APIA ADOLESCENTS & SERVICE UTILIZATION
DEFINITIONS:
Discrimination:
Utilization:
- Use of health care resources for treatment
- Formal services : professional advice and treatment, including help from psychiatrists, mental health specialists, social workers, counselors in private practice, medical doctors in private practice, and services at mental heath centers, psychiatric outpatient clinics at general hospitals, social service agencies, crisis centers
- Informal services : advice and comfort from friends, family, or religious figures in the community
Somatization:
- Presentation of medically unexplained physical symptoms related to psychiatric disorders
- Common syndrome among APIs suffering from mental health disorders
Stigmatization:
- Act of passing judgment or disapproval on an individual or group of individuals
- Many APIs fear the stigma associated with having mental health disorders and therefore resist seeking help from professional mental health services
- Among Chinese Americans, stigma plays an important role in preventing them from seeking help. Culturally, most Chinese tend to hide their feelings in comparison to their western counterparts. A famous Chinese quote states that "family shame should be kept inside the house." While saving face is important to many Chinese, the belief that mental health is shameful is thought to be a result of their lack of knowledge about mental illnesses.
OVERVIEW:
Underutilization of Services
Considerable indirect evidence demonstrates that Asian Pacific Islander Americans tend to underutilize mental health services and prematurely terminate treatment compared to the general population. Often times, services are needed to treat problems including academic stress, interpersonal relations, health/substance abuse, dating, family difficulties, and racial issues.
One study showed that less than 25% of APIs with mental disorders sought care. In the Chinese American Epidemiology Study (CAPES), only 17% of individuals with mental disorders sought care. Studies have also shown that Asian Americans who do use mental health services present more serious illnesses than their Caucasian counterparts. ,
Barriers to utilization of mental health services by APIs include :
- Cultural value placed on the avoidance of shame and loss of face
- Stigmatization of psychiatric disorders
- Differences in language, culture, and ethnicity
- Tendency to endorse somatic rather than emotional and interpersonal problems
- Inadequacy of Western services to meet the needs of the API immigrant population
- Practicality of combining Western and traditional treatments and practitioners
- Lack of knowledge and understanding about psychiatric disorders
- Lack of health insurance
Discrimination, often resulting from language and cultural barriers, is correlated with greater use by APIs of informal services such as help from friends and family than of formal services. Those who use informal services often times have negative impressions of formal services. Research also shows that individuals with health insurance are more likely to use formal services than informal services. Public health workers have advocated for more multilingual education on the availability of Medicaid and for increased funding for public agencies that provide services for the uninsured and immigrant populations.
IMPORTANCE:As the API population in the US continues to grow, it is imperative for society to become more knowledge and aware of the health care problems they face. While APIs have historically been referred to as the ‘model minority,’ they too face severe health challenges such as mental health disorders. It is important to understand how expectations to uphold such a standard, stress, acculturation, and accessibility to health care impact the mental health prevalence and service utilization among APIs.
Adequate funding of mental health services and outreach projects for Asian-American communities are essential in encouraging APIs to seek help when suffering from mental illnesses. Some strategies that can enhance the utilization of mental health services include :
- Developing language and culture specific services
- Providing services specifically tailored to APIs
- Fostering consumer-provider ethnic match
A study published in 2005 evaluated the racial and ethnic disparities in use of mental health services among youth from ages 6-18 years old. High risk Asian American youths were much less like than youths of other ethnic groups to receive any formal mental health treatments.
Only 59% of APIs in the study used services compared to 79% of non-Hispanic white youth, 64% of African Americans, and 70% of Latino Americans (Figure 1). APIs youths were approximately half as likely as non-Hispanic whites to receive any treatment.
A study conducted in 1994 by Tata and Leong found that more highly acculturated Asian Americans were more open to seeking professional psychological help than Asians with lower levels of acculturation. In a more recent study by Leong, it was proposed that the status of being a minority group in the US is a factor that predicts negative attitudes held by Asian Americans toward seeking mental health services. Minority status, and not cultural values or beliefs, was considered a stressor in the study and an obstacle for Asian Americans to seek professional psychological help. Thus, special outreach programs may need to be targeted to low acculturation and recent immigrant groups in the Asian American communities in order to meet their mental health needs.
RESOURCES:
Asian American Mental Health Directory
Asian and Pacific Islander American Health Forum
Chinese Mental Health Association
National Research Center on Asian American Mental Health
Office of Minority Health, U.S. Department of Health & Human Services
REFERENCES:
Garland, A.F., Lau, A.S., Yeh, M., McCabe, K.M., Hough, R.L., Landsverk, J. A. “Racial and Ethnic Differences in Utilization of Mental Health Services Among High-Risk Youths.” American Journal of Psychiatry. 162. 2005. 1336-1343.
Kennedy, M.G. “Utilization of Specialized Mental Health Services by Asian Americans and Pacific Islanders.”
Kwok, C.F.Y. “Mental Health-Chinese Style.” http://www.psychjourney.com/Mental%20Health%20Chinese%20Style.htm
Leong, F. T. L. Lecture. “Cultural Barriers to Mental Health Services Utilization among Asian Americans.” University of Michigan, Ann Arbor. March 30, 2007.
Merkel, L. “Minority Issues in Mental Health-Asian Americans and Hispanics.” January 28, 2004.
Spencer, M., Chen, J. “Effect of Discrimination on Mental Health Service Utilization Among Chinese Americans.” American Journal of Public Health. Vol 94, No.5, May 2004.
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