While it’s safe to say that everyone’s mental health has suffered during the pandemic, it’s also become clear that certain groups have been more impacted than others.
Historically, AAPI communities have been assumed to be a thriving ‘model minority,’ viewed as more highly educated, financially prosperous, and successful compared to other communities of color in the United States. But this harmful and inaccurate stereotype shrouds a far more complex reality. For example, this stereotype ignores the various disparities and structural inequalities that affect different ethnic groups. Furthermore, the collective assumption of AAPI success can also create a kind of internal pressure for individuals to ignore their mental health or other needs in the pursuit of living up to that image.
What Is AAPI?
Therefore, there are many cultural, historical, and other differences and distinctions amongst the AAPI diaspora who are lumped together under this label. Yet it can still be a useful term, particularly given how these groups have shared a history of being othered while living in the United States and can benefit from shared alliances, especially from the work being done on different issues about racism and bias.
AAPI stands for Asian-American Pacific Islander, and is an umbrella term encompassing the diverse identities of people from as many as 50 different countries around the world in regions including East Asia, Southeast Asia, India, and the Pacific Islands.
Mental Healthcare for the AAPI Community
As the spike in anti-AAPI racism during the pandemic has made clear, AAPIs are vulnerable to all kinds of harmful covert and overt forms of discrimination, racism, and violence. For these and other reasons, AAPI populations face particular mental health challenges and obstacles in obtaining effective treatment. That’s why it is so important to develop culturally-sensitive and responsive approaches that address the various obstacles and difficulties faced by AAPI folks today.
AAPI communities experienced high rates of job loss and hate crimes during the pandemic, yet were also less likely to seek mental health care treatments during the pandemic. The loss of employment (through which many people receive health insurance coverage), mass closure of in-person mental healthcare services, and spiking rates of anxiety, depression, and other mental health issues have combined to create the present circumstance, in which many more people are struggling with mental health yet have less supporting resources and access to care.
A recent study found that while the overall mental health of the U.S. population understandably declined during the pandemic, groups including Black, Hispanic, and AAPI were more steeply impacted.
While the reasons for this hesitancy are numerous and vary between individuals and groups, many AAPIs feel a sense of shame or stigma about receiving mental health services, particularly from Western providers who are less likely to provide culturally sensitive and nuanced treatment. However, there are some positive signs that the situation is changing, as the same study showed that second-generation immigrants are more willing to seek a mental health diagnosis than their parents, which hints at some reduction of the stigma.
However, even before the pandemic, studies have shown AAPIs to be the least likely of all racial and ethnic groups to seek mental healthcare. A recent national study found that only 8.6% of Asian Americans seek mental health services and resources compared to 19% of the general population.Another study reported over a third of Pacific Islanders reporting needing mental health services but few seeking them out due to many barriers.
The Need for Culturally Sensitive Treatment
They went on to explain that: “Fear/anticipation of future racism may prevent Asian Americans from accessing needed resources, such as health and mental health care.” It’s important to recognize these barriers and develop innovative solutions, such as online resources and other more accessible tools.
This gap in the need for and access to treatment and care points to a broad lack of culturally responsive, racially aware forms of care. Last year, the Asian American Psychological Association presented a written statement at a U.S. House of Representatives hearing regarding AAPI discrimination and violence, detailing the many longstanding barriers to accessing mental and other forms of health care, including language and cultural barriers as well as economic access.
AAPIs also face challenges in obtaining effective treatment in the form of prescribed medication, particularly those used to treat mood and other mental disorders. Eastern modes of treatment and medicine typically differ from Western health practices in a variety of ways. First-generation AAPIs in particular are more familiar with Eastern practices, which often focus on preventative care, spiritual and holistic practices, and what are considered “alternative” remedies in the Western healthcare system.
Because certain remedies, such as some herbal supplements, can negatively interact with or reduce the efficacy of prescribed medications, it’s important to discuss medication at length with patients. An interpreter may be needed to explain contraindications and to ensure that prescribed medications align well with the patients’ ongoing health practices.
One last issue specific to the AAPI community is the phenomenon of medicines working differently on different people, a field of research also known as pharmacogenetics. Genetic differences can result in different responses to drugs, meaning that a standard dose of a medication may be either too much or too little for an individual person depending on their genetic background. Many clinical trials in the United States still do not account for these genetic differences, spurring researchers to call for the need for more clinical trial diversity.
Researchers also caution that older Asian immigrants may be less likely to comply with the regular dosage or prescribed regimen, particularly for drugs that must be taken long-term in order to be effective. Again, communicating with patients to ensure understanding of dosage and consistency is vital.
For example, a recent study reported that Asian-Americans made up only 1.7% of patients in clinical drug trials in which at least 70% of the trial was conducted in the U.S. This means that, until clinical trials become inclusive, doctors should prescribe low doses and carefully monitor AAPI patients’ reactions in order to ensure that patients receive safe and effective treatment.
A Word From Verywell
The AAPI community face unique challenges in mental health and healthcare. The ongoing stress and difficulties of the pandemic and violence against AAPIs only increase the burden for many.
The issue of pharmacogenetics speaks to a larger issue of AAPIs more generally being neglected in so much of U.S. health research. A 2019 study found that despite being the fastest-growing demographic group in the country, a mere 0.17% of total research funding from the National Institutes of Health went to clinical studies focusing on Asian-American health between 1992-2018. Hopefully, the turmoil of the past couple of years will propel necessary action in redirecting funds and other forms of support addressing AAPI-specific health needs.
Collectively working together to acknowledge, heal, and persevere despite anti-Asian racism is a necessary task toward improving AAPI mental health and wellness. Also, as our society becomes more diverse, it’s clear that Western mental health practices need to evolve in order to accommodate cultural, linguistic, socioeconomic, and other differences.
Every person is a complex individual with a unique set of cultural beliefs and practices, and it’s necessary to approach mental health treatment in ways that account for all their nuances—a one-size-fits-all approach is not enough.
