When Anh Dao Huynh’s teenage son started showing signs of mental illness 18 years ago, she discovered that one of the biggest challenges was finding support.

“There’s stigma from my culture because you feel like people are looking at you like I must be doing bad stuff and that’s why this happened to my son,” she said. “Like I’m a bad woman, I must be very mean and bad, and that what my son is doing is payback.”

“They don’t know that [mental illness] is from the brain.”

Huynh said it was difficult at first to find a doctor, because she didn’t think her son could have “that kind of sickness.” But once she found help, she realized that others in her community would need it too. So she opened a Vietnamese-language class in Garden Grove to offer families of those suffering from mental illness the resources she never had. She has taught the 14-week program for nine years, reaching more than 200 people.

Huynh, vice president of the Orange County Association for Vietnamese Mental Health Awareness and Support, hopes that in doing so, she’ll not only be providing much-needed assistance to families, but also reducing the stigma of mental illness that often prevents many Asian Americans from getting treatment.

“People come to me, they share with me, they ask what do you do, what doctor do you use, how do you talk to the kids—but they don’t want to show their face in public,” she said. “If they are in public, then people will think your family is a bad family or something like that. Because of the stigma, they’re afraid.”

Asian Americans are the least likely racial and ethnic group to seek out mental health services in the United States, according to data from the 2008 and 2012 the National Survey on Drug Use and Health. Just 4.9 percent of Asian American adults seek out mental health services, compared to mixed race (17.1 percent), white (16.6 percent), American Indian or Alaska Native (15.6 percent), black (8.6 percent) and Hispanic (7.3 percent) adults. Asian American adults also had the lowest rates of prescription psychiatric medication use and outpatient mental health service use.

Advocates for mental health do cite cultural stigma as one reason for this disparity. “Some of the mental health terminology isn’t even in our languages, so it’s hard to talk about these issues,” explained Mary Anne Foo, executive director of the Orange County Asian and Pacific Islander Community Alliance.

Yet stigma isn’t the only obstacle —there are also structural barriers such as a lack of culturally competent and in-language services, and affordable health care.

“If you don’t know the language well, explaining what your needs are becomes hard,” said Foo. “And some of the stressors, one community might say, ‘That’s not a big issue, just stand up to your parents, or say this to your husband, or say this to your grandparents,’ but maybe in Asian culture, you would never say things like that to them.”

“It makes it so that people feel like they’re not being understood.”

In addition, Asian Americans’ position as ethnic minorities—and often as immigrants or refugees—means that they often confront a host of social and political factors that can trigger stress, anxiety and depression, or exacerbate existing mental health issues.

One group that is particularly at risk is young Asian American women, who have one of the highest suicide rates within their age and gender, said Eliza Noh, professor of Asian American Studies at Cal State Fullerton. Her research on suicidal Asian American women found that one common theme is the model minority myth, which posits that Asian Americans should achieve at a higher level than others.

“They often talked about those kinds of pressures in school and at work in terms of the expectation to be perfect, to succeed, to do well,” said Noh. “And there’s an additional component of feminine perfection that Asian American women experience—being a good daughter, being a good wife. Which goes to show that stereotypes, whether they’re so-called positive or negative, create pressure for women and girls.”

Elderly Asian American women also have the highest rate of suicide among this age and gender group, said Noh, which she attributed in part to social and linguistic isolation.

Foo said that past traumas, such as war and migration, in addition to present-day struggles such as overt racism, poverty, and U.S. politics, particularly changes to immigration policy and President Trump’s rescinding of the Deferred Action on Childhood Arrivals program, are also common themes among Asian Americans.

“A lot of things that happen on the national stage bring up trauma,” she said. “We see a lot of anxiety is provoked, people feel helpless and they’re not sure what to do.”

But Foo also sees change.

As a result of California Proposition 63, the Mental Health Services Act, which was passed in 2004, community-based organizations have received more funding to provide culturally competent, in-language mental health care for Asian Americans.

Through Prop 63, Foo’s OCAPICA, for example, now offers a free, full service program for severely mentally ill youth and a prevention and early intervention-outreach program in 24 languages, including Vietnamese, Korean, Mandarin and Samoan.

(Huynh’s Orange County Association for Vietnamese Mental Health Awareness and Support is also funded through the Mental Health Services Act.)

To try to reach as many people as possible, OCAPICA counselors and case workers go out into the field—to schools, churches, homes, and even ballroom dancing classes—to offer services and also to educate the community about mental health.

“There are still folks in Orange County that have no idea what mental health is,” said Tina Rocha, program director for OCAPICA’s Well(ness)essity prevention and early intervention program. “So we made a really conscious choice to reduce that stigma by letting folks know that it’s about general wellness—heart, mind, body and soul.”

Offering free, culturally competent, in-language services has worked, said Foo, noting that the organization’s programs have provided therapy to more than 3,000 Orange County residents and educational programs on mental health to more than 30,000. Before Prop 63, she said, most of these people would not have received any care.

“We’re part of the community, so clients really identify with us,” she said. “We can say, ‘I know the pressure you feel from your parents to succeed because I felt that too,’ or ‘I’ve been a refugee so I know exactly what it’s like in camp.’”

“I think more Asians are now talking about mental health as they see other Asians talking about it, and see that it’s ok to talk about.”

That discussion is also happening in Congress. Earlier this year, U.S. Congresswoman Judy Chu, a Democrat from Pasadena and a former clinical psychologist, introduced the Stop Mental Health Stigma in Our Communities Act that would instruct the Substance Abuse and Mental Health Services Administration to partner with local organizations to increase awareness about common mental health symptoms, and provide culturally competent, in-language interventions.

While more culturally competent and in-language care are critical to closing the mental health service gap for Asian Americans, Foo also said that mental health can’t be limited to clinical treatment—it must include social justice solutions as well.

“You can’t just treat individuals or families—you have to change systems, too,” she said, pointing to poverty, housing, fair wages and immigration. “Because if nothing changes, continual anxiety and stress will occur.”

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