Addressing Asian and Pacific Islander mental health in the U.S.

Asian Americans are among the least likely to seek mental health care. In one study, less than 9% sought any type of mental health services over one year compared with 18% of the general U.S. population. The COVID-19 pandemic, compounded by an increase in anti-Asian hate and violence, has further highlighted the lack of mental health awareness, research and treatment among the Asian American and Pacific Islander (AAPI) community.

These were among the issues addressed by a virtual panel of mental health experts during a May 25 event organized by the Stanford Center for Asian Health Research and Education. The panelists, who shared personal and professional experiences, discussed the current state of mental health among the AAPI community and ways to overcome barriers to care.

Moderator Lisa Kim, senior manager of media relations at Stanford Medicine, began by asking the panel how Asian and Pacific Islander families could help their loved ones have more open conversations about mental health.

“We need to ‘reach in’ better,” said Ranak Trivedi, PhD, assistant professor of psychiatry and behavioral sciences, meaning making space for those who are struggling to share, even if it feels awkward. In some cases, she said, “The stigma is so big that people are not able to share even with their most intimate connections that they’re having mental health issues.”

“If we can create a situation where people can feel comfortable or have an ally within their family, within their friend structure, that can be a big lead-in to having those conversations,” she added.

Pandemic silver lining

Raising awareness is key to encouraging AAPIs to seek mental health care, said DJ Ida, PhD, executive director of the National Asian American Pacific Islander Mental Health Association. A silver lining of the ongoing pandemic has been more awareness that mental health issues can affect anyone, she said.

“It begins to take the stigma away because it isn’t, ‘Oh, there is something wrong with me,’” she said. “We always tell people, if you’re breathing, then mental health will be part of your life one way or another.” She added that even mental health professionals like her can forget to give themselves the space to feel grief and pain in difficult times.

As a suicide attempt survivor, Pata Suyemoto, PhD, director of training and programs at the National Asian American Pacific Islander Mental Health Association, shared her own experience of seeking mental health care.

“It was difficult to find a therapist that had cultural humility,” she said. “I’m 60 years old — until my current therapist, no one ever asked me about the impact of my culture on my mental health.” Her mother’s bipolar disorder and her father’s trauma of being imprisoned during World War II in an internment camp were never acknowledged out loud in her family — a silence familiar to many in the AAPI community. “As an Asian American, I feel like it’s really important for us to be out with our healing, if you will,” she said.

When Kim asked about the impact of the COVID-19 pandemic on mental well-being, Shashank Joshi, MD, professor of psychiatry and behavioral sciences, said that one of the surprising things we’ve learned from the pandemic has been how much we took for granted: “the everyday doses of well-being we got from connecting in person.”

A sense of connection and belonging has been empirically shown to benefit mental health, Joshi said. “It makes a difference for people with mental health problems if people can join a community.” Finding that sense of belonging can be particularly challenging for someone who is the only AAPI where they live, and for immigrants and children of immigrants straddling two cultures.

Hesitation about care

Yuhuan Xie, MD, a clinical assistant professor of psychiatry and behavioral sciences and the clinical director of specialty mental health at Asian Health Services, shared her experience working with mostly poor, immigrant, Asian patients in Oakland’s Chinatown. “They come from China, Laos, Cambodia — and the majority of them have experienced some trauma in their home country before they came to this country,” she said. She said they often have a lack of knowledge about mental health and difficulty accessing resources in a complicated health care system.

“They don’t have much knowledge about mental health, sometimes at all. All they know is, ‘I cannot sleep well, I have a stomachache, I cannot get up, I was angry with my children.’” Xie has found that focusing on the biological causes of mental illness can be much more acceptable in Asian populations and a way to open conversations on a stigmatized subject.

Andrew Subica, PhD, associate professor of social medicine, population and public health at UC- Riverside School of Medicine, has encountered a similar hesitation among the Native Hawaiian and Pacific Islander communities he works with. They have told him, “Create all the treatments you want. We are never walking in the door,” he said.  

Many associate mental illness with social and moral failings, such as weakness or sin, as opposed to neurobiological causes, which would be less stigmatizing, he said. And there is a lack of knowledge about the treatment process: how to find treatment, how much it would cost and whether it would be confidential.

The recent rise in anti-Asian violence not only has added more fear and shame to the mental burden, but it has also created another barrier to seeking care, Ida said. “Sometimes people are afraid to seek help because it sort of retraumatizes them to relive and to talk about the fact that somebody attacked them just because of ‘who I am.’”

More culturally and linguistically appropriate mental health providers are sorely needed to counter the stigma and misperceptions in the community, Trivedi said. She again urged those in the community who have more privilege to “reach in.”

“It’s not sufficient to put the onus on the people in need,” she said. “So, those of us who have that identity of an Asian American provider, it’s important for us to reach in to our communities. And I think this panel is a good example.”

In closing the event, Bryant Lin, MD, co-founder and co-director of the center, offered three wishes to the audience: “I wish that we could all feel and be safe. I wish that we could all feel and be heard. And I wish that we can all get help when we need it.”