Mental Health Information and Impacts: Asian Americans and Pacific Islanders (AAPI)
May marks Asian/Pacific American Heritage Month. Below, NAMI information and resources to support our AAPI community members.
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 ethnic groups speaking over 100 languages, with connections to Chinese, Indian, Japanese, Filipino, Vietnamese, Korean, Hawaiian, and other Asian and Pacific Islander ancestries.
Over 24 million Americans, or 7.3% of the U.S. population, are AAPI; however, about two-thirds of the population identify with their specific ethnicity or country of origin.
Ethnic and community identity is considered a notable protective factor to mental health for many AAPIs. The sense of communal identity, connections, belonging and family bonds is a strong predictor of resilience while facing life’s challenges. In fact, 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 can face challenges in 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
AAPIs have the lowest help-seeking rate of any racial/ethnic group, with only 23.3% of AAPI adults with a mental illness receiving treatment in 2019. This is due to the many systemic barriers to accessing mental health care and quality treatment. It may also be driven by stigma and lack of culturally relevant and integrated care that addresses mental health in a more holistic way. These disparities can lead to worsened symptoms and poorer quality of life due to the lack of or delayed treatment.
Over 13 million U.S. residents were born in Asia, representing over 30% of the total foreign-born population in the nation. Overall, 32.6% of AAPI Americans are not fluent in English, and rates of proficiency vary within specific subgroups: 44.8% of Chinese, 20.9 % of Filipinos and 18.7% of Asian Indians are not fluent in English. Additionally, 60% of AAPIs aged 65 years and older have limited English proficiency. The disparity between the high demand and poor availability of linguistically and culturally appropriate mental health service providers is a significant gap in accessing treatment.
Stigma and Shame
According to a recent SAMSHA survey, compared to other racial and ethnic groups, AAPIs are the most likely to quote the following reasons for not receiving mental health treatment:
- Didn’t want others to find out
- Confidentiality concerns
- Fear of 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 9.3%, compared to 6.8% for Asian American communities in 2018.
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/non-western 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)
- Japanese herbal medicine
- Tibetan medicine
- Massage therapy
- Folk nutritional therapy
- Energy healing exercises (such as tai chi and 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 Chinese American people seeking psychotherapy.