Mental Health Among Asian Americans and Pacific Islanders

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Asian Americans and Pacific Islanders (AAPI) are the fastest growing minority group in the US. Data from the 2020 Census Bureau show the AAPI community at 20.7 million strong. Of those, nearly 15 percent reported having a mental illness in the past year.  

Yet AAPIs are three times less likely to seek mental health services than white people. Different ethnic groups under the AAPI umbrella face different complex barriers, such as stigma. These barriers have been exacerbated by the rise in anti-Asian hate due to the political climate as well as the COVID-19 pandemic. AAPI elders, for example, have faced isolation and other barriers to get the help that they need during the pandemic.

Randon Aea, ICHS behavioral health manager, and Jia Yin Lee, ICHS licensed mental health counselor associate, explain why and what we can do to change that. 

Listen here:

ICHS launched “Together We Rise: A Wellness Podcast” in 2022 to empower, educate, and care for the diverse communities we serve. Our topics have ranged from fighting the mental health stigma to cultural sensitivity in diabetes care to the importance of pediatric dental health.

Transcription:

Scott Webb: There are many barriers to behavioral healthcare that we all face, but it’s especially true for the diverse patient population that ICHS serves. And joining me today to discuss these barriers and how ICHS is working to remove them to provide the best medical and behavioral healthcare possible is Randon Aea, he’s the Behavioral Health Manager at ICHS. And I’m also joined by Jia Yin Lee. She’s a licensed mental health counselor associate at ICHS.

Welcome to Together We Rise Wellness Podcast from International Community Health Services. I’m Scott Webb. So I want to thank you both for joining me. We’re going to have an important conversation today. And Randon, I’m going to start with you. What are the barriers to behavioral healthcare for Asian Americans, Pacific Islanders, those communities, you know, what are the barriers that they face?

Randon Aea: I think it’s really important to look at the Asian American and the Pacific Islander community separately. I think we need to disaggregate the data when it comes to the behavioral health needs of both communities and take a look at them in its own light. That being said, if I was going to respond from the Asian American community, I would say that a lot of Asians face stigma related to barriers when it comes to trying to access behavioral healthcare. And I think these stigmas are related to the model minority myth as this myth does not seem to allow room for vulnerability. I also think, from the perspective of looking at the community as a whole, we’re looking at generally a collective community, where those within the community will share their successes and challenges as a whole, as a community, which basically turns out to be most Asians that we are working with here at ICHS just seem to be more reluctant to share their challenges and vulnerability related to behavioral health as, you know, it may be seen as a weakness, not on the individual, but a weakness focusing back to the entire community.

I also think the stigma can also be experienced generationally, as it may be difficult for one generation to speak about their feelings to maybe the older generation. And the whole concept of being vulnerable may be challenging within a family. And I think all of those things are really important things to consider when you’re trying to address stigmas, looking at it from that lens.

Jia Yin Lee: I totally agree on those points. I think, like Randon mentioned, there’s different layers when it comes to individuals, community, family, structures, system. It’s very important for us to break it down in terms of data and also the approach when it comes to addressing some of the barriers, because different communities, different culture, different background have its own unique type of barriers that we need to really put into consideration when we are trying to identify what are the things that we can do to break that barrier or challenge.

Scott Webb: Yeah, Jia. And I know that ICHS serves such a diverse patient population. Eighty-five percent are people of color and many are from immigrant and refugee communities. So how is ICHS providing behavioral health support to these individuals?

Jia Yin Lee: The great thing about ICHS is our main population of our employees, we ourselves are part of the community too. So a lot of us are either first generation or Asian American ourselves. So with that kind of unique background, it’s easier for us to relate with our patient’s struggle. It’s easier for us to understand how it is to be like when you are in a place where you don’t speak the language, you are in a place where you’re unable to communicate, even with just asking a simple question in terms of where’s the lobby or where is the bathroom, right?

So with that kind of unique experience and background, it gives our patient comfort and reassurance that this service fits them really well because, out of other services, on a personal level, we know their struggles and we know the barriers that they experience.

Randon Aea: And I also think it’s important to kind of take a step back and, you know, several studies have shown that there are language barriers and lack of awareness of where and even how to get help. And I think that is also one of the barriers to care since I may not know where to go. And I really think that part of what I’m very proud of of what ICHS does is because we provide integrated primary care with behavioral health.

So to kind of chip away at more of the stigmas and barriers, it’s a lot easier to access care through your medical provider. There’s a trusted relationship with your medical provider and we want to try to leverage that trust to introduce another member of the patient’s care team. And I think it’s really important for the behavioral provider to present themselves as a member of the patient’s team. We try to say, “I’m part of this team already. Did you know that you can access me through your primary care doctor?” Instead of saying,” You need behavioral health. You need to talk about, you know, your depression or your anxiety,” that’s not as engaging or safe. So when you already have someone introducing themselves to you and acknowledging the fact that “I am a part of your care team and I can help carry or support you in this particular manner when it comes to your behavioral health needs,” I think it’s a lot easier to engage in care when you’ve got the one-stop shop, everyone’s already there. You don’t have to take a referral, go to a completely different building and try to access behavioral healthcare somewhere else and start all over again where you don’t know how to get there. Maybe you’re kind of like, “What do I do when I get there?” It’s already here for our patients. And I think that’s really important about the integrated primary care behavioral health model.

