Asian American & Pacific Islander Heritage Month: Some obstacles that prevent clients from seeking mental health care

Asian woman outside of a subway

Mental health stigma affects all ethnicities, cultures, and nationalities, but Asian Americans may be more impacted than most.

Many Asian Americans were not raised to talk about their own emotions. Children grow up hiding them because if you’re “too emotional,” you may be perceived as someone who complains too much and doesn’t try to solve anything for yourself.

Collectivist values over individualism

Generally speaking, Asian families tend to have more collectivist values: they have been taught to think about how their actions might affect their larger community; that the feelings of others are more important than their own.

Independence is sometimes seen as a threat to the family goals and values. Understanding how a specific family negotiates issues with boundaries, independence, decision-making, help-seeking behaviors, etc becomes paramount and we cannot assume we know how these values play out today.

Clients may have been taught to overcome these issues in isolation like their parents and grandparents did before them. In turn, seeking professional help may be viewed as a weakness in character, or a flaw in your upbringing. This often translates to family environments in which silence is a sign of strength and feelings aren’t likely shared.

The Model Minority Myth

The myth of the Model Minority incorrectly perpetuates this idea that all Asians are highly educated and high-income earners, which is simply not the case. Furthermore, by touting Asian Americans as Model Minorities, it has eventually rendered their intercultural struggles largely unseen and their voices have been unheard for a long time.

This myth perpetuates the idea that Asian Americans must not have as many struggles as compared to their Black and Latinx counterparts and drives a divisive spirit between marginalized people of color.

Stopping the stigma

Such barriers as language, culture, and little access to care keep many Asian Americans from receiving help for mental illness.

That might be part of why Asian Americans are three times less likely than white Americans to seek help for mental health issues, according to data from the National Latino and Asian American Study.

And according to the Office of Minority Health at the U.S. Department of Health and Human Services, suicide was the ninth leading cause of death for Asian-Americans in 2014.

The stigma against mental health is already a formidable barrier to treatment for Asians, but once they overcome it, they often find that they don’t know how or where to seek out mental health professionals who are well versed in the cultural nuances that impact mental health in Asian communities.

Facing challenges in therapy

Asian Americans face different challenges and difficulties during therapy, as Jenny Wang, Ph.D. a Licensed Psychologist in Houston, Texas, and the creator of the Asian Pacific Islander Desi American Therapist Directory stated in an interview in May 2020:

“The difficulty in working with individuals from “Asia” is that it comprises a huge breadth of cultures, languages, religions, and ethnic groups. This means that simply being “Asian” myself does not even necessarily equip me to work with all the individuals who fall under the category of “Asian.” As a result, clinicians are tasked with the responsibility to do several things. 

Firstly, we must listen well. Even if I am working with a Taiwanese client, I can never make assumptions that I understand this individual’s experiences or background. As such, we must listen with openness and curiosity.

Second, we must check and recheck our own implicit biases and assumptions. The most glaring errors occur when clinicians do not maintain a posture of teachability from our clients about their history, culture, background, and narratives. We must realize that there is a difference between being overtly biased and implicitly biased and refraining from being overtly biased is not enough. We must go further to question and test our assumptions with each client we are serving. 

Third, working with Asian Americans (or any immigrant) means that we need to be sensitive to how Western psychology may directly or indirectly pathologize cultural practices or dynamics. For example, some cultures have kids who sleep with their parents into early childhood and this may be seen as negative from a Western parenting perspective. However, this practice is highly culturally influenced and may reflect a culture’s focus on interdependence and community. These sensitivities take time to develop, which is why consulting with mental health professionals from all backgrounds is a must if working in communities of color.”

How to Improve therapy

One approach to addressing this problem is for Asian American clients to be served by ethnically and linguistically matched mental health professionals.

Another approach is to examine ways in which non–Asian American counselors can provide more culturally relevant and sensitive services to clients with an Asian American background.

The American Psychological Association provides some guidance on how to properly address Asian American patients: 

  • In addition to assessing personal experiences of racism and oppression of their Asian-American/Pacific Islander clients, treatment providers should be aware of the effects of collectivism on the experience of racism and oppression of Asian-Americans and Pacific Islanders.
  • Clinicians should be knowledgeable about the effects of transgenerational trauma and how it may be manifested in Asian-Americans and Pacific Islanders, particularly among immigrants from war-torn countries.
  • Mental health providers should assess their Asian-American/Pacific Islander clients’ employment history and status, inquire about glass-ceiling effects, and assess the individual’s responses to the discrimination.
  • Treatment providers should be aware of the negative impact of the model minority myth on their Asian-American/Pacific Islander clients.
  • Clinicians should remain up to date on the developing literature on the mental health issues of Asian-Americans and Pacific Islanders and incorporate such knowledge into their practice with Asian-Americans and Pacific Islanders.
  • Mental health providers should be aware of the potential harm of underdiagnosis, misdiagnosis, and over medication of Asian-American/Pacific Islander individuals.

Gradually there are more options

Thankfully, there is an increasing number of therapists available working hard to normalize and de-stigmatize mental health within the Asian community.

One admirable example is the Asian Mental Health Collective, which aspires to make mental health easily available, approachable, and accessible to Asian communities worldwide.
Their Asian, Pacific Islander, and South Asian American (APISAA) Therapist Directory cover clinics and therapists in every state in the country.

Cecilia Racine: Immigration Evaluation Therapist

I’m Cecilia Racine, and I teach therapists how to help immigrants through my online courses. As a bilingual immigrant myself, I know the unique perspective that these clients are experiencing. I’ve conducted over 500 evaluations and work with dozens of lawyers in various states. Immigrants are my passion, I believe they add to the fabric of our country.

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