Educational Resources

Before addressing the mental health needs of AAPI, we first need to understand what is mental health, what is AAPI, and what kinds of mental health problems are they facing. In this page, we have offered you different types of educational resources for you to take a look at and gain more knowledge on mental health, AAPI community, and the struggles they are encountering.

What is mental health?

According to CDC (2021), our emotional, psychological, and social well-being are all part of our mental health. It has an impact on the way we think, feel, and act. It also influences how we deal with stress, interact with people, and make good decisions. Mental health is crucial at all stages of life, including childhood, adolescence, and adulthood.

Poor mental health and mental illness are not synonymous, despite the fact that the phrases are sometimes used interchangeably. A person’s mental health can deteriorate without being diagnosed with a mental condition. A person suffering from a mental illness can also go through phases of physical, mental, and social well-being.

What is mental well-being?

According to the WHO (2018), mental well-being “is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.”

Some of the key facts WHO(2018) identified on mental well-being are:

• It is more than the absence of mental disorders.
• It is an integral part of well-being; indeed, there is no well-being without mental well-being.
• It is determined by a range of socioeconomic, biological and environmental factors.
• Cost-effective public health and intersectoral strategies and interventions exist to promote, protect and restore mental well-being.

Courtesy from NAMI – Asian American & Pacific Islander –  (https://www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/Asian-American-and-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.

As of the 2020 Census, 24 million people identified as Asian and 1.6 million identified as Native Hawaiian and Other Pacific Islander, either as their only identity or in combination with another identity.

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.

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:

• Didn’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 lead 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 (the 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 is struggling with their mental health, it is essential to receive quality and culturally competent care in order 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’s very important that a person feels their identity is understood by their provider to receive the best possible support and care.

More Information

• If finances are preventing you from finding help, contact a local health or mental health clinic or your local government to see what services you qualify for. You can find contact information online at findtreatment.samhsa.gov or by calling the National Treatment Referral Helpline at 800-662-HELP (4357).
• If you or your loved one does not speak English, or are not fluent, you have the right to receive language-access services at institutions that receive funding from the federal government as well as the right to request a trained interpreter and to receive information in your language.