Scott Webb: Sounds really amazing. And sticking with you, you know, I know that anti-Asian violence during COVID-19, during the pandemic, has been particularly traumatizing for members of the community. In a general sense, what are your Asian American clients telling you about how they’re feeling and how they’re doing?

Randon Aea: You know, the first thing I want to say about that is COVID-19 did not bring this. This level of anti-Asian violence has been going on for hundreds of years. I would say that we need to also acknowledge the fact that, you know, anti-Asian violence existed before the COVID-19 pandemic and even dates back to the 1887 Chinese massacre in California or the Chinese Exclusion Act of 1882. And even the imprisonment of Japanese American communities during World War II. I’m not going to say internment. I actually am going to say imprisonment because it’s really important to state that.

You know, since the onset of COVID-19, a lot of Asians feel like they’ve been blamed for the pandemic. And obviously, this will add fuel to a fire that, you know, started centuries ago. Generally, the majority of ICHS Asian patients would agree that violence against Asians is increasing. It’s impacting their daily routines because of the potential of violence they may face. And ultimately, this may lead to further isolation, which worsens feelings of depression and anxiety. So it’s this horrible cycle.

I think it’s especially true of Asian immigrants who are, in some circumstances, already separated from their families, families who may still be living in their home country while you have people living here in America. And I can only imagine how challenging and really terrible that would be, being apart from my family in a new country where I don’t really feel welcomed. I mean, it just adds more and more to this soup, right?

And I would say, just looking at some data, there was some Pew research data back in April ’22, that overall, you know, six in 10 Asian adults, that’s 63%, say violence against Asian Americans in the United States is increasing. And unfortunately, I can’t debate that. I see a lot of fear walking around the neighborhoods of our clinics. And it’s just this general fear, not only for our health, but fear that was already there prior to this pandemic.

Jia Yin Lee: Yeah, I do agree about the general theme of fear. I think, specifically with the immigrant’s trust, it’s so precious that it’s so hard to earn, let alone, to lose, right? So like what Randon just mentioned, when it’s so hard to acculturate in a space or in a place where you don’t feel belong, the trust level, it’s already been jeopardized. On top of that, you have people in the community physically showing you signs of distrust. It’s harder for them to break that challenge and barrier to go out to be more socialized. It’s hard for them to not be judgemental when they’re out there because the trust is not there.

Scott Webb: Yeah, I see what you mean. You know, all folks, everybody has been dealing with a lot during COVID-19, but especially Asian Americans. And as Randon said, this is nothing new, right? Asian Americans, Asian immigrants have been dealing with this for hundreds of years. And Randon, you know, you’re dealing with such diverse populations and so many different needs, but especially through this lens of behavioral health that we’re talking about today. What kinds of coping strategies do you recommend to your clients?

Randon Aea: In order for you to look at how to cope, I think it’s most important to look at what are we coping with? And I think it’s really important to just know the pandemic has impacted everyone equally in a sense. And I think it’s really important that a lot of us are coping with the fact that we’ve been isolated for almost two years. And I think the worst thing that anyone could feel is being completely alone. And even though you have access to loved ones and people to socialize with, the fear of illness and health keeps us away from people we really want to be with. And I really think that is the hardest thing and it has impacted everybody. And I think, when you’re isolated, that only builds upon the anxiety of what’s going to happen next, that depression related to the fact that I feel so alone. And I think the most important coping strategy outside of trying to safely socialize again, because we are social beings, I think the most important coping strategy is to go get help.

I think when you’re trying to access care through the integrated model of care that we offer here, I think that’s the best way to learn more about an established behavioral healthcare while you already have access to primary care. I think a lot of people have put off a lot of their health needs because they need to isolate. And at the same time, that doesn’t help your diabetes, does not help your hypertension. And the interesting thing about that is if you are also more or less experiencing depression and hypertension or diabetic, addressing your depression actually has a positive impact on your diabetes. So if you’re completely isolated, you know, now you’ve got your chronic health conditions getting worse and then meanwhile, you become more isolated and depressed.

So I think, you know, getting care, not only to try to address the depression and the anxiety, but to also keep up on the fact that we all have all these chronic conditions that need to be monitored. So I like to think about it as it’s really difficult to just go talk to a therapist or a counselor. But since I’m already going to talk to my doctor about my diabetes, “Oh, did you know that you also have access to a behavioral health provider?” So the integrated model, I mean, it works itself. And I think it’s really important if we are struggling or if you’re worried about someone who may be struggling, get care, get help. Engage the people you love. Check in with them. And if they’re having a hard time, “Have you seen someone? Have you gone to your doctor?” Usually, people don’t jump out by saying, “Have you gotten counseling?” But a sign of the times lately, I think access to counseling or just talking about counseling has been a lot easier across the board because of where we all are.

