Mental health does not discriminate. It affects one in five people at some point. But people of Asian American and Pacific Islander (AAPI) descent rank last among all ethnic groups seeking care, a particularly disconcerting fact in this time of racism, hate crimes and incidents of bias against Americans and AAPI communities.
“Even before the pandemic, Asian Americans and Pacific Islanders were the least help-seeking group. There were already mental health issues under treatment,” says Columbia psychiatrist Warren Ng, MD. To illustrate the scale of the challenge, he notes that the AAPI as a group is not a monolith and represents over 30 ethnicities and 50 languages.
The pandemic has highlighted what many already knew: there are gaps in the way 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 to be successful, hardworking, and resourceful, despite obstacles that other groups do not face. Consequently, they receive fewer resources and services.
“’Crazy Rich Asians’ and other stereotypes make everyone invisible, especially the bottom 10%,” says Ng. “Thirteen percent of Asian Americans in New York do not have health insurance and 24 percent live in poverty. They don’t know how to access health insurance, and a lot of that is a language and cultural barrier.
Language is especially important when it comes to mental health. And language communicates more than words. Language allows a person to know how they will be heard, seen and understood.
Beyond the literal signs in the proper language (sign up for health insurance here; free mental health help here), there are different viewpoints and words to describe what mental illness and happiness should look like. There is also the difficulty that many people, including American-born English speakers, have in articulating their 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 Latin community of Washington Heights for two decades. “We need to talk about mental health in ways that are appropriate for each individual while respecting their language, culture and community. There is still a lot of stigma and misunderstanding about mental illness.
Asian hatred, racism and mental health
The phenomena of Asian hatred, anti-Asian sentiment, hateful rhetoric, and blaming Asians for COVID-19 have scapegoated AAPIs, leading to more feelings of anxiety, depression, and emotional and psychological suffering. “Pandemic isolation has 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 as well.
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 have experienced racism in the past year.
Unfortunately, in addition to other barriers to getting mental health care, getting out of the community for help can be a challenge. “Culturally, this is true for many ethnic groups,” Ng says. “Keeping issues with family, not bringing in strangers to avoid shame and stigma is common.”
Another reason it can be difficult for AAPI people to seek help is the issue of individualism, a negative in cultures that prioritize collectivism or family or community needs. In an individualistic society, like the United States, you have to speak up, make your needs known, defend yourself. This can be difficult to do if you were raised not to draw attention to yourself.
“It’s a mismatch,” says Ng, “It’s another barrier that prevents people from seeking help and can reinforce feelings of isolation and invisibility.” However, the consequences can be deadly: suicide is the leading cause of death among AAPI people between the ages of 20 and 24.
Speak to a Primary Care Physician
In most cultures, mental health problems are not always seen as ‘real’ or as contributing to disability and impairment. When mental health issues are seen as weaknesses or character flaws, stigma prevents people from seeking treatment.
“Depression is neurobiological and a medical condition,” says Ng. “Almost one in 10 adults is affected. If this statistic applied to cancer, diabetes or heart disease, depression would be treated so differently and with more care and compassion.
In the AAPI community, physicians have a lot of influence because there is great deference to authority figures, Ng says. Seeing a primary care provider helps confirm that mental health issues are real and medical, validating an individual’s experience. It also helps avoid stigma issues and hopefully helps people accept mental health care.
Screening for depression is part of primary care. Ask your doctor if you’ve been screened for things important to your mental health and general well-being. You can be connected with a mental health provider who will work with your primary care physician.
If you are not eating, sleeping, playing, or living a life that includes joy, tell your doctor or other people you trust (religious 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 are right for you. Questions you can ask:
- What is your experience with 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 responses and determine if you feel respected, heard and seen.