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Working Toward Healthy Minds

Stanley Sue, a U.C. Davis psychology and Asian American studies professor, who helped found AAPA. Photos by Jennie Sue

Surgeon general says minorities face mental health care hurdles

By Asianweek Staff & Wire Reports

Mental illness has long been stigmatized in Asian and Asian Pacific Islander American cultures. That hasn’t curved incidences of mental diseases, however.

Consider these statistics: Cambodian American adolescents who survived Pol Pot’s concentration camps have a 50 percent chance of suffering from post-traumatic stress disorder (PTSD). Native Hawaiian adolescents take their own lives at rates higher than Hawaiian teens of other ethnicities. And APIA women have the highest suicide rate of all U.S. women over 65.

These and other findings were examined in a 200-page report by U.S. Surgeon General David Satcher, which concluded a history of discrimination, violence and poverty contribute to minorities being less likely than whites to receive mental health care and more likely to receive poor treatment.

In a follow-up to his 1999 report on mental health, Satcher emphasized that blacks, Latinos, Asians Pacific Islander Americans, and Native American and Alaskan Americans face the greatest challenges, partially because so many within those communities have gone without treatment or have been given substandard care.

“We know massive gaps exist, we cannot wait. We must find a way to make our health system more relevant to these races,” Satcher said at a meeting of the American Psychological Association in San Francisco.

The report, released on Aug. 26, cites poverty as a key factor why many minorities do not receive proper mental health care. It found that racial and ethnic minorities are less likely to have access to treatment, and those who do often receive a lesser quality of care.

Cultural and language differences, mistrust and economics all factor into why minority groups experience more lost work days and greater daily limitations than whites.

Satcher urged mental health workers to use such factors as language, religion and folk healing to reach out to patients, or at least to understand and appreciate their cultural differences.

“The stigma around mental illness is so devastating people are too embarrassed to seek care,” Satcher said. “When it comes to mental health, culture counts.”

The study reports that minorities share the same overall rate of mental disorders as whites.

Though APIAs are not overrepresented among high-need populations, such as people who are homeless, incarcerated or have substance abuse problems, the study found that they are heavily represented among refugees. Many Southeast Asian refugees are at risk for PTSD associated with trauma experienced before and after immigration to the United States. One study found that 70 percent of Southeast Asian refugees receiving mental health care met diagnostic criteria for PTSD. In a study of Cambodian adolescents who survived Pol Pot’s concentration camps, nearly half experienced PTSD and 41 percent suffered from depression 10 years after leaving Cambodia.

The report also cited a study that found compared to the suicide rate of white Americans (12.8 per 100,000 per year), the rates of Filipino (3.5), Chinese (8.3), and Japanese (9.1) Americans are substantially lower. However, Native Hawaiian adolescents have a higher risk of suicide compared to that of other adolescents in Hawaii. Moreover, older APIA women have the highest suicide rate of all women over 65 in the United States.

Despite these statistics, which indicate a need for services, APIAs appear to have extremely low use rates of mental health services relative to other U.S. populations. For example, in one study, only 17 percent of those experiencing problems sought care. Among APIAs who use services, severity of disturbance tends to be high, perhaps because APIAs tend to delay seeking treatment until symptoms reach crisis proportions. Shame and stigma are believed to figure prominently in the lower use rates of APIA communities.

Moreover, Satcher pointed out that knowledge of the mental health needs of APIAs is still limited. National epidemiological studies have included few APIAs.

The report found that sparse research made it hard to predict the level of need. More minorities working in the mental health field could help minorities feel more comfortable seeking help, Satcher said. Currently, there are approximately 70 APIA providers for every 100,000 APIAs, compared to 173 per 100,000 whites.

“More people on the front lines,” such as primary care providers, also should boost their knowledge of mental illness to educate minorities about the disorders and to help patients receive care, Satcher said.

Community and social strength

Asian American Psychological Association board member, Alvin Alvarez.

“This is the only national convention addressing these topics,” AAPA board member, Alvin Alvarez said. “This conference allows us to bring together the freshest ideas on how to serve the community.”

Pat Okura, the first Asian Pacific Islander American to have graduated from UCLA’s master’s program in psychology in 1935.

“At the National Institute of Mental Health, we started the programs for minorities — for blacks, Hispanics, Asians and Native Americans in the 1970s,” he said. “Until then, the government did very little for minority mental health.”

He added: “We’ve made some progress but we still have much further to go. Support for minorities has been up and down and right now, it’s not that good.”

“We saw that although Asians had lower rates of divorce, there were many disrupted families,” he said. “We also saw all kinds of parent-child problems. Children reported extreme anxiety, and tremendous loneliness and shyness.”

The Asian American Psychological Association held it's annual one-day conference this year at the University of San Francisco.

And because mental health directly impacts family and community structure, it lies at the base of such social discord.

“We concluded that for cultural reasons, Asian Americans tended to avoid using services,” Sue said. “Only the most severely disturbed, who lacked other resources or who posed management problems for the family or community, tended to enter the mental health system.”

Sue found that bicultural, bilingual programs increased APIA participation in mental health counseling.

“We’re now investigating what therapists have to do to have good outcomes in their patients, what kind of culture skills,” he said. “We can no longer ignore mental health. It has so much to do with children’s achievement, problems with delinquency. It has to do with family.”