By Kyrios LoNigro
NOTE: Mention of s**cide.
When we talk about civic engagement, one of the largest barriers to access is disability. It is hard to block walk with a cane, and equally as difficult to ask someone with chronic fatigue to attend marathon hearings. Even less spoken about than physical disabilities are mental ones. While both physical and mental health resources are difficult to access in Texas (the nation’s leading state of uninsured persons) accessibility is far worse for our Asian communities. Asian communities are highly diverse, representing 48 countries, over 2,000 languages, and a myriad of different needs. The majority of Asian Americans are immigrants, with many not having a reference point for mental health care due to the lack of that type of infrastructure in their home countries. These barriers combined with lack of representation create a sometimes deadly cocktail for Asian mental health.
Our Asian community is the most rapidly growing in the nation, with Texas having the second-highest Asian population, just behind California. A high proportion of Asian Americans are immigrants, a status that presents unique barriers. Levels of English proficiency vary greatly depending upon a person’s country of origin and reasons for migrating. While Japanese, Indian, and Filipino persons tend to have the most English-speaking ability, those from Myanmar and Bhutan have the least. Similar disparities are reflected in income inequality, making Asians the most financially stratified group in the U.S. While financial straits may prevent someone from seeking care, those who try to seek care may find themselves unable to communicate with health professionals.
When providers don’t speak your language, your ability to seek services shrinks dramatically. Asian Americans have struggled to gain access to the COVID-19 vaccine due to language barriers that make it nearly impossible to navigate the systems needed to sign up. While many may turn to family as a primary support when tackling these hurdles, they may not do the same when it comes to mental health due to stigma. Asian American men in high school experiencing suicidal ideation is higher than whites. Similarly, the amount of Asian American women ages 15-24 who have attempted suicide is higher than that of white people. Suicide is the leading cause of death for young Asians. However, despite these disparities, our Asian community members seek care at less than half the rate of whites.
The model minority myth, pressures by family to be successful, and inheritances from colonialism have led to Asians underreporting their symptoms and not seeking treatment. As Asia was colonized by Europeans, westernized mental asylums overtook community health practices. Mental asylums were often kept far from the rest of the community, developing separately from other healthcare systems. As a result, most Asian countries have a historically poor approach to teaching medical students how to navigate mental illness. Those needing psychiatric help are still viewed more as oddities than people, and the focus continues to be on severe presentations of illness and not on daily care. Medical approaches dominate over the holistic, and mental health care continues to be chronically underfunded as estimates show that the mental health budget for the majority of Asian countries is less than the World Health Organization’s recommended minimum. In the Asia-Pacific, anywhere from 50 to 90 percent of those needing treatment are unable to access it.
Access may be greater in the U.S. but these stigmas stay with immigrants even as they face new limitations by income and language barriers. When communities do not have the language to start conversations around mental health, the ability to seek it remains impaired. If someone does have the language, they still may feel as if they cannot ask for help due to the immense pressure experienced by being a young Asian from an immigrant family. In immigrant families, the need to advance the status of yourself and your family overpowers many of the needs which prioritize the self: rest, relaxation, and therapy. The model minority myth puts impossible standards on a diverse group of people struggling to, like the rest of us, survive.
Amidst the mental health crisis happening amongst youth in the United States, it is paramount that we not leave behind any group suffering from lack of access and acceptance. I often joke with other descendants of immigrants that our families do not believe in mental health, but that joke comes at a price. Our own well-being should not be the butt of a joke but should instead be a rallying point for those in our communities who share the experience of being unheard. With layers of oppression weighing us down, if we do not have these conversations our power will never be fully realized, and our circumstances will not change.
The National Institute of Minority Health hosted a mental health essay contest for high school students in 2019. Amanda, one of the winners, wrote, “It sometimes feels as if my Asian-American peers and I are all ducks—calm on the surface, but paddling frantically under the surface just to stay afloat. Many of us experience the same struggles, but each of us believes we are alone if we keep silent about it. Students should be taught the importance of all emotions, good and bad. It is just as important to experience and acknowledge negative feelings as it is positive ones; the danger lies in suppressing negative emotions or feeling shame for having them.”