different views and words for what mental illness and happiness should look like. There’s also the difficulty many people, including American-born English speakers, have in articulating feelings and experiences.
“Different groups may express sadness and depression in different ways,” says Ng, a Chinese American who has provided mental health care to the largely Latinx Washington Heights community for two decades. “We need to talk about mental health in ways that are appropriate for each individual with respect for their language, culture, and community. There is still a lot of stigma and misunderstanding about mental illness.”
Asian hate, racism, and mental health
The phenomena of Asian hate, anti-Asian sentiment, hate rhetoric, and blaming Asians for COVID-19 has made AAPI people scapegoats, leading to more feelings of anxiety, depression, and emotional and psychological suffering. “Pandemic isolation provided relative security and safety. Now, as people are in more social, public spaces, they are being targeted. It's very traumatic,” says Ng. These attacks create mental health crises for family members and witnesses too.
Ng notes the intersection of racism and misogyny: 62% of victims of hate crimes and bias incidents are women. About 74% of Asian American women experienced racism in the past year.
Unfortunately, in addition to other impediments to getting mental health care, going outside of the community for help can be a challenge. “Culturally, this is true of many ethnic groups,” says Ng. “Keeping issues with the family, not bringing in strangers to avoid shame and stigma is common.”
Another reason it can be hard for AAPI people to reach out for help is the issue of individualism, a negative in cultures that prioritize collectivism or the needs of the family or community. In an individualistic society, like the United States, you need to speak out, make your needs known, advocate for yourself. That can be difficult to do if you’ve been raised not to draw attention to yourself.
“It’s a mismatch,” says Ng, “It’s another barrier preventing people from reaching out for help and can further the sense of isolation and invisibility.” The consequences, however, can be deadly: Suicide is the leading cause of death among AAPI people between 20 and 24 years of age.
Talk to a primary care physician
In most cultures, mental health issues are not always seen as “real” or contributing to disability and impairment. When mental health issues are viewed as weaknesses or character flaws, the stigma prevents people from seeking care.
“Depression is neurobiological and a medical condition,” says Ng. “Nearly one in 10 adults are affected. If that stat applied to cancer, diabetes, or heart disease, depression would be treated so differently and with more care and compassion.”
In the AAPI community, doctors have big sway as there is great deference to authority figures, says Ng. Going to a primary care provider helps confirm that mental health issues are real and medical, thereby validating an individual's experience. It also helps sidestep stigma issues and hopefully helps people accept mental health care.
Depression screening is part of primary care. Ask your doctor if you’ve been screened for things that are important to your mental health and overall well-being. You can be connected to a mental health provider who will work with your primary care doctor.
If you’re not eating, sleeping, playing, or otherwise living a life that includes joy, talk to your doctor or other people you trust—faith-based leaders, social service providers—and ask for help finding a mental health care provider.
Seek culturally competent care
When considering a mental health care provider, ask questions to make sure they’re a good fit for you. Questions you can ask:
- What is your experience treating people from different backgrounds?
- What languages do you speak?
- How do you view mental health and medical issues?
- Are you open to seeing things through different cultural lenses?
Listen to the answers and determine if you feel respected, heard, and seen.
Warren Y.K. Ng, MD, is professor of psychiatry, medical director of outpatient behavioral health, and director of clinical services in the Division of Child and Adolescent Psychiatry, Department of Psychiatry, at Columbia University Vagelos College of Physicians and Surgeons. He is president of the American Academy of Child and Adolescent Psychiatry.