Gaps in Mental Health Care for Asian and Pacific Islander People and Other People of Color

This year, the marking of Lunar New Year was marred by yet another tragic mass shooting in Monterey Park, California, which was closely followed by a second mass shooting in Half Moon Bay, California. Many, but not all, of the victims of both shootings were Asian, as were the perpetrators. These shootings occurred against the backdrop of rising racism and discrimination and hate crimes against Asian people amidst the pandemic. Motives for both shootings remain under investigation and mental illness is not a strong predictor of such shootings. However, as efforts are made to help the victims recover and to respond to the broader ripple effects of violence on the health and well-being in these communities, it is important to consider how our health care system meets the mental health care needs of Asian and Native Hawaiian and other Pacific Islander (NHOPI) people and other people of color and gaps that could be addressed to improve their care. This policy watch provides insight into these issues.

The COVID-19 pandemic has contributed to and coincided with worsening mental health across the population, including Asian and NHOPI people. In addition to the negative health and economic impacts of the pandemic experienced across the population, Asian people also have experienced increased discrimination and hate crimes, which research suggests have negatively impacted their mental health. These issues are not new, as Asian and NHOPI people have faced longstanding racism and discrimination among other challenges, including exclusionary immigration policies, internment, and stresses associated with the model minority stereotype, and acculturation. These experiences are linked to poor mental health.

Overall rates of mental illness are generally lower among Asian people compared to White people, but this may reflect underdiagnosis and undertreatment among the population. In 2021, 16% of Asian adults reported any mental illness in the past year compared to 24% of White adults; there was no statistically significant difference in rates of mental illness between NHOPI and White adults. The lower rate of mental illness among Asian adults may be reflective of underdiagnosis and underreporting. It also may mask variations in mental illness rates among subgroups of the population. Among people with mental illness, Asian people are less likely to utilize mental health services compared to other racial and ethnic groups. In 2021, among adults with any mental illness in the past year, only 25% of Asian adults reported receiving mental health services compared to 52% of White adults (Figure 1). Data on utilization were not available for NHOPI people. Moreover, data show rising rates of suicide death among Asian and Pacific Islander adolescents (ages 12-17). Although they have lower rates of suicide death compared to their White peers, suicides were the leading cause of death among Asian and Pacific Islander adolescents in 2020, and suicide death rates more than doubled among this population from 2010 (2.2 per 100,000) to 2020 (5.0 per 100,000).

Gaps in the mental health care system pose an array of challenges to accessing care for Asian and NHOPI people. While stigma and cultural attitudes towards mental health are factors that may lead to lower reporting of mental health concerns and service utilization among Asian people, it is also important to consider how the health care system shapes their ability to identify needs and access care. For example, research points to the lack of a diverse mental health provider workforce and the absence of culturally informed treatment options for Asian people, which may contribute to lower utilization. Moreover, the Asian population is not a monolith. There is wide variation in the characteristics of Asian and NHOPI people that affects their experiences, health needs, and ability to access health care. Overall, over one in four Asian people is a noncitizen and nearly one in three speaks English less than very well, with even higher rates among some subgroups. Noncitizens and individuals with limited English proficiency may face increased barriers to accessing care, including immigration-related fears and lack of access to linguistically appropriate services. Additionally, some subgroups of Asian and NHOPI people have higher uninsured rates and are more likely to face social and economic challenges that may pose logistical and financial challenges to accessing care.

Research and data to understand mental health needs and care among Asian and NHOPI people remains limited. Many datasets have small samples of data for Asian and NHOPI people and some report data for these individuals in a combined group, limiting the ability to examine experiences of NHOPI people and variations in experiences among Asian subgroups. Moreover, some research suggests that underreporting of mental health concerns among Asian people in national survey data may, in part, be due to limited survey language options. Smaller studies offered in multiple languages have identified greater mental health concerns and underutilization of mental health services among Asian people.

Response to the victims and communities affected by recent mass shooting tragedies has turned national attention and focus to mental health care for Asian and NHOPI people, groups that too often remain overlooked and left out of data and policy discussions related to health disparities. As efforts unfold to assist the victims and prevent and respond to future events, it will be key to reflect on how the system can adapt to better meet the needs of a diverse population, including Asian and NHOPI people.