Scott Webb: Yeah. And you mentioned earlier, you used the expression sort of one-stop shopping. And it really does seem like the ICHS, that integrative model really lends itself well to that kind of one-stop shopping, if you’re there for your blood pressure, your diabetes or whatever it is, you can also, you know, address your mental health needs, right?

Randon Aea: And I also want to add, in addition to one-stop shopping, no door is the wrong door. All doors lead to the care that you need. So if you ever walk through a building and you find a locked door, it’s like, “Oh, that door’s locked.” Well, we want to look at it as all doors can lead you to access the care you need. So there’s no locked doors.

Scott Webb: Yeah, we just need to walk through the door metaphorically. And Jia, I’m sure you probably, you know, you’re sort of there on the front lines and dealing with people on a daily basis, what kinds of coping strategies are you recommending?

Jia Yin Lee: I think that one of the most effective coping or healing process needs to be in the process of connection. No matter what issue you’re dealing with, mental health-wise, physical health-wise, the power of connecting with another individual who shares the same issue with you, that itself, it’s already the first step of healing.

I agree, like what’s mentioned before by Randon with the socializing piece, I think that is the single most effective way to cope with any issue, again, in regards to physical and mental health. Of course, talking to another person does not cure your diabetes, does not cure your heart issue, does not cure your cancer, but it helps you to find other options when it comes to, “Can we have a buddy system?” and in terms of going on evening walks. Can we have someone that we hang out with in the park when we’re trying to discuss very intimate issues in regards to our struggle with dealing with pain. So, I think socializing, connecting with others is the most powerful thing that we can give ourselves in terms of healing. And that’s not something that we can always rely on other people to do when it comes to coping.

Scott Webb: I think you’re so right. I think there is strength in numbers, especially with people that we trust, that we respect, whether that’s friends, family, you know, healthcare providers and so on. Such great advice, especially after what we’ve all been through during COVID-19. It’s been a really important conversation today and I’m glad that we had it. Randon, as we wrap up here, what can we do on a state or federal level to offer services and to educate the community about behavioral health?

Randon Aea: So, I guess have to take off my behavioral health hat and put on my advocacy hat, right? And this was an issue pre-pandemic, parity of care. Even though there are stigmas that are connected to trying to access care, there’s a lot of situations where even if you could access care, your insurance wouldn’t cover it. And I think we have to kind of take another look back at how things were prior to the pandemic and look at all of those barriers that have nothing to do with the patient itself, but the system. And if we’re looking, you know, at a state or a federal level, I think the access to care is ultimately being able to have it paid for.

And I also think that we should advocate for behavioral health parity, equal treatment of mental health and substance use conditions in insurance plans. I think we should have equally covered for behavioral healthcare as if it would cover your primary care. My broken arm can probably get a lot more, you know, care and be covered by my insurance, but not necessarily my depression. And I really think that if we’re going to look at the person as a whole, if we’re going to heal the person with their emotions, their anxiety, their depression, in addition to their chronic medical conditions, you’ve got to be able to pay for both equally. If we’re talking about holistic, you know, care, we should have holistic payment. I think it’s really, really important. And I feel like we’ve been kind of talking about this, leading up to the pandemic, but the pandemic really just leveled everything, so everyone feels, you know, how important our behavioral health meets are. As tragic as the last two years have been, I think it now is the opportunity to leverage that, to advocate for making sure that not only we have access, but we can pay for it.

I think it’s also important that we should continue to integrate primary care and behavioral health. And I think that we should also look at, you know, barriers that may be related to seeking a higher level of behavioral healthcare. So I’m talking from the primary care office to like an outpatient level where you may need more care than what you would get at your doctor’s office.

I think I’m advocating for both. I think if you go to your primary care doctor and you need a surgery, that should be covered, right? It’s the same thing if you are a little bit depressed and then you get a lot depressed and then you have to go get outpatient care, I think that should be covered as well. I also think that more education on how depression and anxiety has an impact on our primary care conditions like diabetes and hypertension. When we have to take a look at trying to look at one or the other, I think we should be looking at both and how our mental health needs actually have an impact on our physical needs.

And if you think about it, it’s the inverse as well. If I have a broken leg and I feel isolated and depressed, it goes both ways. So I really think we should look at it holistically. I think we should care for the human being as a whole. We should look at our emotional needs, just as much as our physical needs.

Scott Webb: That’s really well said. You know, I was thinking, as you were speaking there, that healing minds should be just as important and just as much a priority to insurance companies, uh, and the state and federal authorities as healing bones.

And so as far as we’ve come, we have a long way to go, uh, conversations like this educational conversations, like this are so important. So thank you both. And you both stay well. Thank you. Thank you.

And for more information, go to ichs.com. This has been the Together We Rise Wellness podcast from International Community Health Services. If you enjoyed what you heard, please be sure to share in your social media channels and check out our entire podcast library for additional topics of interest. I’m Scott Webb. Stay well, and we’ll talk again next time.

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