It’s Time We Talked About It

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Hoiyan Isabel Pang has had a difficult, yearslong journey finding a mental health professional who understood all of her intersections: She is a bisexual woman, Asian American immigrant and survivor of childhood sexual abuse.

Pang saw a range of therapists and counselors, all of whom were white, before making the decision to work only with therapists of color. That move has helped her to feel more open and understood.

“I needed someone who could have balance and empathize with the act of walking through this world with multiple identities,” Pang, a 27-year-old social worker from Florida, said in an email.

HuffPost heard from more than half a dozen Asian Americans who connected via the Subtle Asian Mental Health (SAMH) Facebook group, a fast-growing online community with close to 60,000 members. The group is managed by the Asian Mental Health Collective (AMHC), a nonprofit with a mission to build community, raise awareness, provide resources and challenge stigmas around mental health for Asian Americans.

“I think there are a lot of people who are itching to have these conversations and they just haven’t found a community in which they can have them,” said Kaila Tang, an Atlanta-based psychotherapist and chief program officer at AMHC.

The organization has mushroomed from a small Facebook group to a far-reaching mental health resource inventory for Asian Americans in just three years. It created a directory of Asian, Pacific Islander and South Asian American therapists, and it organizes roundtables and panels to raise awareness and kick-start conversations on mental health in the AAPI community. The group offers a space for current and prospective mental health professionals of Asian background to connect and educate one another. It elevates the mental health journeys and experiences of Asian Americans and Pacific Islanders; amplifies AAPI leaders, artists and experts; facilitates peer listening and Q&As with therapists; and provides a safe space for its members to share and relate on experiences and challenges that have influenced their well-being.

Discussions in SAMH are wide-ranging but can often revolve around topics such as overcoming toxic parenting, stigmas about mental health, imposter syndrome, and racist microaggressions in life and at work. There are graphics reminding people to be kind to themselves, Asian mental health memes aplenty and a resounding chorus of people asking one another, “Does anybody else feel this way?”

Lillian Nguyen, a 27-year-old psychiatric nurse, said that while growing up Vietnamese in a predominantly white community in Pennsylvania, she struggled to find connection. Since joining SAMH and reading what others share there, she has developed a better understanding of how her parents and her upbringing affected her mental health. It confirmed for her that she wasn’t alone, she said. Since then, she’s joined the group as a volunteer and found her first Asian therapist through the group’s directory.

Conversations about Asian mental health have become more urgent following a troubling surge in anti-Asian discrimination and hate crimes brought on by the pandemic, in particular the horrific fatal shooting of six Asian women in Atlanta-area spas in March.

These events certainly exacerbated the anxiety and distress felt by the AAPI community.

But the issues are nothing new. Organizations have been fighting for years to cultivate awareness about Asian mental health and to dismantle the damaging myth of the “model minority” ― a broad stereotype casting all Asian Americans as hardworking, smart and likely to achieve socioeconomic success.

Lillian Nguyen has been in and out of therapy for 10 years and has been diagnosed with depression, anxiety, PTSD and anorexia. She’s recently started working with an Asian therapist. This has allowed her to speak about her family relationships without having to give context on why her parents do the things they do, she said.

Lillian Nguyen

What’s different about Asian mental health?

Difficulties adjusting to and balancing cultural differences, stigma, internalized racism, intergenerational trauma, identity struggles and societal pressures to succeed are just a few of the challenges AAPI individuals face that can influence mental health.

Bernie Wong, manager of research and design at Mind Share Partners, a nonprofit seeking to change the culture of workplace mental health, noted that along with the complex and intergenerational mental health challenges imposed by immigration, this community faces elements including income inequality and joblessness, anti-Asian discrimination and violence, and the erasure of all of these challenges under the guise of the model minority.

Due to a number of cultural and structural barriers, research has found Asian Americans to be the least likely of any racial group to seek mental health care. In addition to factors like stigma, lack of access to health care, limited data and research on AAPI people, and language barriers, that statistic is also linked to the limited number of AAPI therapists.

The psychology and therapy workforces in the U.S. are overwhelmingly white. Asians make up less than 5% of psychologists in the U.S. and just over 10% of therapists. It can be particularly difficult in some parts of the country to connect with an AAPI mental health professional.

Jeanie Chang, a licensed therapist and AMHC president and board chair, said that in a white-dominated field, creating directories of therapists of color is relatively new.

“It encourages the AAPI population to seek treatment when already they’re the least likely to go. So just knowing that a fellow Asian possibly could be in their state or in their city can help start that conversation to get help,” she said.

