Overcoming barriers to AAPI mental health treatment

When addressing mental health amongst AAPI communities, nuanced care goes beyond overcoming linguistic barriers, moving towards understanding cultural norms that can powerfully affect attitudes towards mental health. 

According to The Asian American Federation’s “Seeking Help, Finding Hope: mental health challenges and solutions for Asian Americans in New York City” study, a majority of Asian American New Yorkers struggle with anxiety and feelings of isolation, yet remain reluctant to seek treatment. 

One of the driving forces behind this mental health decline stems from the stress of high living costs, as one third of AAPI New Yorkers are low-income, an often underrepresented figure given widespread assumptions of AAPI New Yorkers as high achievers. Stereotypes such as the model minority myth have added to these pressures, further stressing and isolating struggling individuals. 

“A lot of people actually find this surprising because there is a common belief that Asian Americans are financially fine, when many are struggling to make ends meet,” said Linying He, associate director of research of the Asian American Federation. “This financial pressure is more than just money, it can take a toll on their well being. And it’s also interlinked with the model minority myth, since there is this pressure that you always have to be on top of your game,” 

Additional factors that aggravate mental health include racial and religious intolerance and perpetual foreigner stereotypes – all emphasizing the feelings of isolation felt within the AAPI community. These pressures feed into cultural notions of shame, as AAPI members tend to feel reluctant to admit to mental health struggles. According to He, providers can best tackle mental health issues by shifting the way such challenges are framed. 

“We’ll encourage them to talk about their physical symptoms, because oftentimes, especially with older generations, they are more comfortable talking about feeling tired, or any physical discomfort, instead of directly expressing their emotional stress,” He explained. “What we found is that if they start talking about sleep patterns, appetites, stress, they are more willing to share what's going on.” 

Providers should also implement action-oriented approaches which open discussions by addressing physical stressors, before diving into issues surrounding mental health. 

“One thing we realized is a lot of Asian Americans go into therapy sessions framing it as if they're facing a problem, to which they’re looking for a solution,” He continued. “Therapists who deal with Asian American patients will frame [the issue] into a problem that's solvable. When you break it down into smaller parts, they are more willing to make improvements and become more open over time.”

In addition to being well-versed in culturally implicit communication styles, AAPI mental health providers need to be linguistically competent, as 83% of the study’s respondents noted language-access being a significant barrier to mental health care. With many AAPI languages not possessing actual terms for mental health issues, many AAPI community members tend to display low levels of mental health literacy, thus aggravating stigmas towards mental health. 

“For a lot of Asian ethnic groups, there aren’t terms for mental health issues. It's related to being mentally ill, and they are very worried about being labeled as mentally ill. This could be a shame to their family, either for older or younger generations,” He said. 

According to AAF, community based organizations are best equipped to lead the change in attitudes towards mental health, given both their linguistic and culturally-sensitive expertise, and proximity to AAPI populations.

“We have organizations who are on the ground doing this work, and they really have the trust of their community members,” said Daphne Thammasila, associate director of programs. “And that's also true with mental health as well, [which is] why we have our roundtable, where we’re serving all different communities across the city, because they are the ones who can actually speak the language of community members to provide culturally appropriate mental health services,” 

Through their ability to nimbly address the nuanced elements of support, community based organizations are equipped to bridge gaps in AAPI mental healthcare. AAF’s mental health roundtable aims to encourage policymakers to increase support in community-based organizations through robust funding and investments in a linguistically and culturally competent mental healthcare workforce. Additionally, through the organization’s AAF Mental Health Directory, AAPI community members can find clinical and non-clinical mental health providers tailored to their needs. The first database of its kind, the directory aims to bridge gaps in access by connecting patients to a wealth of underutilized resources. 

“CBOs are the trust piece. A lot of the community members trust those CBOs because they were on the ground serving the community for so many years,” said He. “So if they are there in a venue where they feel comfortable, they are definitely more willing to talk to doctors. And that’s very important. When you want to start talking about mental health to someone who doesn't feel safe, you need to be in a place that they feel comfortable to start.”