Asian American & Pacific Islander
Asian Americans and Pacific Islanders (AAPI) are an integral part of the American cultural mosaic, encompassing a wide range of diversity. AAPI communities consist of approximately 50 distinct ethnic groups speaking over 100 languages, with connections to Chinese, Indian, Japanese, Filipino, Vietnamese, Korean, Hawaiian, and other Asian and Pacific Islander ancestries.
Ethnic and communal identity is considered a notable protective mental health factor for many AAPIs. The sense of communal identity, connections, belonging and family bonds is a strong predictor of resilience while facing life’s challenges. Studies have shown that a strong sense of ethnic identity is linked to lower suicide risks and predicts higher resilience in the face of racial discrimination, which is, unfortunately, an issue for many in this population.
On the other hand, second-generation AAPI immigrants may face challenges in their cultural identity, struggling to balance their familial ties to traditional cultural values with the pressure to assimilate to mainstream American society. Additionally, an emphasis on community identity can create a strong burden of expectations, which may increase stigma and shame if a person doesn’t meet those expectations.
Many cultural traditions within Asian American Pacific Islander (AAPI) communities emphasize “collectivist” values, where personal identity is defined by the interconnectedness and relationships with other community members. The needs and interests of the community often take priority over the needs and wants of each person.
This culture can create a burden of high expectations and family pressure, which can worsen, or even cause, mental health issues. Additionally, having mental health issues typically does not align with the expectations a person is supposed to meet — and too often, people in the AAPI community will try to hide their symptoms from friends and family to avoid the cultural shame and stigma that is so closely associated with mental health issues.
Barriers to Mental Health Care
Compared to those of other racial/ethnic backgrounds, Asian Americans are least likely to receive mental health treatment - only 20.8% of Asian adults with a mental illness received treatment in 2020. There are many systemic barriers to accessing mental health care and quality treatment for Asian Americans, which are exacerbated by stigma and a lack of culturally relevant and integrated care. These disparities can lead to worsened symptoms and poorer quality of life if treatment is unavailable or delayed.
Language Barriers
As immigration is a primary driver of AAPI population growth within the United States, many AAPI do not speak English as their primary language. 30.9% of Asian Americans do not consider themselves fluent in English, and rates of English language proficiency vary depending on nation of origin. Additionally, 60% of AAPIs aged 65 years and older have limited English proficiency. Language barriers and limited availability of culturally appropriate mental health service providers may prevent people from getting the care they need.
Stigma and Shame
Compared to those with other racial/ethnic identities, AAPIs are more likely to report that they did not receive mental health treatment because they:
- Don't want others to find out.
- Feared their neighbors' negative opinions.
Lack of understanding about mental illness and stigma associated with mental health issues can lead to denial or neglect of mental health problems, especially among first-generation AAPI immigrants. The notions of shame and “loss of face” is an important factor in understanding low use of services among AAPI people.
Mental illness has often been considered a weakness or a sign of poor parenting, and a source of shame not only to the individual, but also to the entire household. The desire to protect the family’s reputation can often discourage help-seeking until there is a crisis.
The Model Minority Myth
Asian American communities are burdened with the “model minority” stereotype, a prevalent and misleading assumption that depicts AAPIs as uniformly well-adjusted, attaining more socioeconomic success than other minority groups through strong work ethic, conforming to social norms and excelling academically. The fact is the AAPI community is highly diverse across subgroups in rates of socioeconomic, health and mental health challenges. The social and familial pressure created by this deceptive stereotype can prevent community members from seeking mental health care.
Insufficient Health Insurance Coverage
Concerns over the high cost of mental health care also led to lower rates in help-seeking and treatment adherence. Some groups within the AAPI community face disparities in coverage — Native Hawaiian or Other Pacific Islander (NHOPI) populations have a higher uninsured rate of 13.0% , compared to 7.0% for Asian American communities in 2019.
Immigration Status
Some AAPI immigrants may not seek necessary mental health care due to fears of jeopardizing their immigration status or citizenship application process.
Faith and Spirituality
Faith and spirituality have important influences on mental health, especially for the AAPI community where religious diversity is a distinct characteristic, and more people identify as Buddhists, Hindus, Muslims or other religious affiliations compared to the U.S. average.
