CHAPTER 5

Mental Health Care for Asian Americans and Pacific Islanders

Conclusions

Asian Americans and Pacific Islanders can be characterized in four important ways. First, their population in the United States is increasing rapidly, primarily due to the recent large influx of immigrants. Second, they are diverse, with some subgroups experiencing higher rates of social, health, and mental health problems than others. For example, poverty rates are higher among Southeast Asians and Pacific Islanders than among AA/PIs as a whole. Third, AA/PIs may collectively exhibit a wide range of strengths (e.g., family cohesion, educational achievements, motivation for upward mobility, and willingness to work hard) and risk factors (e.g., premigration traumas, English language difficulties, minority group status, and culture conflict), which again point to the diversity within the population. Fourth, very little national data are available that describe the prevalence of mental disorders using standardized DSM criteria. In terms of what is known about mental health issues among AA/PIs, several conclusions are warranted:

1.   Our knowledge of the mental health needs of Asian Americans is very limited. Two of the most prominent psychiatric epidemiological studies, the ECA and the NCS, included extremely small samples of AA/PIs and were not conducted in any of the Asian languages. The only contemporary study of AA/PIs using DSM criteria is CAPES, but it is limited to one Asian ethnic group and focuses primarily on mood disorders. No study has addressed the rates of mental disorders for Pacific Islander American ethnic groups. When symptom scales are used, Asian Americans do show an elevated level of depressive symptoms compared to white Americans. Although these studies have been informative, most of them have focused on Chinese Americans, Japanese Americans, and Southeast Asians. Few studies exist on the mental health needs of other large ethnic groups such as Filipino Americans, Hmong Americans, and Pacific Islanders.

2.   Available mental health studies suggest that the overall prevalence of mental health problems and disorders does not significantly differ from the prevalence rates for other Americans, although the distribution of disorders may be different. This means that AA/PIs are not “mentally healthier” than other populations. For example, they may have lower rates of some disorders but higher rates of others, such as neurasthenia. Types of mental health problems appear to depend on level of acculturation. Those who are less Westernized appear to exhibit culture- bound syndromes more frequently than those who are more acculturated. The acculturated population shows more Western types of disorders. Furthermore, the rates of disorders vary according to within-group differences. Rates tend to be higher among Southeast Asian refugees, for instance.

3.   Without greater knowledge of the rate and distribution of particular disorders and the factors associated with mental health, care providers have a difficult time devising optimal intervention to treat mental disorders and promote well-being.

4.   AA/PIs have the lowest rates of utilization of mental health services among ethnic populations. This underrepresentation is characteristic of most AA/PI groups, regardless of gender, age, and geographic location. Among those who use services, severity of disturbance is high. The explanation for this seems to be that individuals delay using services until problems are very serious. The unmet need for services among AA/PIs is unfortunate, because mental health treatment can be very beneficial.

5.   The low utilization of mental health services is attributable to stigma and shame over using services, lack of financial resources, conceptions of health and treatment that differ from those under-lying Western mental health services, cultural inappropriateness of services (e.g., lack of providers who speak the same languages as limited english proficiency clients), and the use of alternative resources within the AA/PI communities.

6.   Attention to ethnic or culture-specific forms of intervention and to racial or ethnic differences in treatment response is warranted to effect greater service utilization and more positive mental health outcomes. The ethnic matching of therapists with clients and the services of ethnic-specific programs have been found to be associated with increased use of services and favorable treatment outcomes. The development of culturally and linguistically competent services should be of the highest priority in providing mental health care for Asian Americans and Pacific Islanders. Attention must also be paid to differences in responses to medication because effective dosage levels of psychotropic medication may vary considerably among Asian Americans, with many people requiring lower than average doses to achieve therapeutic effects.

7.   It is imperative that more research be conducted on the AA/PI population. Priority should be given to investigations that focus on particular AA/PI groups, the rate and distribution of mental health problems (including culture-bound syndromes), culturally competent forms of intervention, and preventive strategies that can promote mental health.