Hello All! I originally posted this blog for the clinic I work for, Freedom Institute, here. Addressing the concerns of the Asian American community in regards to mental health care is an issue I am passionate about. I hope you enjoy the post.
May is both Asian American and Pacific Islander (AAPI) Month and Mental Health Awareness Month. I happen to be Asian American (or a Pacific Islander, I can never decide) and a mental health care professional. I’ve read about theinitiatives being lobbied for in Washington on behalf of the AAPI community and several blog posts/articles about depression, suicide prevention, and substance abuse treatment. As this month comes to an end, the lack of mental health parity in this community, and all the reasons for it, gives me reason to reflect on my experiences as a clinician and as an Asian American.
About a year and a half ago, a dear family friend was in need of a referral for a family member struggling with severe alcohol dependency. The hurdle was that the person seeking treatment only spoke his native language. I knew it would be near impossible to find any clinician – regardless of specialty – that spoke the same language. Recently, he passed away due to medical complications related to his alcoholism. It’s a tragic loss, and since I found out I’ve kept thinking, “If only I could have found someone.”
Yet, there may have been no one to find.
This experience is not unique to me. The lack of mental health care resources for the extremely diverse AAPI community is a silent plague impinging on our universal well-being. This community, my community, is the fastest growing ethnic group in America according to the 2010 Census1. AAPI’s are often identified as the, “model minority,” since popular perception is that AAPI are well-educated, law abiding, and gainfully employed, thus contributing to society at large. Yet, this conceptualization of AAPI’s masks underlying concerns: immigration laws that inadvertently contribute to family trauma, crime, and poverty, and a lack of culturally and linguistically appropriate mental health care services. According to the National Asian American Pacific Islander Mental Health Association, only 1.5 % of psychologists, 2% of social workers, 0% of psychiatric nurses and .01% of marriage and family therapists are of Asian American, Native Hawaiian and Pacific Island decent. There is no data on bi-lingual clinicians2. Furthermore, among persons in need of alcohol or illicit drug use treatment, Asian Americans or Pacific Islanders were less likely than persons of other racial and ethnic groups to receive treatment at a specialty facility in the past year (5.3 vs. 10.4 percent)3
What does this mean for mental health care professionals? We must make a concerted effort to train and hire culturally competent clinicians. We must also work with advocacy groups to educate the Asian American community about mental health to alleviate the shame that so often prevents AAPI’s from seeking appropriate treatment. Often, and this is especially true of first generation immigrants, AAPI’s somaticize mental health concerns like depression. Thus, they may seek medical treatment from a primary care physician as opposed to a qualified mental health care practitioner. Lastly, sensitivities to the particular psycho-social stressors that affect second- and third- generation Asian Americans must come into the consulting room. As is the case with many hyphenated Americans, straddling two cultures with opposing world views can create challenges that lead to depression, anxiety, and substance abuse.
We see this in the students of color we work with in the Independent Schools: there is often an unspoken added stress of being “other” on top of traditional school stresses. Interesting, in the Independent School population I often encounter students who are AAPI and have been adopted by non-AAPI parents. These students have candidly shared the obstacles they have encounter as they navigate their social worlds. For many students of color, the greater imperative to belong to a racially homogeneous social world increases their susceptibility to alcohol and/or drug abuse.
Complicating this issue further is inherent individualism engrained in American culture which directly opposes the family-centric sense of self found in Asian cultures. For many Asian and Asian Americans, one’s own personal struggles (albeit with depression, anxiety or substance abuse) are direct reflections of their family’s self-worth. The desire to protect the family from humiliation, AAPI who are in need of treatment will not seek it out. As we see this with the AAPI adolescents we work with, education about what substance abuse is and how to appropriately treat it are often the first treatment goals. At Freedom Institute, our clinical focus on family treatment to address substance abuse enables us to work in a manner that is culturally attuned to the AAPI population.
The breadth of challenges related to AAPI’s underutilization of mental health treatment is far too intricate to delineate in this post. “The overall health and well-being of the Nation is improved by the extent to which the entire population has access to substance use treatment when it is needed. Understanding whether Asian Americans or Pacific Islanders seek and receive specialty treatment may help improve outreach and treatment programs for this population4.” Raising awareness about these challenges to all Americans is vital, the more we are aware of these issues, the more we can do to solve them regardless of race, color or creed.
References
- Retrieved from http://naapimha.org/wordpress/media/NAAPIMHA-Immigration-and-Mental-Health-5-13-2013.pdf
- Retrieved from http://naapimha.org/resources/fact-sheets/
- Retrieved from http://www.samhsa.gov/data/2k13/NSDUH125/sr125-aapi-tx.htm
- Retrieved from http://www.samhsa.gov/data/2k13/NSDUH125/sr125-aapi-tx.htm