Faith communities often offer a built-in social support system. However, religious communities may perpetuate stigma around mental illness that can delay treatment. For example, characterizing mental illness as divine punishment, bad karma, disturbed flow of life energy or imbalance of basic elements inside the body. This is especially true for AAPI families who turn to their religious leaders first for mental health support.
Alternatives to Treatment
Traditional medicine or indigenous healing practices, which often emphasize the integration of mind and body in maintaining health and promoting healing, remain popular forms of mental health intervention in some AAPI communities. These practices include, but are not limited to:
- Traditional Chinese medicine
- Ayurveda - traditional medicine of India
- Kampo - Japanese herbal medicine
- gSo-ba Rigpa - Tibetan medicine
- Acupuncture
- Massage therapy
- Folk nutritional therapy
- Energy healing exercises (ex: tai chi, qi gong)
- Guided meditation
- Spiritual healing
Some AAPIs, especially first-generation immigrants, consider traditional/non-western medicine their primary treatment rather than a complementary treatment. This can result in delaying or refraining from seeking mental health care.
Challenges in Research
Insufficient research on AAPI communities often leads to an inaccurate picture of the experience and needs of these communities. Due to the broad diversity of the community overall, and the relatively small population size of specific cultural subgroups, it can be challenging to obtain adequate samples or to generalize the needs of this population.
Despite these challenges, researchers and clinicians have made progress recently in bridging the gap of quality treatment by exploring culturally relevant interventions for AAPI people. An example is the first NIH-funded study that tested a form of cognitive-behavioral therapy (CBT) adapted for recent Asian American immigrants seeking psychotherapy.
How to Seek Culturally Competent Care
Culturally competent providers understand each person’s values, experiences, and personal beliefs, and strive to provide services that support their goals and are aligned with their cultural values. When a person struggles with their mental health, it is essential to receive quality and culturally competent care to improve outcomes.
Given the vast diversity of AAPI groups, culturally competent providers for these communities often show a strong desire to establish a trust-based therapeutic relationship with the individuals they are treating through effective listening and willingness to learn. They may understand and work with individuals to address concerns over medication, such as fear of side effects. A culturally competent provider may also demonstrate knowledge and acknowledgement of “cultural bound syndromes,” such as:
- "Hwa-byung" - Korean syndrome similar to DSM-5 major depression
- "Taijin kyofyusho" - Japanese disorder similar to DSM-5 social phobia
- "Shenjingshuairuo" - Chinese term for neurasthenia
While we recommend seeking help from a mental health professional, a primary care professional can be a great place to start for an initial assessment or to get a referral for a recommended mental health professional.
When meeting with a provider, ask questions to get a sense of their level of cultural sensitivity. Providers expect and welcome questions from their patients since this helps them better understand what is important in their treatment. Here are some questions to ask:
- Have you treated other AAPI people?
- Have you received training in cultural competence or on AAPI mental health?
- How do you see our cultural backgrounds influencing our communication and my treatment?
Whether you seek help from a primary care professional or a mental health professional, you should finish your sessions with health professionals feeling heard and respected. You may want to ask yourself:
- Did my provider communicate effectively with me?
- Is my provider willing to integrate my beliefs, practices, identity, and cultural background into my treatment plan?
- Did I feel like I was treated with respect and dignity?
- Do I feel like my provider understands and relates well with me?
The relationship and communication between a person and their mental health provider is a key aspect of treatment. It is important that a person feels their identity is understood by their provider to receive the best possible support and care.
Coping and Recovery
You are not alone. AAPI individuals and families contribute to NAMI’s collective wisdom in coping, healing, and recovery. We are fighting to remove the systemic and cultural barriers to quality mental health care for all through awareness campaigns, education, support, outreach, and advocacy.
There are many pathways to healing and the journey of recovery is individual for each person. It can be a long journey, but in an adage ascribed to Laozi, “a journey of a thousand miles begins with a single step.” It is okay to reach out. Your mental health matters and there is always hope.
Listen to NAMI Ambassadors Diana Chao & Martin Hoang discuss the mental health experience of Southeast and East Asian Americans. These two inspiring peer advocates discuss the diversity of the Asian American experience, generational trauma and stress, the effects of stereotypes and racism, and how cultural stigma can play a role in mental health.
Listen to Pooja Mehta’s story where she shares her mental health story as a South Asian American.
