Why culturally competent mental health care is a must for the AAPI community

May is Mental Health Awareness Month and Asian American Pacific Islander (AAPI) Heritage Month.

In Chinese culture, there is a saying, “chi ku,” that translates to “eating your bitterness.” The underlying belief is that when bad things happen to you—and they inevitably will—the brave choice is to grin and bear it, push through hardship, and move on. On the one hand, this behavior likely served as a protective mechanism that allowed generations of people to keep going in the face of war, trauma, and loss. At the same time, we now know that suppressing our feelings is associated with a higher risk of early death, heart disease, and cancer.

A few years ago, when I came across the stat that Asian American and Pacific Islanders (AAPI) are one of the racial groups least likely to seek mental health treatment in the US, I immediately thought of all the times I’d heard chi ku mentioned growing up, from family members, my friends’ parents, and even old Chinese films set centuries ago. There’s still a stigma in many AAPI communities, where talking about one’s depression or anxiety is seen as a sign of weakness, preventing people from seeking help In fact, a 2021 KFF analysis of SAMHSA’s national drug & health survey data found that among U.S. adults with any mental illness in the past year, only a quarter of Asian adults reported receiving mental health treatment compared to over half of White adults. 

Add to that the language barriers for many first-generation AAPI immigrants and the difficulty in finding a mental health professional who understands them—let alone their unique cultural experiences and challenges. 

At the same time, the need for mental health care is greater than ever. We’re living in a world of skyrocketing levels of stress and anxiety about everything from the economic climate to the actual climate. On top of that, many AAPI, particularly those of East Asian descent, experienced more anxiety and fear as anti-Asian sentiment and attacks spiked during COVID. Harmful stereotypes like the “model minority myth" also continue to place undue pressure on many Asian Americans, which can lead to feelings of inadequacy and shame if they don’t fit the "mold." A 2023 study of the Medicaid population also found that Asian Americans with behavioral health issues were more likely to say that language, cultural stress, and cultural identity needs interfered with their functioning, compared to White or Black Americans.

Fortunately, the AAPI community’s openness to discussing mental health may be starting to change. Susan Ko, Ph.D., Twill’s VP of Clinical Affairs, maintains a practice in the Greater Los Angeles area, and has noticed an uptick in AAPI clients over the last few years. “I’m seeing more Asian males and Asian couples giving therapy a chance. It’s become more accessible as some employers have started to offer mental health sessions as a benefit,” she says. “I’m really happy to see things changing as more Asians see mental health treatment as an option for support and development, as opposed to an indictment that brings embarrassment and shame.” 

If you’re not sure where to begin, look into these AAPI mental health organizations, which can help you find a culturally competent therapist. A 2018 study published in the Journal of Clinical Psychology found that mental health treatment was more effective when clients perceived their therapist to be culturally competent. “Our cultural background plays a role in our identity. For some people, it plays a larger role, while for others it may be smaller. For some it may be more conscious and intentional, and for others, less so,” explains Ko. She says there’s no one right way to integrate culture or background into one’s identity, “but a culturally competent therapist will know how to ask questions to better understand its role for you, and subsequently, how to use culture as a lens for understanding your experience.”

If you’re evaluating a new therapist to see if they’re a good fit, ask about their experience working with diverse populations. “It’s a useful way to learn if they’re merely interested or actually have experience providing care. Ask them what they view the role of culture to be in therapy, and see how you feel about their response,” suggests Ko. 

It’s equally as important for mental health organizations and creators of mental health tools to take background and culture into account. A 2021 Deloitte report found that approximately 20,000 mental health apps exist, but how many of them can address the complex needs of an increasingly diverse population? 

At Twill, our content team has created well-being programs in partnership with diverse experts who truly understand the unique needs and challenges of different populations. 

At the height of COVID, when many Asian Americans felt heightened levels of fear and anxiety due to a rise in anti-Asian attacks, we collaborated with Taiwanese-American therapist Michelle Pow to create a track on our app Happify (now Twill Therapeutics) featuring activities designed to help them feel less anxious while bolstering their resilience. We also partnered with Korean-American meditation teacher Hannah Moon to create custom guided meditations specifically for the AAPI community, and our editorial team consistently publishes content that’s relevant to AAPI mental health. 

We strive to do the same for other underserved populations including the Black, Hispanic/Latinx, and LGBTQ+ communities and people with chronic conditions, because the more tailored the content, the better chance we have of reaching—and helping—people everywhere. And our work isn’t finished. 

The mental health crisis is on all of us to solve. Tech leaders, health care practitioners, researchers, and individuals—we can all do our part to learn about the unique needs of diverse populations, share those learnings with others, and steer people towards care that is culturally competent and tailored to the individual.