Asian Americans work to end stigma
As the global emergency surrounding the COVID-19 pandemic ended last year, directors at Self-Help for the Elderly, an agency serving San Francisco’s Asian American community, figured seniors would emerge from their seclusion and return to social activities they once embraced: community lunches, tai chi sessions, walks in the park.
Instead, they found, many continued to stay home, alarmed by continuing reports of anti-Asian violence.
“They don’t dare to go out because of a really deep fear of being attacked,” said Anni Chung, the agency’s president and CEO. “That leads to a lack of physical activity and, eventually, signs of depression.”
Nationwide, pandemic-related isolation, anti-Asian rhetoric and abuse – along with mass shootings that claimed Asian victims in Atlanta and California – have exacerbated the mental health challenges faced by Asian Americans. Meanwhile, studies show Asian Americans are least likely to seek mental health services, partly because of the cultural stigma.
“Having these conversations and seeking mental health care are still stigmatized across Asian American communities,” said Nicole Dowd, director of public programs for the Smithsonian’s National Museum of Asian Art in Washington. That’s one reason the museum made mental health and well-being the theme of its second annual Asian American, Native Hawaiian and Pacific Islander Heritage Month festival, which ran May 10-12.
The struggles faced by some segments of the community suggest postpandemic challenges remain. Asian Americans, Native Hawaiians and Pacific Islanders were among the racial/ ethnic groups that experienced the highest increases in suicides from 2021 to 2022, according to the U.S. Centers for Disease Control and Prevention.
Last year in San Francisco, as the pandemic faded and the agency began reopening community centers, it found many seniors were still reluctant to congregate. Instead, centers offered to-go meals, with hundreds of seniors lined up outside for meals they took home and ate alone.
Now, with all centers having since reopened and to-go options discontinued, attendance at those same centers barely hovers around 80 people.
“The fear is still there,” Chung said. “COVID and the anti-Asian attacks did something that impacted their behavior. They have no one to talk to or socialize with, and without that connection, they’re going to get frail both physically and mentally.”
Advocates say Asian Americans may be reluctant to seek mental health care for many reasons, especially given the wide range of experiences and cultural traditions depending on whether their heritage is, for example, Chinese, Japanese, Korean, Filipino, Vietnamese, Hmong or South Asian.
“No experience in the Asian American community is monolithic,” Dowd said. “Everyone has their own histories and reasons.”
Grace Kim, chair of Boston University’s
counseling psychology and applied human development department, said many view physical and mental health in tandem, making them less likely to separate out mental health and instead couching it in terms of fatigue or low energy rather than depression or anxiety.
Chung said that for her agency’s senior Chinese clients, translations for the term “mental illness” carry negative connotations.
“The translation in Chinese means ‘crazy,’ ” she said. “No one wants to be, or wants their family members to be, labeled that way, so they want to hide it because it’s such a taboo.”
The lack of culturally competent mental health providers is one that plagues most communities of color.
“Even in Chinatown, where we have 200,000 Chinese, I don’t think you could easily find a bilingual psychiatrist who practices in the community,” Chung said.
According to a 2020 American Psychological Association report, 84% of the psychology workforce is white, while Asians make up just 4%.
That means Asian American clients face challenges finding mental health professionals aware of their lived experiences. The few therapists who do meet those qualifications often have workloads already stretched by the pandemic, with waitlists not uncommon.
“We know that there are fewer inlanguage providers available to meet the needs of all minoritized communities, including Asian Americans,” said Anne Saw, an associate professor of psychology at Chicago’s DePaul University.
Saw said that if there’s any silver lining to the crisis, it’s that some in the community are becoming more willing to talk openly about mental health.
“There’s still that stigma, but people are more willing to engage in these conversations because they’ve seen firsthand the impact of all these stressors on their families and children,” she said.
Kim agreed. “Many Asian Americans, especially young adults, are talking about mental health and seeking out supports specifically through Asian American therapists or other therapists of color,” she said.
In San Francisco, with seniors reluctant to go to mental health clinics, Chung’s agency has found ways to have the clinics come to them. For instance, one city mental health provider Chung knew would visit the agency’s community centers, sifting out symptoms of depression through casual conversation and making suggestions to help them address the issue, such as socializing more.
“If you asked our patients to walk into a mental health clinic, there’s no way they would go,” Chung said. “So it was a cultural way of dealing with a difficult and taboo subject.”
The agency relies on a half-dozen other retired clinicians who occasionally drop in to engage seniors in the same way, Chung said.
Meanwhile, Chung said some social workers now employ terms such as “psychological” or “spiritual health” when speaking with seniors to avoid triggering alarms while asking about telltale signs like loss of sleep, appetite or a desire to see family or friends.
“The seniors would never tell you outright that they’re depressed or anxious,” she said. “They don’t want to be stigmatized.”