By Tiffany Tran and Led Camille Soriano
The Asian American and Pacific Islander (AA/PI) community is the fastest growing racial group in the United States, but the U.S. Department of Health and Human Services reports that AA/PIs had the lowest rates of mental health utilization compared to every racial group. One study found that only 28% of Asian Americans sought mental health services compared to 54% of the general population.
Because AA/PIs have been known to delay or rarely seek out help for their mental health problems, studies show their conditions are usually more severe and chronic than those of other cultural backgrounds when they do finally receive mental health care. Even so, keep in mind everyone’s mental health journey is unique, and these challenges do not apply to everyone.
Learning how to find a balance between the individualistic, American culture and the collectivistic, Asian culture can be difficult. It can become a large source of stress and lead to a confused cultural identity. Negative mental health outcomes may result, especially to those born in the U.S. or who are second- or third-generation citizens.
How are these cultural values different? Collectivistic and individualistic cultural values are:
- Interdependent view of self
- Emphasis on interpersonal relationships and harmony
- Hierarchal relationships
- Suppression of emotions
- Independent view of self
- Emphasis of self-fulfillment and self-development
- Egalitarian relationships
- Expression of emotions
Other Asian cultural values include respect for elders/authority, putting family needs over individual needs and saving face. A family member’s success is the whole family’s success; a family member’s failure is the whole family’s failure. Your actions do not just affect you, they affect everyone.
How do these cultural values get in the way of discussion about mental health in this community?
Shame & Stigma Around Mental Health
A strong stigma around discussing mental health and seeking out mental health care exists. Like anyone, AA/PIs may view having mental health problems as a weakness. But to speak up about them would not bring shame to themselves and the entire family. Many Asian American children are taught to uphold their family’s positive image. As a result, they may suffer in silence for extended periods of time. The fear of shame and social stigmatization plays a huge challenge in receiving mental health care and can often lead to high levels of anxiety, depression, and fear and mistrust of mental health providers.
Suppression of Emotions
Many AA/PIs have difficulty expressing their emotions because it is usually discouraged in Asian cultures. They may view expressing their emotions or feelings as bringing disharmony or imbalance to the family or community. This restraint can be seen as a way to avoid conflict or cause others to feel uncomfortable. Asian children are usually taught to be attentive to other people’s emotional states and try to maintain that harmony and balance. Because the suppression of emotion is so ingrained in Asian cultural values, many studies have found that AA/PI individuals often express psychological distress through the body rather than the mind. Somatic symptoms, such as a stomachache or a headache, are usually more socially acceptable.
A language or communication barrier can be a huge obstacle in receiving effective mental health care. Being able to express your feelings or experiences is crucial in the therapeutic process, and not having a mental health professional understand what you’re saying can affect both diagnosis and treatment. It may even lead to clinical misjudgment.
Additionally, the wide range of Asian languages and dialects and the lack of mental health professionals able to provide bilingual care causes a significant barrier to those in search of mental health treatment. Not being able to understand or directly translate what you’re saying can be extremely frustrating and dissuade people from seeking out mental health services.
Like many others, AA/PIs tend to turn to informal solutions for their mental health problems before seeking out mental health professionals. This includes looking for the support and advice from close friends and family.
When their conditions worsen, they prefer contacting nonprofessional sources (online support, self-help strategies), healers (traditional Chinese medicine providers) or medical professionals.
Religion can also play an important role in many AA/PIs’ lives, so relying on faith to help them through tough times or a crisis is quite common. Many people also defer to the way of thinking such as “whatever happens, happens,” “it will work itself out” and “leaving it all up to God.”
The culture encourages seeking out a mental health professional when symptoms become severe or unmanageable.
What do we do from here?
The need for more culturally competent and linguistically diverse mental health professionals is crucial for this community. Clearly, overcoming the stigma around mental health will take some time, but we hope this post will help inform others and lead to discussions about why it can be so hard to talk about mental health problems within the AA/PI community.
About the Authors
Tiffany Tran and Led Camille Soriano are research assistants at The Menninger Clinic. Ms. Tran’s research interests include children and adolescent populations, family dynamics and relationships and cross-cultural issues. Ms. Soriano’s research interests include adolescents, adults, anxiety and eating disorders.