When people talk about addressing mental health among Asian Americans, there’s one topic in particular that Medha Ghosh observes tends to dominate those conversations: stigma. It’s not exactly a productive point of emphasis, says Ghosh, senior policy coordinator for health at the New York nonprofit Coalition for Asian American Children and Families (CACF), because it places the burden of healing on individuals. “It's like, well, you have all this stigma and you need to deal with that. And we have all these services, and you have to figure out how to connect to that,” they say.
It’s one of multiple barriers Asian Americans—who are three times less likely to seek mental health services than white Americans—face when accessing mental health services. There’s also financial strain, a lack of awareness, and a shortage in clinicians, among others, all of which affect the general U.S. population.
“The reality is that having a feeling of community is so vital to well-being. To make it into this kind of individual problem and individual type of care is, I think, stigmatizing in itself.”
Yet for the nation’s fastest growing ethnic group, another critical piece needed to address mental health needs is greater accessibility to holistic care. It’s a sharp contrast to Western mental health services—talk therapy and medication—which focus on helping individuals. Ghosh says that may not resonate with Asian Americans because they tend to come from a community-first way of living. “The reality is that having a feeling of community is so vital to well-being,” they say. “To make it into this kind of individual problem and individual type of care is, I think, stigmatizing in itself.”
A 2022 report published by CACF made several recommendations to address AA+PI mental health needs through community-centered approaches rather than clinical ones, and emphasized supporting and uplifting holistic practices. Holistic practices are defined in a 2017 study published in the journal Healthcare as approaches that are “characterized by the treatment of the whole person, taking into account mental and social factors, rather than just the symptoms of a disease.”
Huong Diep is a board certified psychologist who employs a culturally and trauma-informed approach in her practice, and is passionate about serving BIPOC and LBGTQIA+ communities. She agrees that part of the reason that Western mental health care may not always work for Asian Americans is because its focus on the individual doesn’t always account for clients’ role as a family member or community member.
Part of the reason that Western mental health care may not always work for Asian Americans is because its focus on the individual doesn’t always account for clients’ role as a family member or community member.
Diep says her clients who have seen non-BIPOC-identifying therapists have described their previous therapy sessions as not focused on the big picture, but rather honing in on solving presenting problems and symptoms instead. “You might help the individual, but they’re going to go back into a community or family or system that might be dysfunctional or need some support,” Diep says. “So then the issue is going to continue anyways.”
The recommendations in CACF’s report to address AA+PI mental health needs were guided by community-based organizations in the coalition. Some of them spoke with JoySauce about programming that contributes to the community’s mental well-being. Representatives from these organizations didn’t didn’t refer to their programming as mental health services, but they all described spaces that foster a sense of community and social support.
Mekong NYC, a social justice organization, launched healing circles in 2012 to provide community members with a space to unpack trauma, says Khamarin Nhann, campaign director at the nonprofit. This is done in a variety of ways, including storytelling through art projects. Community building is also a focus, and may take the guise of apple picking, gardening or visiting temples. Nhann says some of the feedback the group has received from participants is that they feel safer and more heard in healing circles compared to psychotherapy.
Eng Young, 56, first participated in Mekong NYC’s healing circle in 2019 after learning about the space through friends, she says through Anna Srey, community organizer at the nonprofit who serves as an interpreter for this interview. Young previously sought community through a local temple, but that did not provide much opportunity to socialize. Through Mekong NYC’s healing circles, she has found a safe space to discuss topics like health issues and gender-based violence—something she saw firsthand at a refugee camp in Thailand before coming to the United States. It’s also simply a nice place to have meals with people who share her language and culture. She’s even made a few close friends.
“What we’ve been taught is, our people know how to hold each other...What are some of the practices that our people have done over generations to hold space and talk about these different things?”
“What we’ve been taught is, our people know how to hold each other. There wasn’t medication back then, so what is the alternative way around being able to heal?” Nhann says. “What are some of the practices that our people have done over generations to hold space and talk about these different things?”
