Supporting the Mental Health of AAPI Youth

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CLINICAL CONVERSATIONS

May is Asian American/Pacific Islander (AAPI) Heritage Month. Apurva Bhatt, MD, a child, adolescent, and adult psychiatrist at Stanford Medicine Children’s Health and clinical assistant professor at Stanford University School of Medicine, sat down with Psychiatric Times to share more information for clinicians on care for AAPI patients, the youth mental health crisis, and early psychosis identification/intervention.

PT: In 2019, suicide was the leading cause of death for AAPI individuals aged 15 to 24.¹ What suggestions do you have to support clinicians in address suicidality in a culturally competent manner?

Bhatt: To effectively address suicidality among AAPI youth, it is crucial for clinicians to embrace culturally competent approaches. This means receiving ongoing training to understand the unique cultural nuances and stigmas related to mental health in AAPI communities. By promoting open dialogue and reducing the shame associated with seeking help, we can make a significant impact. It is essential to recognize that developing cultural competence is a continuous journey that helps clinicians grasp how culture influences an individual’s experiences and their willingness to seek help. Clinicians should also incorporate culturally relevant coping strategies and offer services in multiple languages to overcome any language barriers. Lastly, clinicians working closely with AAPI mental health organizations can provide tailored resources and support systems that meet the specific needs of this population.

PT: In your opinion, what impact does culture have on the current youth crisis?

Bhatt: The way mental health is framed within a culture plays a role in how individuals perceive and talk about their experiences, and can contribute to stigma and shame. Cultural framing of mental illness also influences the mental health treatment journey, including who one might reach out to first regarding these experiences and what treatments will be pursued, with typically culturally acceptable options being sought out first. Studies have shown that Asians are less likely to access mental health treatment compared with white individuals, highlighting a disparity in perceived need for mental health services.² The COVID-19 pandemic negatively impacted youth of all backgrounds. Due to cultural framing of mental illness and stigma, AAPI youth experiencing mental illness symptoms postpandemic may be less likely to seek out mental health treatment early on and present later in crisis.

PT: How does culture impact youth resilience and susceptibility to developing psychiatric disorders/substance use disorders?

Bhatt: Culture can impact youth resilience and susceptibility to developing psychiatric and/or substance use disorders.

Cultural stigma surrounding mental illness can discourage some youth from seeking help. The way mental health is perceived and talked about within a culture—whether as a health condition or something influenced by spirituality or personal weakness—can affect how youth and their families approach treatment. Additionally, acculturative stress, which refers to the psychological impact of adapting to a new culture, can elevate the risk of developing psychiatric disorders, especially for immigrant youth and children of immigrants. Youth experiencing acculturative stress may experience cultural conflict (where the cultural values of their parents or original culture conflict with the new culture), language barriers (difficulties in communication due to language differences), and discrimination (facing prejudice based on their cultural background). They may also experience assimilation stress and grapple with the consequences of losing parts of one’s original cultural identity. They may also lose important social supports from individuals from their native culture, increasing feelings of isolation. All these factors can increase risk factors for developing mental illness.

On the other hand, when someone feels well-rooted in their culture and lives in a community who accepts them and offers them opportunities to participate in activities that promote a sense of belonging, this can be a protective factor against developing some psychiatric disorders. Some cultural values and norms contribute to strong support systems and foster resilience by promoting community, family bonds, and coping strategies. When individuals live in a community that is open and appreciative of diverse cultures and perspectives, this can lower acculturative stress, assimilation stress, and potentially reduce discrimination, which in turn can lower the risk of an individual developing a psychiatric disorder.

PT: What barriers to care do Asian American/South Asian youth face? How can clinicians help break those barriers down?

Bhatt: According to the Pew Research Center, Asian Americans are the fastest-growing demographic in the US,³ but there is still a significant lack of culturally informed youth mental health care programs nationwide. Many Asian American and South Asian youth avoid seeking care due to stigma, and when they do, they often encounter clinicians who lack experience in navigating the intersection of mental health, culture, and family dynamic factors that influence care. This can lead to disengagement from care by youth and their caregivers. Clinicians can address these barriers by practicing cultural humility and continuously improving their cultural understanding to provide more effective, culturally informed care. There are some social media accounts that are working to break down stigma and improve understanding of cultural factors related to mental health. Creating environments where individuals feel comfortable and understood is crucial. Additionally, clinicians can enhance workforce diversity by offering early exposure to mental health careers, along with training and mentorship opportunities, to help bring in individuals from diverse backgrounds into the field.

PT: Are there any differences in how culture impacts diagnoses and treatment/treatment acceptance between immigrants, recent immigrants, and those born in the US?

