Asian American Mental Health: Culture, Stigma, and Barriers

Apr 11, 2022

By The Lyra Team

Like other cultures, millions of Asian American people have mental health conditions like depression and anxiety. However, due to systemic barriers and stigma, research shows that members of the Asian American community are three times less likely than other racial groups to seek help. In 2019, just 23 percent of Asian Americans and Pacific Islanders (AAPI) with mental health issues sought treatment. When challenges are left untreated, people’s symptoms may worsen and contribute to a poor quality of life. 

Furthermore, world events have exacerbated Asian American mental health challenges. The pandemic brought a perfect storm of distressing factors: Asian American-owned businesses were hit hard during the pandemic’s economic downturn. At the same time, political attacks against China following the emergence of the coronavirus led to increased race-based discrimination, harassment, and violence against Asian American people.

The diversity of the AAPI community

It’s important to remember that the Asian American community is not a monolith, and neither is Asian mental health. According to the National Alliance on Mental Illness, AAPI communities consist of about 50 ethnic groups speaking over 100 languages, with connections to Chinese, Indian, Japanese, Filipino, Vietnamese, Korean, Hawaiian, and other Asian and Pacific Islander ancestries.

Given the diversity of this community, it’s important to avoid generalizations about the Asian American community and mental health, and hold space for differing experiences within individual communities. For example, research surveying Native Hawaiian and Pacific Islanders (NHPI) found a higher prevalence of mental health disorders than overall AAPI rates, likely due to historical traumatization, with 35 percent of NHPI respondents reporting the need for mental health services compared to 17 percent of the broader group. Many times, Pacific Islanders do not identify as Asian, and being lumped into the term AAPI may not fully encompass their lived experience. 

Barriers to mental health in the Asian American community

A mix of systemic and cultural barriers makes it difficult for many Asian American people to seek mental health support. Here are some common barriers to mental health in Asian American cultures:

Lack of culturally competent mental health providers

It can be difficult for Asian American people to find mental health providers of the same race or ethnicity. Racial and ethnic populations only represent one-sixth of psychologists, even though these communities represent closer to 40 percent of the U.S. population

The United States’ relatively lax attitude toward multilingual learning means it also can be difficult for non-English speakers to find providers who are fluent in their language. About one-third of the overall AAPI American population is not fluent in English, though this number varies by subgroup and age group. 

In addition, many mental health providers aren’t educated in non-western medicine, and may not understand their clients’ approach to mental wellness. Traditional as well as indigenous medicinal practices are important to many members of the AAPI community, and finding a mental health provider who is respectful of and knowledgeable about these practices can be challenging.

Lack of health insurance

AAPI subgroups face varying levels of economic stability and insurance coverage. Even with the Affordable Care Act, financial hardship can put health coverage out of reach for families and individuals. Even those with insurance may find it hard to access mental health treatment, due to a shortage of qualified providers, long wait times, and other challenges. 

Inadequate research

A lack of research has left mental health professionals largely in the dark about the rates of mental illness among some AAPI subgroups. These subgroups may have very different outlooks, cultural stressors, generational trauma, and religious beliefs affecting their mental health.

The “model minority” myth

The stereotype of the “model minority” paints Asian American people as exceptionally successful within American society due to their special intelligence and work ethic. Besides being a backhanded dig at other minority groups, who are seen as less industrious and cooperative than the “model” group, this harmful myth prevents the recognition of the struggles and needs of AAPI individuals. Employers, friends, health care providers, and even mental health professionals may see members of the Asian American community as well-off and accomplished, and miss signs of distress. Breaking down the data within the AAPI community can help illuminate the unique challenges facing each subgroup.

Mental health stigma in Asian American communities

In many Asian cultures, mental health disorders are thought to reflect poorly on family lineage and suitability for marriage. This can create mental health stigma, possibly causing Asian American populations to feel shame about their illness or feel obligated to hide their pain. With that in mind, Asian American people may be more likely to report physical symptoms like headaches or dizziness than emotional ones, such as sadness or worry. In addition, traditional values that hold family obligations in high regard may place more pressure on this demographic. 

Religious and spiritual beliefs

Religious diversity flourishes within the AAPI community, which encompasses Buddhists, Hindus, Muslims, and members of many other faiths. While faith can be a source of deep comfort and stability, it can also be a source of pain if a religious community blames mental illness on sin, divine punishment, a lack of belief, or personal dysfunction or imbalance. Because faith communities offer strong social support, these beliefs can add to mental health stigma in Asian American communities.

Mental health in Asian American men vs. women

Mental health conditions may have different causes and/or manifest differently for AAPI men and women. For example, Asian American women’s mental health may be impacted in the following ways:

  • Negative stereotypes and hostility toward the AAPI community may cause distress, while the “model minority” stereotype simultaneously makes it hard to reach out and make others understand the depth of the problem.
  • Unrealistic expectations for success and competence in every area of life may keep some women in a constant state of striving and low self-esteem. These unrealistic expectations may be set by family members or internalized within the individual, and are a common influence on Asian American women’s mental health.
  • Differing cultural values can lead to guilt and confusion about how to make decisions and prioritize responsibilities.
  • Many Asian American women have internalized messages that they should handle internal turmoil privately. Some may have seen mental illness play out in the lives of family members who never sought help.

In general, Asian American men are less likely than their female counterparts to seek mental health support. As with women, gender-related factors contribute.

  • AAPI men more often feel pressure to be self-sufficient leaders who can handle problems on their own.
  • The fear of bringing shame or embarrassment to the family may keep them from getting help.
  • In some AAPI families, men are encouraged to guard their emotions, which can lead to a reluctance to recognize and engage with their inner experience.
  • Cultural stereotypes cast AAPI males as less masculine than other groups, which can lead to avoidance of behaviors that could be interpreted as weak or backing down. These stereotypes can lead to bullying or violence against AAPI boys and men.
  • Research has revealed that suicide rates in places like Hawaii, Guam, Western Samoa, and Micronesia are higher for men than for women. 

The importance of culturally responsive care

Culture impacts mental health in profound ways, but isn’t always accounted for in mental health treatment. Culturally responsive care addresses this gap by teaching mental health providers to intentionally and consistently see, respect, and celebrate the aspects that make each person unique. Culturally responsive care stresses that the context of an individual’s background will impact their perception of the world and of current events—and therefore needs to be considered when providing treatment. 

Culturally responsive care helps people feel more comfortable getting mental health support and stay engaged in treatment. It also improves communication, motivation, and openness, and makes the experience of receiving care more satisfying for patients.

Culturally competent mental health providers:

  • Deliberately consider and engage in relevant discussion about all aspects of a client’s life and how these aspects have shaped the person
  • Have strong cross-cultural interpersonal skills
  • Can speak different languages  
  • Foster an environment where people are fully seen in all aspects of their identity through holistic and anti-oppressive therapy, which takes into account power imbalances to create an environment that is free from racism, oppression, and other forms of discrimination

 

With care tailored to their needs and experiences, along with proactive efforts to combat stigma, the Asian American and Pacific Islander community can receive effective care that improves their well-being and quality of life.