Another important component of addressing Asian American mental health needs is having clinicians who can provide linguistically and culturally responsive care. Ghosh says focusing on stigma as a barrier in the community overlooks important considerations. “It ignores the history of a divided approach in care, and the violence that these communities have faced because of the system, which then can lead to stigma,” they say. Some examples of instances that lead to distrust of the system include the incarceration of Japanese Americans in internment camps during WWI and the rise of Islamophobia after 9/11, Ghosh adds.
Diep says her clients who identify as AA+PI appreciate her understanding of cultural nuances, as it frees them from the task of explaining those parts of their lives. She also says that talk therapy isn’t always the best approach for everyone, particularly when dealing with trauma.
Research on trauma among Asian Americans is sparse, and what exists is often a decade or more old. Findings in one study indicate that 70 percent of Southeast Asian refugees receiving mental help were diagnosed with PTSD.
Diep says it’s difficult to ascertain who isn’t receiving care because those individuals are not likely to participate in surveys about why they aren’t seeking help. But it’s likely that most who are dealing with PTSD and other trauma haven’t received care and/or are not currently receiving care, she adds, due to barriers like stigma, lack of resources and lack of psychoeducation.
“For some folks, even if they can talk about it and have the language, a lot of times, trauma is still stuck in the body. For some folks, movement is a form of healing as well.”
“For some folks,” she says, “even if they can talk about it and have the language, a lot of times, trauma is still stuck in the body. For some folks, movement is a form of healing as well.” One practice she incorporates with some of her clients is walk-and-talk therapy sessions. She says it can feel less intimidating for clients, and helps with processing and reorganizing trauma.
Diep also dedicates time and effort to connecting her clients with resources like books, newsletters, articles and even Tai Chi groups to provide them with a robust arsenal of tools that they can use—if it works for them—on their mental health journeys. And, she makes it a point to ask clients what activities or practices they’ve done in the past that have worked for them.
Vaidehi Jokhabar, CEO and founder of Mind the Gap Initiative, a nonprofit dedicated to spreading awareness of the importance of mental health among BIPOC communities in New York, says a number of effective practices have existed for years without being formally linked to mental health. These include things like yoga and meditation—both of which her organization facilitated in a park in New York last summer.
“Utilizing the public space of a public park into your mental health—this is not something that you need to have a lot of money for. This is a space that’s mostly accessible to everyone.”
The event was a two-part yoga seminar to improve mental wellness that consisted of instructor-led yoga, followed by guided meditation. The second part of the seminar encouraged mindfulness among participants by having them focus on the sound of the wind and participate in breathing techniques, Jokhabar says.
“Utilizing the public space of a public park into your mental health—this is not something that you need to have a lot of money for,” she adds. “This is a space that’s mostly accessible to everyone.”
She also notes that activities like this can be an avenue to care for mental health without so much stigma.
“Even though they’re not saying, ‘I’m gonna go take care of my mental health,’ saying: ‘I’m going to go do yoga for 45 minutes’ or saying, ‘I’m gonna go meditate’—that’s probably more digestible for some people, than ‘I’m gonna go see a therapist.’”
CACF’s report highlighted other practices that benefit mental health, such as reiki and acupuncture, and recommended raising support and awareness for such mental health services that provide more culturally responsive care to AA+PIs. Research has found that reiki improves certain mental health symptoms, while acupuncture may improve psychological disorders.
Ghosh says raising awareness about the effectiveness of community activities like healing circles and practices like acupuncture—as well as conducting more research that validates their benefits—is a crucial piece of addressing mental health needs among AA+PIs. That’s because proof leads to more funding, they add.
“A lot of these are individual practices. They’re struggling themselves,” Ghosh says. “Making sure that they’re seen as part of this whole ecosystem of care then leads to having these kinds of spaces that are getting enough support and are also accessible to more community members.”
Published on March 16, 2023
Words by Agnes Constante
Agnes Constante is a freelance journalist whose byline has appeared in NBCNews.com, Los Angeles Times, Women's Health, KCET, Inquirer.net, Prism, TimesOC and Asian Journal. Her work has been recognized by the Los Angeles Press Club and Philippine American Press Club. Agnes is currently a Carter Fellow and board member for the Los Angeles chapter of the Asian American Journalists Association.