Facilitating Conversations about Mental Health in Asian American/Pacific Islander Households

Illustration: Jenica Rose Garcia

Facilitating Conversations about Mental Health in Asian American/Pacific Islander Households

By Kellie Toyama

With the rise of uncertainty in these unprecedented times, there has been a rise in people of all ages struggling with mental health and substance abuse since April. Even more concerningly, the CDC has found that young adults from the ages of 18-24 are experiencing “disproportionately worse mental health outcomes, increased substance use, and elevated suicidal ideation.” With this information in mind, it is important to consider who is most likely to report symptoms of mental illness. The stigma around mental illness fed by misconceptions and biases is no doubt prevalent in every culture. Asian Americans and Pacific Islanders, for example, have reported higher levels of “self-stigma,” when regarding mental health, and feel “less hopeful” than their white counterparts when considering themselves as contributing members of society. Asian-Americans are the least likely ethnic group to report symptoms of mental illness—not necessarily because they are the least affected, but presumably because they are the least likely to report it. 

As a third-generation Asian-American immigrant, I know there are many generational barriers to overcome when it comes to conversations about mental health at home. For immigrant parents, it is confusing to hear their child struggle emotionally and mentally because our experience is inherently more privileged than theirs. “How can you be sad when you have a roof over your head and food at the table?” is no doubt a question I and many of my peers have heard over the years. But we must remember that struggling to keep a stable/healthy mental state does not make you an ungrateful child. Mental illnesses are the result of trauma and complex environmental circumstances. You, as an individual, are never to blame. Regardless of having physical bodily needs met, we still deserve to have our emotional needs considered. This concept may be difficult for different generations to grasp, but it’s an idea worth bringing up for the sake of our well-being and a family’s holistic well-being. It feels daunting to tackle the systemic ways in which mental health treatment is inaccessible, but initial conversations at home with intergenerational dialogue can be more influential than you may think. 

In my mixed Japanese/Chinese household, it took almost all of my teenage years to work up the courage to talk to my parents about seeing a psychiatrist, though I had been struggling with depression since I was fourteen and anxiety long before that. When I was surprisingly met with a willingness to understand, I wished I had done it sooner. At college, it feels natural to talk about taking care of myself and my mental health. At home with family and in predominantly Asian and Pacific Islander (API) communities though, mental health still feels like a taboo subject, even though it shouldn’t be. 

Though everyone’s home situation and family dynamics are different, and older API generations might be dismissive of acknowledging mental health altogether, here are a few things that I’ve found helpful in facilitating these uncomfortable but necessary conversations in API spaces:

1. Acknowledge the cultural values that may be “in conflict” when talking openly about mental health. Don’t allow these clashing ideas to discourage you from thinking about the care and healing you deserve. 

Many East Asian cultures place value on the image of a family before the individual. This is where parents might be coming from when they want to sweep instances of mental illness under the rug. However, this idea does not have to be a destructive concept. Your physical and mental health is actually something that can benefit the family as a whole in the long run. Wanting to be better for yourself and others is not a selfish thing. Yes, the topic of mental health is very Westernized, but it is not a betrayal of your culture to engage with it. 

2. Help people understand mental illnesses by starting from a scientific, logical perspective. 

While this explanation doesn’t fully encompass the complexities of depression and anxiety, common mental illnesses manifest as chemical imbalances in your brain. It might be easier to ground concepts of emotion in solid theory and reason. It’s not realistic for a person to simply handle emotional/mental struggles silently on their own, just as it wouldn’t be realistic for a diabetic person to will more insulin into their bloodstream. Since most adults are generally more receptive to physical healing than emotional healing, consider your brain chemistry as an extension of your body that deserves the same degree of care. 

3. Try to be a patient educator, keeping in mind the internal conflicts the people you are talking to might have themselves. 

It can be especially exhausting to explain your existence to people who are simply unwilling to hear your struggles. They can never fully know what we are feeling, and we can never know what feelings they might be hiding. However, showing your care for their well-being may help them be receptive. 

At the end of the day, the initial conversations are the most daunting. But the more comfortable we get in talking about mental health, the more we can destigmatize it, and the easier it is to open doors to accessibility. In the meantime, if you are in a household that is ultimately un-affirming, you can visit sites with accessible services and connections like the National Alliance on Mental Health for communal healing practices.