Asian Pacific American Heritage Month: Let’s break through mental health stigma

By Regence

May 22, 2023

As we honor Asian Pacific American Heritage Month in May, we continue to examine how we can create more equitable health outcomes in mental health, including for the diverse population of Asian Americans and Pacific Islanders (AAPI) and bring light to some of the disparities these communities face.

According to the National Alliance on Mental Illness (NAMI), mental illness affects one in five adults in the United States. Of AAPI adults with a mental illness, more than 73 percent do not receive treatment, compared to 57 percent of the overall U.S. population.

Mental health is just as important as physical health, but it continues to be an uncomfortable and often stigmatized topic in many communities of color. Of all racial groups, AAPI adults are the least likely to seek mental health treatment. That’s one of the reasons we why need to change the way we talk about mental health and make it a priority in all communities.

A tapestry of distinct differences

The AAPI population in the U.S. includes about 25.6 million individuals, but it’s important to recognize that the AAPI label encompasses a wide range of countries, ethnicities, languages and identities, with vast differences in socioeconomic status, education, immigration, religion, cultural values and gaps in care. These differences influence the barriers to care experienced by AAPI communities.

However, Asian Americans (defined as those with ancestry from East Asia, Southeast Asia or the Indian subcontinent) and Native Hawaiians and other Pacific Islanders (defined as those with ancestry from Hawaii, Guam, Samoa or other Pacific Islands) have often been combined into one giant dataset in research studies. This approach makes it harder to recognize the unique experiences and distinct health care needs of each group, limiting the ability to identify important health disparities and their causes.

Due to the limited research overall on AAPI individuals, this article acknowledges the inadequacy of this umbrella label in its discussion of barriers to mental health services for the broader group.

Why is mental health so stigmatized?

In AAPI cultures, mental illness is often viewed as a weakness or a personal failure. Seeking help for mental health issues may be stigmatized, and people may feel ashamed or embarrassed to talk about their struggles. As a result, AAPI adults tend to dismiss, deny or neglect their symptoms, often focusing on treating the physical signs, such as poor appetite, trouble sleeping, upset stomach or rapid heartbeats, rather than the underlying psychological cause.

Many traditional AAPI communities also prioritize the needs of the family and community over the personal needs of the individual. As a consequence, many AAPI adults feel that it is their responsibility to take care of their family and community first before attending to their own needs as it seems selfish. This cultural emphasis on family also makes it challenging for people to disclose their mental health struggles to their loved ones for fear of burdening them or causing them to worry.

“We need to break the stigma of mental health issues by opening up about them,” said Gary Lau, Regence’s senior associate general counsel and chair of the AAPI employee resource group. “Many traditional Asian cultures value stoicism and suppressing emotional hardships. But emotions are an essential part of our existence. Normalizing conversations about mental health and sharing our experiences with our families and communities will help dismantle the stigma and shame.”

Stigma can also lead to discrimination and negative stereotypes, including the "model minority" myth that suggests AAPIs are not challenged by health disparities. These stereotypes can prevent AAPIs from seeking care, as they may feel that their struggles are not valid or that seeking help will perpetuate further stereotypes.

To normalize mental health, it is important to promote mental health awareness and education within AAPI communities. This can involve working with community leaders and organizations to create messages and programs that are culturally relevant and encourages individuals to seek help for their mental health. Media and storytelling can also address negative stereotypes and promote positive attitudes toward mental health.

Language barriers lead to care barriers

Language barriers make it difficult for many AAPIs to access mental health services and communicate effectively with providers. Overall, 30.8 percent of Asian Americans and 12.1 percent of nonelderly Native Hawaiians and Pacific Islanders do not speak English fluently. Research shows that English fluency is associated with perceived need for care and willingness to use psychological services.

To address language barriers, many mental health professionals have called for greater bilingual services and better coordination between health systems and community resources that serve AAPIs, including engaging peer support and community health workers. Additionally, increasing the inclusion of non-English speakers in medical research can help prevent biased sample populations overrepresenting AAPIs who have high levels of education and income, which overshadows the barriers faced by other groups.

The importance of cultural context

AAPI providers are often underrepresented in the mental health field, and many mental health providers may not be familiar with the unique cultural beliefs and values of different AAPI groups. The lack of cultural competency among providers may lead to misdiagnosis or underdiagnosis of mental health issues, further perpetuating the stigma around seeking help.

To solve for this, it is critical to increase the representation of AAPIs and other ethnicities in the mental health field. This can involve providing funding and resources to support AAPIs interested in pursuing careers in mental health. When mental health providers understand and respect the cultural context of their patients’ diverse values and backgrounds, it helps build trust and can improve health outcomes.

Virtual care can help address barriers of stigma, access and diversity

A long road lies ahead to make mental health care more equitable for communities of color, but one step Regence is taking is improving access through virtual care. Most Regence members have access to multiple virtual and in-person mental health providers who treat a wide range of conditions.

Virtual care offers geographic flexibility and enables members to connect with a wider variety of providers, competencies and availabilities, offering more potential for finding a compatible provider. Virtual care can also eliminate transportation barriers and is particularly beneficial for members living in rural or underserved areas with limited access to mental health services.

As virtual mental health care becomes more widely adopted and accessed through everyday online platforms, it may help normalize seeking care for mental health concerns. While virtual care may help lessen stigma, it's important to note that stigma is a complex societal issue with a wide range of contributors.

Combining virtual care with broader mental health advocacy and education, increasing and diversifying providers, and supporting policy changes that improve access can all help reduce disparities and promote a more supportive and inclusive environment for individuals seeking mental health support.