Maura Leahy (AMCHP): Many of us may not be familiar with the prevalence of mental health conditions of AAPIs. Could you give our readers a little background to mental health in AAPI and the prevalence of mental health conditions or behaviors among AAPI AYAs?

Jaclyn Dean (NAPAWF): I think the most important thing to realize is that there is just not a lot of data about us. When data is collected on our communities, it’s not done very thoroughly and it’s not disaggregated in the way that we would like.

We do know that among Asian Americans ages 15 to 24, suicide was the leading cause of death and Asian American females in grades 9-12 were 20% more likely to attempt suicide compared to their non-Hispanic white peers. Asian American adolescents and younger women also experience higher rates of major depressive disorder than their peers. There has also been a little bit of research that shows that Asians are the least likely of any racial group to seek mental health resources. Only 43.9% of Asian American adults who experienced a major depressive episode received treatment, far less than the about 69% of white adults.

All of these statistics overlap and coincide with each other and I think for many people, that can be really surprising. When you think of Asian Americans or Pacific Islanders, or what the media tells us and a lot of the stereotypes and norms we’ve grown up with, you think of this high achieving, more economically and socially successful group of people, this “model minority” myth that has kind of culturally become acceptable even though it really masks a lot of the issues and struggles that we face, especially when it comes to mental health. So mental health issues are very prevalent, but mental health is just not really talked about and it’s not very visible to people outside of our community and sometimes even within our own community itself.

Maura: Thanks for sharing these statistics, Jaclyn. I agree that some of our readers might be surprised by these numbers especially given the prevalence of the model minority myth. Could you talk a little more about some unique challenges and barriers AAPI AYAs may face around their mental health?

Jaclyn: I think the thing that stands out to me the most, one common experience that lots of us have – and this is speaking from my personal experience so note that AAPIs have many very different experiences across the U.S. – is that most of us are either immigrants or children of immigrants. What comes with that is you are straddling two different cultures and you know that what you’re taught at home might be very different from what you’re taught in schools, and the themes that you see on TV or in the media may be very different from whatever cultures or ethics you’re taught at home. Themes like the acceptance of LGBTQ identity, sexuality, or even a lot of social norms can be really difficult for AAPI youth to have to navigate.

I think that has a lot of implications for mental health that people may not realize. I can imagine that it is something that has become more normal for people to recognize as something that’s different among AAPI youth, but it definitely shows up in a lot of different ways. All of this is compounded by what I talked about earlier: lack of visibility in our communities and lack of data.

There is a lot to say about just growing up in an immigrant household, but I think immigration itself has an effect on mental health. Actually being separated by your parents at the border is not as prevalent among AAPI youth but many have to deal with a lot of immigration issues, especially if your parents are undocumented and you have to act a certain way or hide certain things about your family – that has a huge toll on mental health. Many Asian American families, specifically Southeast Asians, have had family members deported in the last administration and could potentially be deported in this administration as well and that is just another form of family separation that can take a huge toll on mental health – growing up without a parent or family member and having to navigate immigration enforcement.

Another thing is that mental health is not something that is really talked about in our communities. It is not something that is seen as an issue that really needs to be addressed. A lot of times it could be things like “Oh, you’re sad but pick up the work,” this immigrant mentality of just putting your head down and working hard. Many of our parents and grandparents had to cross oceans just to make ends meet. Maybe they had depression, but they didn’t label it as such–for them it was just survival. Growing up, a lot of our family, friends, and my community thought depression and mental health disorders aren’t conditions that are treated like physical health. I think that is true outside of the AAPI community as well, but I think especially for our community. Mental health is not something that is in the lexicon of Asian cultures – I personally do not even know what that translates into in Mandarin Chinese.

I think all of that combined means that there is a lot of repression and lots of unlearning that needs to be done about what health is and how mental health plays into that and giving it attention and acknowledgement from a young age, especially within immigrant or AAPI families.

Maura: 2020 was an extremely challenging year for everyone with the COVID pandemic, but we also witnessed (and are still witnessing) violence and discrimination against AAPIs in the United States. Can you speak to some additional challenges of what it’s been like for AAPIs during these already trying times and how this might impact AAPI AYA mental health? How might these manifest or persist for AAPI AYAs after the pandemic is over?

