Growing up, Tony remembers feeling like an orphan, even though he had two parents. Wherever he went, even with his own family, he felt like he didn’t fit in.

Tony, who did not want his last name included because of stigma around mental illness, immigrated from China to the Bay Area 40 years ago. At age 12, he began to struggle with depression and anxiety. He had a hard time talking to his family about it, which left him feeling isolated. His family’s uncommon dialect also made it hard for him to talk to other Chinese immigrants. And the enormous pressure he felt to succeed meant he was too busy studying to make many friends.

“If I had bad grades, I felt suicidal,” said Tony, who is now 46. “For me, it was like, life or death,”

Tony’s symptoms worsened in high school, but his parents refused to let him see a professional.  In many Asian Americans communities, such reluctance to seek mental health care is common. A 2007 study by Jennifer Abe-Kim, a psychology professor at Loyola Marymount University, found that less than 9 percent of Asian-Americans sought any type of mental health services compared to nearly 18 percent of the general population nationwide. A survey released in October by the National Alliance for Mental Illness (NAMI) found that 77 percent of Asian Americans with mood disorders reported struggling to talk about their  condition compared to 69 percent of white people.

Yet access to mental health care has never been more important. According to The Household Pulse Survey conducted by the U.S. Census Bureau in 2020 and 2021, about 30 to 40 percent of adults reported symptoms of anxiety or depression during the pandemic, up from 10 percent in 2019.  For Asian Americans, the rise in anti-Asian hate has taken an added toll on mental wellbeing, increasing their need for mental health support.

But many aren’t getting it. According to experts familiar with the Asian American experience, stigma, pressure to live up to the myth of Asian American success, and culturally inappropriate services prevent people from getting the mental health care they need. To address this problem, experts recommend creating an approach to mental health care that is more culturally sensitive to the needs and beliefs of Asian Americans, uses non-stigmatized language — such as “behavioral health professional” instead of “psychotherapist,” — provides individually tailored treatment, and increases availability of bilingual therapists.

Lack of mental health treatment can make it difficult for people to function in society. It can affect people’s marriages and families, lead to job loss, and even to substance abuse as people turn to drugs or alcohol to cope with their symptoms, said Dr. Vasudev Makhija, founder and president of the South Asian Mental Health Initiative and Network.

“In some cases, sadly, the most tragic consequence is suicide,” Makhija said.

Barriers to mental health services also delay much-needed care. Nancy Liu, associate clinical professor at UC Berkeley, compared mental illness to a wound that can worsen or get infected if it is not treated.

“There is a cost to delaying treatments,” Liu said. “Because when (people) do show up, then the needs are going to be higher and more intense.”

Battling stigma

Stigma is one of the main barriers preventing Asian Americans from seeking mental health services, experts said. Julian Chow, professor at UC Berkeley’s School of Social Welfare, said that some Asian cultures believe that mental health problems are the result of wrongdoings in a past life. This leads people to accept mental illness as a hardship they must endure, rather than seek help. 

Tony said his family used the word “crazy” as a synonym for inappropriate behavior when he was growing up. It was only when his mental health symptoms became severe and he ran away that his parents finally gave in and sought professional help. He was eventually diagnosed with bipolar disorder.

The pandemic was a particularly difficult time for Tony. The isolation and sedentary lifestyle of staying at home put a strain on his mental health and on his relationship with his partner at the time. He was hospitalized twice for suicidal ideation after calling a crisis line.

Many Asian Americans, however, do not reach out for help when it comes to mental health.

Stigma not only creates shame around mental illness but also a lack of awareness about what resources are available. Pata Suyemoto, 60, a mental health activist and suicide prevention advocate, said she experienced this with her Japanese-American father. When, as a child, she told him she was having suicidal thoughts, he turned away from her, not knowing what to do or say. As an adult, she reflects back on this experience with empathy. She said her dad was not taught how to talk about mental health issues or how to get help.

The toll of racial stereotypes

The surge in anti-Asian hate crimes and attitudes has impacted the mental health of Asian-Americans, including Suyemoto. She said she’s experienced many instances of racism, including a woman leaping off the sidewalk to avoid her while she was walking near her home in Cambridge, Mass. After numerous similar experiences during the pandemic, she remembered feeling scared to leave her house. Other people in her community have shared with her similar stories and fears.

“I had to get a COVID test and I thought: I wonder if this person will be rougher with me because I’m Asian?” Suyemoto said.

The “model minority myth” is another barrier to mental wellbeing for Asian Americans. It creates the illusion that the community doesn’t have problems, said Makhija, and also puts pressure on people to hide their mental illness or not reach out for help.

On top of that, being an immigrant creates added pressure, according to Winston Tseng, associate director of research with Health Research for Action at UC Berkeley. Many people feel they must push themselves to succeed in order to provide for families back home.

Although the NAMI survey and other studies show that Asian Americans and Pacific Islanders face more challenges to obtaining mental health services than other populations, not all of their challenges are the same. Some Southeast Asian communities with refugee status, for example, are more likely to have a history of PTSD or substance abuse because of the trauma they’ve endured. Pacific Islanders, on the other hand, may not have access to the health care system at all because they’re more likely to be uninsured than other Asian Americans.

Liu said it’s important to address both the commonalities among Asian Americans and to tailor therapy to an individual’s specific stressors and socioeconomic and cultural background. Training more therapists on how to deliver culturally appropriate therapy would help, she added. 

DJ Ida, executive director of the National Asian American Pacific Islander Mental Health Association, said the need for culturally aware, bilingual mental health professionals is greater now than ever before.

To get more Asian Americans to seek care, providers need to recognize that some cultures don’t see mental and physical health as separate. She said they also need to think beyond medication and talk therapy, which can sometimes re-traumatize people.  Other, more culturally appropriate avenues for addressing mental health difficulties could include gardening or exercising for example.

Suyemoto, who suffers from depression, said her treatment includes medication and therapy, but also Reiki, acupuncture, journaling and activism. She’s glad to have a therapist who takes an interest in how her culture affects her mental health.

For Tony, healing has come from going to church, where he feels welcomed and accepted. He said he recently opened up to the congregation about his mental health struggles and about how he had never felt connected to anyone else. The church members started to pray for him and put their hands on him.

“I started to cry, you know, because for so long I felt so isolated and so disconnected from others and to have (people) actually care enough to put their hands on me and to pray for me in that moment. It was such a powerful and touching moment,” he said.

Although his parents had a hard time accepting his mental health struggles, Tony now speaks highly of them. They worked hard to buy him a house a half mile away from their home, and he visits them often. His relationship with them has improved.  

“When I was younger, I thought the pressure from my parents was so strong to succeed that if I didn’t succeed they were going to disown me,” he said. “But in reality, even after I failed and even after my brother had failed in many ways, my parents were still there.”

If you or someone you know is struggling with suicidal thoughts or other mental health challenges, you can call the National Suicide Prevention Lifeline at 800-273-8255, or contact the Crisis Text hotline by texting “HELLO” to 741741.