In recent years, a distinctive phenomenon has been taking place within the United States: life expectancy has gone down, caused by an increase in deaths during middle age. These increases in deaths, called “Deaths of Despair,” are linked to alcohol, drugs, and suicides. Since 2007, the suicide rate in the United States has risen, becoming the 10th leading cause of death among Americans. In much of the United States and the majority of the international community, there has been a growing conversation about mental health and well-being. However, the topic of mental health and mental illness has long been swept under the rug amongst Asian-American and Pacific Islanders, and it’s time Asian-Americans join the long overdue discussion.
One big reason that conversations about mental health haven't taken root amongst Asian-Americans is due to the cultural values associated with mental health. Throughout Asia, there is a strong emphasis on the concept of family loyalty and harmony. The insistence on conformity and unity as well as additional societal pressures leads to many Asians to refuse to acknowledge mental disorders or seek treatment in order to save face and prevent shame. These cultural values are passed on amongst immigrant communities, continuing to dictate the views of many Asian-Americans.
Traditional views toward spirituality and religion also affect cultural perception towards mental health and treatment amongst Asians. Mental disorders are often thought to be due to a lack of harmony, evil spirits, or simply sadness. As a result, many mental illnesses are treated with traditional alternatives such as herbs, acupuncture, or spiritual action instead of Western medicine. There is no issue with using Eastern medicinal techniques to help treat some mental disorders. For example, studies have shown that traditional Chinese medicine has helped with anxiety and PTSD. However, with more serious mental disorders like schizophrenia and bipolar depression, Western medicine or Western medicine complemented by Eastern medicine is the best course of action. This seems to be a realistic solution, especially as Western practitioners are adopting Eastern medicinal practices like acupuncture as a less invasive and less risky form of treatment.
Another reason is because there are less available mental health resources within Asia. According to the World Health Organization, The ratio of mental health personnel to the general population is significantly lower than the recommended WHO levels. In China, there are only 15,000 psychiatrists despite the Chinese population being close to roughly 1.2 billion people, or roughly 1 psychiatrist per 80,000 people. These disproportionately low levels are consistent across Asia. In India, there is only 1 psychiatrist per 330,000 people. In Indonesia, the ratio is even lower: 1 psychiatrist per 466,000 people. These statistics become even more dismal when you consider that the majority of these mental health professionals are based in big cities, meaning the rural Asian population lacks access to even the most basic of mental health services.
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Additional barriers present themselves for AAPI youth in the United States. Many young Asian-Americans are first-generation or second-generation Americans, meaning their parents or grandparents made many sacrifices to come to the United States for greater opportunities and stability. For many Asian-American children, the expectation from their parents is to return the favor by succeeding in academics and becoming a highly skilled professional. This is only compounded by societal pressures to fulfill certain Asian-American stereotypes like fitting the “Model Minority” mold (see our Model Minority Myth article). While AAPIs are classified as one large group, they are diverse both culturally and socioeconomically within the U.S. According to the Washington Center for Equitable Growth, these disparities can be seen in college attainment. Nearly 75 percent of Asian Indian and Taiwanese people have a bachelor’s degree or higher. In comparison, roughly 15 percent of Hmong and Cambodian people have a bachelor’s degree or higher, significantly lower than the American average of about 30 percent. Despite the socioeconomic differences among various Asian-American groups, the stereotype of the studious Asian who naturally excels at math and science has been ingrained into the American education system. Such expectations only creates a self-fulfilling prophecy that continuously pushes the bar higher and creates unrealistic expectations for Asian-American students, contributing to mental health issues. Additionally, racial discrimination and the struggle to balance life between two cultures also contributes to mental health problems for Asian-Americans. As a result, AAPI youth often, willingly or unwillingly, sacrifice their well-being to try to fulfill these societal expectations.
One problem with seeking treatment especially within the United States is the cost of mental health services, like talk-based therapy. Mental health services are not prioritized by health insurance companies. Even if therapy is justified as a preventative health measure, because of the seemingly lack of importance of talk-based therapy in society, many insurance companies either do not cover it or will stop covering it for patients. Thus, many patients are forced to pay out-of-pocket, making services like therapy accessible only based on socioeconomic status. Additionally, many therapists don’t take insurance because of the low rates that insurance companies pay them, a direct result of the perceived lack of importance of mental health services by insurance providers.
There are distinctly AAPI issues as well with mental health services. Because seeking mental help is considered taboo, few AAPIs seek out mental health services and many mental health professionals are not trained with the cultural competence necessary to properly treat Asian-Americans. This lack of training, coupled with racial discrimination as well as language barriers contributes to overall AAPI distrust of the American mental health care system.
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However, there is hope. Advocacy organizations and lawmakers are working for change. Although none have been implemented, there are Congressional representatives attempting to take action at the national level. In June of 2017, House Representative Judy Chu (D-CA-27 ) introduced H.R. 2677, otherwise known as the Stop Mental Health Stigma in our Communities Act. Chu, a former clinical psychologist and the first Chinese-American woman elected to Congress, created the act to end mental health stigma in Asian-American communities. The act calls upon the Substance Abuse and Mental Health Services Administration to work with local advocacy groups to create education and outreach strategies to educate Asian-Americans about mental health. A similar bill was introduced by House Representative Barbara Lee (D-CA-13) called the Health Equity and Accountability Act, or H.R. 5942. The proposed bill would improve health care and health literacy for minorities, improve data collection, and health workforce diversity. Within the healthcare industry, broad reforms must take place to address mental health. Mental health care professionals must be trained in cultural competency and knowledge of AAPI cultural values to better treat AAPIs and establish a link of trust between Asian-Americans and the mental health system. Insurance companies must also realize the importance of mental health services and sufficiently cover these services under their plans. It’s time as a country that we start prioritizing the mental health of our citizens and it’s time as an AAPI community that we ensure that destigmatizing mental health care becomes the norm.