Based on a better understanding of the client’s culture, an Asian therapist might also be able to offer more nuanced guidance and treatment.

HuffPost spoke with a number of individuals who said that therapists without experiences as people of color were unable to grasp their struggles as Asian Americans. Some others said they’d had positive experiences but understood the need for better representation and training in this field as a whole.

“I realized that I’d experienced cultural insensitivity in two types of ways,” Pang said of her experiences in therapy. “One made culture and race my entire identity, and the other who completely erased it.”

Being a member of another marginalized group often complicates these challenges for Asian Americans.

Wong said his experience managing chronic depression as a gay, Asian American man led him to minimize aspects of his identity for much of his life.

“Homophobia is prevalent within the AAPI community; racism is pervasive within LGTBQ+ circles; and both communities face ongoing social, structural and systemic disenfranchisement,” he said.

Multiple Asian Americans who identify as LGBTQ+ reported significant challenges finding therapists who could appropriately treat them.

Sydney Rae Chin, a third-generation Chinese American who is a queer, polyamorous woman, said she saw three therapists before finding someone she connected with.

“I’ve been lucky to [currently] work with a queer East Asian woman as my therapist who understands all my intersections,” Chin said. “But I know this is rare.”

“Working with her has been one of the most life-changing things for myself; I think being seen in wholeness in all my intersections is affirming.”

AMHC is in the process of revamping and expanding its therapist directory to allow people to run intersectional searches, including for providers who are LGBTQ+ affirming.

Hoiyan Isabel Pang, who grew up in Malaysia and moved to Florida as a teen, said that when therapists generalized about her culture, it made her feel defensive, “and like I had to fight for my heritage, as if they were perceiving that sexual abuse and lack of support from family on trauma is just a defining feature of Asian cultures.”

Provided by Hoiyan Isabel Pang

Where do we begin to address it?

Organizations like AMHC are bringing support directly to the AAPI community. Other advocates are fighting for more systemic change. The Asian American Psychological Association (AAPA), for example, has been working since 1972 to advance AAPI mental health through research, practice, education and policy.

It has members actively researching specific topics in Asian American psychology, including identity issues and microaggressions, to guide training on cultural competence. It’s working to increase representation in mental health care via mentorships, scholarships and development programs for students. It advocates for policies that would close the gap in access to health care.

Chang, who does a range of work on Asian mental health advocacy and awareness, said she has been calling for educational reform across the board.

“First of all, getting racism and model minority and Asian American history into the public school system,” she said. “But I’m really focusing on wanting someday to change college campuses and graduate programs in psychology or social work that barely touch on cultural competence.”

“I just really don’t understand how the training is still so outdated.”

For mental health care professionals, better cultural competence comes from education and addressing internal biases.

“The first step to cultural competence is awareness, for therapists to be aware of their own biases,” said Gloria Wong-Padoongpatt, secretary-historian of AAPA and an assistant professor of psychology at the University of Nevada, Las Vegas.

“When I teach multicultural psychology … I spend the entire semester just working on that first step of building awareness. So building awareness of their own world views.”

Though representation in the field is important, and some individuals may feel more comfortable and understood by an AAPI clinician, all providers should be able to offer some level of culturally appropriate support to patients of all backgrounds.

“We’re talking about systemic change for the future of psychology to shift,” said Chang. “We need to have better education in the psychology program. So white, non-Asian or even Black clinicians know exactly, or actually feel pretty equipped to treat an AAPI individual.”

At a time when Asian Americans are the targets of increased levels of discrimination and violence, it’s important to be aware of the social and political moment, and to call out racism against the community.

“Without naming it and just pretending that it’s not happening is very detrimental for everyone involved,” Wong-Padoongpatt said. “This is a learning moment.”

In her research on the effects of microaggressions on marginalized people, Wong-Padoongpatt found that Asian Americans experience lower self-esteem, resulting in more stress from everyday slights perpetrated by non-Asians. She used examples like, “Where are you really from?” and comments about English-speaking abilities in her experiments ― offhand remarks in daily life that are all too familiar for many Asian Americans and other minorities.

Making communities and workplaces better, safer and more equitable environments for AAPI people takes time, education and investment.

“You are not expected to become experts about the challenges that every community and their intersections face,” Bernie Wong said.

“Take time — regularly — to consider what you are uniquely positioned to do to unravel our long history of disenfranchisement on the premise of gender, identity, culture, community membership and more.”

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This article originally appeared on HuffPost and has been updated.

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