Bhatt: There are differences in how culture impacts mental health literacy, diagnosis, and treatment acceptance among immigrants, recent immigrants, and those born in the US. For immigrants and recent immigrants, language barriers and unfamiliarity with the health care system can make accessing and accepting treatment more challenging. They may also hold cultural beliefs about mental health that differ from Western medical models, influencing their mental health treatment journey, as well as their willingness to seek and adhere to treatment. For example, some cultures might view mental health symptoms as a sign of personal weakness or something that brings shame to the family (affiliative stigma), which may discourage seeking help. Recent immigrants might still be adjusting to a new cultural environment, leading to acculturative stress, which can impact their mental health and how they perceive treatment. They may also rely more on traditional or community-based healing practices rather than Western-based medical care.

In contrast, those born in the US, including children of immigrants, might be more familiar with the health care system and more likely to accept Western medical diagnoses and treatments. However, they can still experience cultural conflicts between their family’s values and mainstream practices. Overall, clinicians need to be aware of these cultural nuances and adapt their approaches accordingly, offering culturally sensitive and informed care to effectively support all individuals.

PT: What recommendations do you have for a clinician who is treating an Asian American/South Asian child or adolescent?

Bhatt: The most important thing that clinicians can do is practice cultural humility and continually expand their understanding of different cultures, values, beliefs, and how these factor into an individual and family’s understanding of mental health experiences and treatment approaches. Ultimately, working together with the shared goal of helping the young person feel better.

PT: How does the mental health industry need to change to better address the issues Asian American/South Asian youth face?

Bhatt: Our field is making progress, but there is still a lot of work to be done. First is ensuring adequate funding of culturally informed youth mental health programs and funding training programs that recruit individuals from diverse backgrounds to improve the youth mental health workforce shortage.⁴ Second, consulting youth and individuals with lived experience of mental illness through advisory groups can be very helpful in designing appropriate and timely solutions. The Allcove Centers are an excellent example of how Youth Advisory Groups can guide solutions for youth mental health. Recently, I have also been hearing from youth that they want more interventions and mental health education directed at parents/caregivers to help them understand that mental health is treatable and where individuals can access care.

Finally, Asian Americans and South Asian populations are understudied in most mental health related research, ranging from risk factors for mental illness to treatment options. Historically, most epidemiological reports on youth mental health and suicide have excluded Asian American youth. Our recently published paper sheds light on AAPI youth mental health and suicide, but there is still more work to be done across the industry to better help this population.⁵

PT: Your research focuses on early psychosis evaluation. Are there any upcoming treatments in the pipeline that you find promising?

Bhatt: We are living in an exciting time in relation to early psychosis care. In California and nationally, there has been more funding for early identification and intervention programs for early psychosis, specifically coordinated specialty care (CSC) programs for early psychosis. CSC involves a multidisciplinary team that includes psychiatrists, psychologists, social workers, peer support specialists, supported education, and employment specialists, and has been shown to improve outcomes for individuals experiencing a first episode of psychosis. The average duration of untreated psychosis (length of time between onset of psychosis symptoms and receiving evidence-based treatment) in the United States is about 18 months and research has shown that long periods of untreated psychosis can have negative prognostic factors. It is my hope that we will begin to recognize and support youth experiencing psychosis earlier and connect them to evidence-based, culturally-informed services earlier to improve recovery for young people living with psychosis.

PT: Thank you!

Dr Bhatt is a child, adolescent, and adult psychiatrist at Stanford Medicine Children’s Health and clinical assistant professor at Stanford University School of Medicine.

References

1. Mental and behavioral health - Asian Americans. US Department of Health and Human Services; Office of Minority Health. Accessed May 22, 2024. https://minorityhealth.hhs.gov/mental-and-behavioral-health-asian-americans

2. Abe-Kim J, Takeuchi DT, Hong S, et al. Use of mental health–related services among immigrant and US-born Asian Americans: results from the National Latino and Asian American study. Am J Public Health. 2007;97(1):91-98.

3. Budiman A, Ruiz NG. Asian Americans are the fastest-growing racial or ethnic group in the U.S. Pew Research Center. April 9, 2021. Accessed May 22, 2024. https://www.pewresearch.org/short-reads/2021/04/09/asian-americans-are-the-fastest-growing-racial-or-ethnic-group-in-the-u-s/

4. Workforce maps by state. American Academy of Child & Adolescent Psychiatry. Accessed May 22, 2024. https://www.aacap.org/aacap/Advocacy/Federal_and_State_Initiatives/Workforce_Maps/Home.aspx

5. Reyes MP, Song I, Bhatt A. Breaking the silence: an epidemiological report on Asian American and Pacific Islander youth mental health and suicide (1999–2021). Child Adolesc Ment Health. 2024;29(2):136-144.