Jaclyn: We actually released some new polling a few weeks ago that had a lot of specific questions about how AAPI women experienced racism and violence, especially in the last year during open but also generally. This poll found that in the past two years, even before the onset of the pandemic, 78% of AAPI women had been affected by anti-Asian racism and nearly one third said that the COVID-19 pandemic had an impact on their mental health.

Many of us AAPI women can talk about this compounded racial and sexist violence, this effect of racial misogyny on our ability to just be out in public and feel safe in public that has a toll on our mental health. This is something that a lot of Asian women grow up with and experience from adolescence, from being asked in school “what are you?” and then having a lot of sexual harassment also be about our race. Being an Asian women, I think this is something that we’ve all experienced at some point in our lives and it’s only become a lot more clear to others in the two last months especially since the Atlanta shootings. But this hasn’t been new for a lot of us.

Queer, young people of color have also experienced this kind of harassment that is not just based on their gender but also their race. One study showed that 45% of black, 49% of AAPI, 54% of Latinx, and 65% of indigenous LGBTQ youth reported feeling unsafe at school based on their sexual orientation. Those are really large and concerning numbers for queer people of color feeling safe in school. A lot of times they’re discouraged from reporting that. A lot of our schools also don’t have the resources or the kind of support for addressing racial violence or sexual violence, and racialized sexual violence together can be difficult in some settings. I think especially in the Asian community, there is a belief that if you report something, nothing is really going to happen anyway. And again, it goes back to that mentality where it’s just easier to put your head down and continue on.

Maura: What suggestions would you have for Title V and youth-serving professionals working with AAPI AYAs and what MCH can do to prioritize AAPI AYA mental health? What organizations or resources would you recommend to someone wanting to educate themselves?

Jaclyn: I think the most important thing is to increase access to culturally and linguistically appropriate care. This means not just improving language and interpretation services, but also the ability for staff and people who are serving AAPI youth and AAPI people to be able to have a better understanding of the culture in which they come from and to be able to talk to them in a way that looks at their health within the context of their entire lives and to think about the cultural background that may make their experience different from somebody else’s. A lot of times this might include trainings; it’s also about hiring and building a pipeline for more AAPIs or people of color in these types of professions. There is a huge difference in walking into a clinic and being seen by somebody who looks like you. Culturally appropriate care is especially important for immigrant communities and for those who are facing violence or harassment in their homes. That extra layer of understanding and support can go a really long way.

Another thing is to do away with the model minority myth. A lot of AAPIs are low wage workers and AAPI women are actually overrepresented in the low wage workforce and the frontline workforce. It’s important to keep that in mind when serving patients and addressing a lot of these psychological outcomes of racism.

We also really need a lot more data on AAPIs, and especially on queer youth and on AAPI youth from different backgrounds and low incomes. Disaggregating this data means that it has to be disaggregated by ethnicity, so I as a Taiwanese American woman may have a very different experience from a Cambodian woman who may have a very different experience from a Fijian woman. We have to disaggregate this data in order to see the full picture of AAPIs and not just take whatever aggregate or average term for at face value. That data also needs to be cross tabulated and further broken down by sexual orientation and immigration status, a lot of these other factors that are really important factors in health outcomes that we might overlook.

There aren’t really any AAPI organizations that are focusing solely on mental health since there aren’t that many AAPI organizations to begin with and then we’re all stretched across these various different issues. I would definitely recommend looking at the Association of Asian Pacific Community Health Organizations. They represent many community health organizations that primarily serve the AAPI community and are a great resource into learning more about what culturally competent and linguistically appropriate care looks like, what that means in certain contexts, and follow the lead of these community health centers who are working on the ground directly in these communities that serve AAPI youth, especially when it comes to mental health. The National Federation of Filipino American Associations promotes the welfare and well-being of Filipino Americans through leadership development, civic engagement, advocacy, and providing resources to facilitate their empowerment. The Asian Pacific Islander American Health Forum does health care advocacy broadly and are a great resource in learning about the health of AAPIs.  I would also recommend Empowering Pacific Islander Communities. They are specifically focused on the Pacific Islander community in general and the various host of issues that they face, such as the long lasting impacts U.S. militarism has had on Pacific Islanders and their livelihoods generally.

If you or someone you know is struggling with thoughts of suicide, please call the National Suicide Prevention Lifeline at 1-800-273-8255 or visit their webpage to chat with someone online.