Breaking the Silence: How the mental health system fails the AANHPI communities — and how to help

By Grace Galletti
Originally published in the California Health Report

Tony’s symptoms worsened in high school, but his parents refused to let him see a professional. In many Asian American, Native Hawaiian and Pacific Islander communities, such reluctance to seek mental health care is common. 

A 2007 study by Jennifer Abe-Kim, a psychology professor at Loyola Marymount University, found that less than 9 percent of Asian-Americans sought any type of mental health services compared to nearly 18% of the general population nationwide. A survey released in October by the National Alliance for Mental Illness (NAMI) found that 77 percent of Asian Americans with mood disorders reported struggling to talk about their condition compared to 69 percent of white people.

RELATED: Congressional resolution - May 10 as AANHPI Mental Health Day

Tony’s symptoms worsened in high school, but his parents refused to let him see a professional. In many Asian Americans communities, such reluctance to seek mental health care is common. A 2007 study by Jennifer Abe-Kim, a psychology professor at Loyola Marymount University, found that less than 9%t of Asian Americans sought any type of mental health services compared to nearly 18% of the general population nationwide. A survey released in October by the National Alliance for Mental Illness (NAMI) found that 77% of Asian Americans with mood disorders reported struggling to talk about their condition compared to 69%of white people.

Stigma attached to mental health

Stigma is one of the main barriers preventing Asian Americans from seeking mental health services, experts said. Julian Chow, professor at UC Berkeley’s School of Social Welfare, said that some Asian cultures believe that mental health problems are the result of wrongdoings in a past life. This leads people to accept mental illness as a hardship they must endure, rather than seek help.

Tony said his family used the word “crazy” as a synonym for inappropriate behavior when he was growing up. It was only when his mental health symptoms became severe and he ran away that his parents finally gave in and sought professional help. He was eventually diagnosed with bipolar disorder.

The pandemic was a particularly difficult time for Tony. The isolation and sedentary lifestyle of staying at home put a strain on his mental health and on his relationship with his partner at the time. He was hospitalized twice for suicidal ideation after calling a crisis line.

Many Asian Americans, however, do not reach out for help when it comes to mental health.

Stigma not only creates shame around mental illness but also a lack of awareness about what resources are available. Pata Suyemoto, 60, a mental health activist and suicide prevention advocate, said she experienced this with her Japanese-American father. When, as a child, she told him she was having suicidal thoughts, he turned away from her, not knowing what to do or say. As an adult, she reflects back on this experience with empathy. She said her dad was not taught how to talk about mental health issues or how to get help.

The toll of racial stereotypes

The surge in anti-Asian hate crimes and attitudes has impacted the mental health of Asian-Americans, including Suyemoto. She said she’s experienced many instances of racism, including a woman leaping off the sidewalk to avoid her while she was walking near her home in Cambridge, Mass. After numerous similar experiences during the pandemic, she remembered feeling scared to leave her house. Other people in her community have shared with her similar stories and fears.

“I had to get a COVID test and I thought: I wonder if this person will be rougher with me because I’m Asian?” Suyemoto said.

The “model minority myth” is another barrier to mental wellbeing for Asian Americans. It creates the illusion that the community doesn’t have problems, said Makhija, and also puts pressure on people to hide their mental illness or not reach out for help.

On top of that, being an immigrant creates added pressure, according to Winston Tseng, associate director of research with Health Research for Action at UC Berkeley. Many people feel they must push themselves to succeed in order to provide for families back home.

FOR HELP: If you or someone you know is struggling with suicidal thoughts or other mental health challenges, you can call the National Suicide Prevention Lifeline at 800-273-8255, or contact the Crisis Text hotline by texting “HELLO” to 741741.

Although the NAMI survey and other studies show that Asian Americans and Pacific Islanders face more challenges to obtaining mental health services than other populations, not all of their challenges are the same. Some Southeast Asian communities with refugee status, for example, are more likely to have a history of PTSD or substance abuse because of the trauma they’ve endured. Pacific Islanders, on the other hand, may not have access to the health care system at all because they’re more likely to be uninsured than other Asian Americans.

Liu said it’s important to address both the commonalities among Asian Americans and to tailor therapy to an individual’s specific stressors and socioeconomic and cultural background. Training more therapists on how to deliver culturally appropriate therapy would help, she added.

DJ Ida, executive director of the National Asian American Pacific Islander Mental Health Association, said the need for culturally aware, bilingual mental health professionals is greater now than ever before.

To get more Asian Americans to seek care, providers need to recognize that some cultures don’t see mental and physical health as separate. She said they also need to think beyond medication and talk therapy, which can sometimes re-traumatize people. Other, more culturally appropriate avenues for addressing mental health difficulties could include gardening or exercising for example.

Suyemoto, who suffers from depression, said her treatment includes medication and therapy, but also Reiki, acupuncture, journaling and activism. She’s glad to have a therapist who takes an interest in how her culture affects her mental health.

For Tony, healing has come from going to church, where he feels welcomed and accepted. He said he recently opened up to the congregation about his mental health struggles and about how he had never felt connected to anyone else. The church members started to pray for him and put their hands on him.

“I started to cry, you know, because for so long I felt so isolated and so disconnected from others and to have (people) actually care enough to put their hands on me and to pray for me in that moment. It was such a powerful and touching moment,” he said.

Although his parents had a hard time accepting his mental health struggles, Tony now speaks highly of them. They worked hard to buy him a house a half mile away from their home, and he visits them often. His relationship with them has improved.

“When I was younger, I thought the pressure from my parents was so strong to succeed that if I didn’t succeed they were going to disown me,” he said. “But in reality, even after I failed and even after my brother had failed in many ways, my parents were still there.”

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