It's no secret that there is often a stigma in discussing or even acknowledging the topic of mental health within Asian-American communities. Not only does this leave members of our communities feeling isolated and misunderstood, but it has contributed to the gap in research and treatment options that exist. I believe it's the responsibility of our generation to break this cycle of stigma and silence and provide our children with the education and tools they need to understand and manage their mental health.
In honor of April being Autism Acceptance Month and May being Mental Health Awareness Month, we chatted with Dr. Rishi Patel (Child & Adolescent Psychiatrist), on the importance of discussing mental health issues in these communities, why it is often avoided, and how to overcome the cultural barriers to have these conversations.
Q: How can we increase awareness and reduce stigma around mental health issues in Asian American communities, and what role can healthcare providers play in this effort?
A: Often mental health is considered a taboo subject. Simply talking about it as a normal part of the human experience takes a lot of the stigma away from it. Most people face some level of mental distress which is considered a normal part of life, but when thoughts, emotions, or neurotransmitters become unbalanced it may need intervention by a mental health professional.
Q: What are some of the cultural stigmas and barriers that prevent Asian Americans from seeking mental health support, and how can we address these?
A: This is an interesting question because a lot of the stigmas surrounding mental health did not form until the 1800’s in some regions and 1950’s in others. If we look back thousands of years, mental health was a pillar in many of the Asian cultures. This includes Chinese traditional medicine and Ayurveda. As society modernized, a lot of the beliefs and practices around mental health were thought to be antiquated in the face of modern medicine. It wasn’t until recently that some of these techniques, including meditation, yoga, and acupuncture, have been integrated back into modern medicine.
Q: What are some common mental health challenges that are particularly prevalent among young, 2nd gen Asian Americans that you have seen?
A: One challenge that we’ve seen with 2nd generation Asian Americans is having access to care, especially care for populations under 18. Often depression, anxiety, or other mental health disorders are not acknowledged by other family members due to the aforementioned stigma so children may not be taken to a mental health specialist consistently or in a timely manner. Instead, symptoms may be dismissed as a surmountable challenge that just requires willpower, further feeding the “model minority” stereotype. That being said, since COVID we have been slowly seeing a shift in Asian communities to be more open to mental health care.
Q: What are some things we as a community can do to support inclusion, accommodation, and education of mental health?
A: One of the best things that we can do in the community is to simply acknowledge mental health as a routine part of a physical health check up. The brain is an organ just like the heart and lungs, and may require medical intervention at times.
For purposes of inclusion, we have to remember that there is a rich history of mental health within our communities and that it is nothing new. If we take the approach that it is a part of our culture rather than a foreign concept, then it can help people understand mental health on their own terms. Moreover, it is also the responsibility of mental health practitioners to practice cultural curiosity and ask about the patient’s individual experience to tailor their care accordingly.
Accommodating for mental health is another challenge faced in the Asian American community and may be considered a “crutch”. Rather than a crutch, we can consider accommodations as a tool to help patients achieve their goals.
Q: You mentioned there are major gaps with research in the Asian American community in this area. Tell me about the importance of addressing these.
A: The Asian American community is very diverse and with that diversity comes some divergence. This simply means, research should be specific to subgroups within the Asian American community to be more representative. The issue we face is 2-fold, there is a lack of research on specific communities and a lack of research on the Asian population as a whole. This leads to challenges in understanding how therapy, medications, and other interventions affect the group. Furthermore, it affects how practitioners are trained, creating a deficit in understanding the individual needs of this culturally diverse and rich population.
Q: What is autism spectrum disorder, and how is it diagnosed?
A: Autism spectrum disorder is a disorder that is thought to be caused by divergence in brain development. The exact cause of it is unknown but it could be secondary to environmental factors in addition to genetic predisposition. Some symptoms include: differences in communication, processing of interactions, repetitive motions, fixated interests, and difference in sensory processing. It can be diagnosed by a mental health expert through the Diagnostic and Statistical Manual 5-TR or through neuropsychological testing. This can reliably be done usually by the age of 2.
Q: How common is autism, and what are some common misconceptions about the condition?
A: Autism presents in about 1 in 36 children according to the CDC. Some common misconceptions of autism:
I. Children with autism are not able to form relationships. False: People with autism express their feelings and emotions in different ways. They too can create meaningful relationships even through different means.
ii. There is a cure for autism: False: at this time there is no “cure” for autism. We take the approach of treating symptoms as needed. Some children with autism may need interventions, others may not need any at all.
Q: What are some of the challenges that individuals - esp. children with autism face in
their daily lives, and how can these be addressed?
A: Some challenges that children with autism face are difficulties in interacting with their peers. This often leads to bullying at school or failed romantic relationships. This in turn can affect their self esteem and result in depression or social anxiety.
Early intervention is key. While many of the social skills can be learned later in life, using techniques such as Applied Behavior Analysis (ABA therapy) can teach invaluable social skills that the child can grow with.
Q: What are some of the most effective therapies or interventions for individuals with autism, and how do they work?
A: The most evidenced based treatment is called Applied Behavior Analysis (ABA therapy) It works through reinforcing socially appropriate behaviors. An example of this would be if a child with autism shared a toy with another child. This would be reinforced with words of affirmation. On the other hand if a child with autism took away the toy from another child without asking politely, then the child with autism would lose their privilege to play with toys themselves.
Q: How can parents and caregivers support children with autism, and what resources are available to help them?
A: Absolutely! Caregivers can be some of the greatest supports to children with autism. This can include helping with their activities of daily living, listening to them in their interests, guiding them through social interactions, and providing access to mental health and medical care they need.
A good resource to start with is www.aacap.org and search for autism resources. It gives you an evidence based understanding of autism and its treatment. Furthermore, there are resources to find a local mental health professional in your area. It is important to find credible sources on the internet as there can be a lot of misinformation presented.
Q: What advice do you have for those wanting to have the tough conversations at home
with Asian American parents on the topic of mental health?
A: Take your time when talking about it. Oftentimes parents want to be helpful but the notion of a mental health disorder might be scary to them. Speaking with them from a place of empathy goes a long way. In some cases it may be necessary to reach out to a professional to help facilitate that conversation. This could include your primary care physician or school.
Dr. Rishi Patel graduated from UT Dallas and went to medical school at Lake Erie College of Osteopathic Medicine in Bradenton, FL. As a DO, Dr. Patel is Board Certified in Psychiatry and is uniquely positioned to bring together pharmacology and lifestyle recommendations for a more holistic approach to care. He completed his residency training at UMKC in psychiatry and is fellowship trained in child and adolescent psychiatry at UT Southwestern.
Dr. Patel uses evidenced-based methods from both western and eastern traditions to incorporate psychotherapy, meditation, breath work, diet, exercise, and medication management for optimized care. He enjoys working with individuals to help them better understand their strengths and differences to help achieve their goals.