When James started taking a more active role in his mother’s health care needs around six years ago, he came to appreciate something he had not understood before. “I didn’t realize without [a family member’s] help that my mom is actually a survivor,” he said. Born in China, James’ mother emigrated to the United States as a young woman and has lived in the Boston area for over 40 years. She has also dealt with mental health issues since she was a teenager. Having grown up in a community in which mental health was a taboo subject, she continues to face challenges to treatment and quality care even with increasing social recognition of the importance of mental health. James experienced firsthand these challenges while navigating the healthcare industry to advocate for his mother: “Every time my mom’s gone to the hospital for something,” he tells me, “it’s a nightmare.”

One consistent problem has been a dearth of linguistically and culturally appropriate psychiatric care. The National Alliance for Mental Illness (NAMI) reports that non-English speakers and those for whom English is a second language are less likely to seek help because they are unable to find bilingual mental health services. This problem was recognized over a decade ago in a study published in the American Journal of Public Health, the authors of which concluded that Asians in particular “have difficulty accessing mental health services because of the language barrier.” In the decade since, the problem remains. James had to act as a translator for his mother for a number of years, and though he has since been able to find doctors and nurses who speak both Mandarin and Cantonese, it was not easy. “We had to get another psychiatrist that wasn’t in the network of anywhere,” James says, “because I couldn’t find a psychiatrist…to even speak the language.” Is it a surprise, then, that Asian Americans are around three times less likely to seek mental health services than the general population?

There are a number of other barriers to mental healthcare for people of color, immigrants, and non-English speakers. A March 2021 report by the Southeast Asia Resource Action Center found that mental health resources for Southeast Asian communities are “limited in their effectiveness by a lack of financial investment, support, and integration in the mental healthcare industry.” A NAMI survey from October 2021 concluded that Asian Americans and Pacific Islanders “face more challenges to obtaining mental health services than other populations.” Members of these communities must also battle stigmas internal to the communities themselves. The problem is therefore twofold: how do we continue to address stigmas surrounding mental health, and how do we improve access and care? One cannot be solved without the other, but the road is long and complicated. 

There are some encouraging signs of societal shifts in attitudes regarding mental health. A study from 2021, published in the JAMA Network Open medical journal, found that by the turn of this century there was “a substantial increase in the public acceptance of biomedical causes of mental illness” and that a major positive change occurred in the way people understood depression. Popular organizations like Bring Change 2 Mind and Make It OK encourage dialogue and understanding of mental health conditions in the public sphere, and mental health was even a focal point of the most recent State of the Union address. Yet Asian Americans in particular may face cultural stigmas which are less easy to overcome. “[My mom] still gets shunned to this day,” James tells me, and points to the need for new perspectives. “Until people experience that…it’s perspective, it’s really perspective.” Lee, a young Asian woman with an as-yet-undiagnosed mental health condition, tells me that she has resisted seeking treatment because she’s worried her family might find out. “It’s not something I can talk about with them,” she says. Because of these concerns, she does not foresee herself getting help in the near future. 

While we work to overcome these stigmas, both general and culturally specific, we must also acknowledge that the on-the-ground reality of accessing mental health services is one of confusion, bureaucracy, poor communication, and low-quality care. When I ask him what caused some of the problems he’s faced, James smiles and sighs: “It’s a big system. When it’s a big system, and there’s money, and there’s a lack of case managers, [better mental health care] isn’t going to get the funding. They need to clear the bed for the next patient.” Even as he details the clotted bureaucracies and questionable policies he’s had to maneuver, James praises many of the healthcare professionals he has interacted with. The problem is not necessarily the doctors and nurses themselves, he suggests, but the fact that they feel pressure in a profit-driven industry to provide care quickly and move on. The economics of mental healthcare, then, are another critical reason why so few people get the help they need. 

The Harvard Medical School Primary Care Review (HMSPCR) attributes increasing suicide rates and worsening comorbid conditions to the rising costs of services and the poor integration of mental healthcare into primary healthcare. One reason mental health services are so expensive is the lack of insurance coverage: a shocking 45% of psychiatrists do not accept any form of insurance. Those who do face the difficulties of entering an insurance network, a process that can take up to six months or more. Patients who can afford insurance may nonetheless have difficulty finding anyone in their network, let alone a psychiatrist who speaks their language or understands their cultural background. Finally, even those who manage to find the right person for treatment may have to wait several months for an appointment. 

What can be done about these aspects of the mental healthcare industry? The same article in the HMSPCR advises reimbursing “telemedicine” visits (virtual visits with healthcare providers) at the same rates as in-person visits, as well as lifting some regulations, such as the requirement for a clinician to be in the same state as a patient during these virtual visits. It also calls for simplifying the process for providers to join insurance networks and making it easier to link mental health providers with primary care groups. Whatever reforms are proposed, they must be enacted with an eye towards the barriers underserved communities face. More bilingual and culturally sensitive services, more accessible and affordable healthcare responsive to people’s unique needs, and more activism to challenge social stigmas will help to address some of these problems.

It’s also crucially important that we work to understand mental health and the individual human beings who are suffering from and surviving these conditions. “You have to seek to understand it,” James says. He praises his mother’s resilience and her ability to connect with people despite her struggles. “My mom has touched the hearts of people I didn’t even know about,” he tells me, emphasizing parts of his mother’s life that we may all too easily overlook. People with mental health conditions deserve respect, understanding, and quality mental health care. We must address the problems of access, affordability, and quality in the mental healthcare industry or risk forgoing our responsibilities to the vulnerable members of our society. In working together to solve these problems, we can ensure that people like James’ mother will not only survive but thrive.

SAMPAN, published by the nonprofit Asian American Civic Association, is the only bilingual Chinese-English newspaper in New England, acting as a bridge between Asian American community organizations and individuals in the Greater Boston area. It is published biweekly and distributed free-of-charge throughout metro Boston; it is also delivered to as far away as Hawaii.