Language, AAPI cultures become barriers to seeking mental health care

Spa shootings caused spike in requests for treatment, but resources aren’t always there

He knew it wouldn’t be easy, but he needed to pay his respects to the spa shootings’ victims.

Standing at one of the scenes was a lot for the 22-year-old to take in. He felt sadness for the eight lives that were lost in the metro Atlanta area shootings on March 16. Suspect Robert Long has been charged in their deaths.

“I got destroyed,” said the Chinese American college student, who agreed to speak to The Atlanta Journal-Constitution under the condition of anonymity due to privacy concerns. “I got absolutely destroyed, because one of my secondary connections was a victim. And I contributed to the person’s GoFundMe and everything. And the picture that he used was kind of like any Asian family photo and then I was like ‘Wow, this could of happened to any of us.’”

The college student had an outlet to process his emotions, as he’d just started seeing a therapist in the spring to work through some familial issues. But not everyone had the same outlets.

The stresses of the past year have put a strain on Asian Americans and Pacific Islanders. In 2020, anti-Asian hate crimes reported to police rose by about 150% in 16 of America’s largest cities, according to data from the Center for the Study of Hate and Extremism at California State University, San Bernardino. For some, the spa shootings were a turning point that caused them to seek mental health support. But a variety of language and cultural barriers, along with simple supply and demand, have prevented many of them from getting the help they need.

“We did see an uptick in just trauma being triggered in this community, so we’ve had our hands full,” said Roger Lin, an Atlanta-based licensed psychologist.

Raising awareness

With dozens of nationalities with distinct cultures making up the Asian American and Pacific Islanders community, finding providers who can connect with a patient’s native language and culture can be complex.

“We’re all trying to partner together to refer to each other, but we’re all full in terms of professional providers,” Lin said.

The Asian American Resource Center received dozens of calls after the shootings from people asking for help. As a result, the organization has increased its mental health outreach services, and began hosting a series of seminars in multiple languages designed to educate and to connect people with counselors.

“We were motivated by the spa shootings,” said Xavier Kim, managing director of the AARC. “This has always been an issue and we wanted to structure (the talks) in a way to give motivation to people. We wanted to reach minority groups and groups in need.”

Credit: Paradise Afshar, AJC

Credit: Paradise Afshar, AJC

The need for expanded services is clear. In 2019, death by suicide was the leading cause of death for Asian Americans / Pacific Islanders ages 15 to 24, according to the U.S. Department of Health and Human Services. That same year, about 7% of Asian American adults received mental health services, compared to nearly 20% of the non-Hispanic white population.

Asian Americans are considered the least likely racial group to seek mental health services. While language and cultural barriers often get in the way of finding the right therapist, social stigma is also a major barrier.

“We put the value on what you can give to our families and our communities, but as soon as we need something, we see ourselves as a problem or a detriment,” said Tommy Hoang, an Atlanta-based licensed clinical social worker. “You feel shame, you feel like it’s a weakness. It’s a stigma that is hard to break. It’s culturally something that we don’t deal with.”

ExploreFear, anxiety still lingers for Metro Atlanta Asian Americans

The college student who visited the Atlanta spas to pay his respects, explained that in Chinese culture— along with others throughout Asia — the concept of “face” holds significant weight. This idea pushes people to maintain a level of dignity, and thus “saving face” is valued.

This can add to the stigma of seeking mental health support within the community.

“It’s not easy talking about it to your friends. Keep it secret, keep it in house,” Bona Kim, a licensed master social worker, said. “I think some parents and older generations may think, ‘We lived without mental health professionals. You can do it. too. You can get through it, go out and have more friends, go to church. Do you really need to see a therapist?’”

Credit: Paradise Afshar, AJC

Credit: Paradise Afshar, AJC

She explains that it’s not uncommon for first-generation immigrants to become hyper focused on providing for their families when they come to the United States, and to put their own health needs on the back burner as a result.

“Their values are so shifted to one area, it can create an imbalance within the family,” said Bona Kim. “So having that empathy and that time to let out their emotions can be difficult within a family, especially when there may be language barriers in the family.”

Tom Liu, an Atlanta-based therapist who treats trauma, sees this dynamic play out in his practice.

“The Asian community isn’t very big in Atlanta, so there is a fear of ‘What if I see this person at church or what if I see a therapist and he knows all my secrets, and I see them out in Chinatown?,’” Liu said.

He’s had people come to therapy and refuse to call a translator for fear it would be someone from their community who might know them personally.

“You got them in the door already and you hit another barrier,” Liu said.

A rebranding of services

In order to remove some of the cultural barriers, mental health services are sometimes rebranded as “mindset training” and topics like emotional intelligence are stressed.

Lin says this tactic can be effective.

“We’re trying our best with different strategies to provide this resource for them,” he said. “Mental health has so much stigma in terms of Asian culture values. Education is a common one; focus attention, strong mind that’s a good one. Anything to help them see we’re trying to get you help, we’re trying to get you resources.”

Credit: Paradise Afshar, AJC

Credit: Paradise Afshar, AJC

Hoang made a presentation at a recent resource center seminar where he told a personal story about a family member who never got mental health treatment because finding a local therapist who spoke Vietnamese proved to be impossible.

“It hit hard because she reached out to me, and I couldn’t help her,” he said.

To help bridge the gap, Lin encourages younger members of the Asian American community to get into the field as a way to expand options for those seeking treatment.

And for those who are seeking help, or currently getting support, Hoang’s advice is simple: stick with it.

“I stress the point of seeing a professional because it’s something you think you have a handle on and think you can just manage,” he said. “But it’s like having a hammer and trying to pound everything in and make it fit when it doesn’t because you don’t have the right tool set.”

Paradise Afshar is a Report for America corps member covering metro Atlanta’s immigrant communities.