What is culturally responsive mental health care (and why is it valuable for Asian Americans?)
Effective mental health care can never be one-size-fits all – because we, as humans, are no two alike. Each of us is unique in our genetic makeup, life experience, and cultural context. While the mental health care industry has taken into account past health history, intersectionality and cultural values have not received the specialized attention they deserve.
Our cultural context – the heritage we experience by virtue of our family, as well as our experiences moving through society due to our circumstances, including discrimination, unique pressures and expectations, etc. – hugely informs our wellbeing. Culturally responsive mental health care acknowledges this context by offering a modality that is sensitive to the different lived experiences of people of color (POC).
Contents
Why does the Asian American community need culturally responsive care?
What mental health care inequalities exist, specifically?
What does culturally responsive mean?
Does my provider have to be the same ethnicity as me to provide culturally responsive care?
How does Anise’s culturally responsive mental health care work for Asian Americans?
Signs you could benefit from culturally-responsive care
Final thoughts
Why does the Asian American community need culturally responsive care?
Let’s backtrack a little, first. Why the need for “culturally responsive” care to begin with?
Minorities in the United States have historically experienced oppression and systemic racism, leaving them underrepresented in the foundational research powering the current standard of care.
In addition to the fact that POC are disproportionately affected by poor mental health, in part due to the added stressors of being a minority living in a majority culture, it has been proven that they experience poorer outcomes from traditional one-size-fits-all treatment.
This care is not centered around taking into account the cultural influences on a person's specific situation, family dynamics, the expectations that others have of them and that they have of themselves. If we continue to expect POC to conform to modalities of care that haven’t been designed to acknowledge their needs, we’re likely to see even more underutilization of care, ineffective treatment, misdiagnosis and long-term rates of chronic depression and suicidality.
What mental health care inequalities exist, specifically?
Emotional suppression
Resilience is a quality that is often highly valued by immigrant and POC communities, most likely as it was a necessary trait for surviving uniquely challenging circumstances and discrimination. Emotional vulnerability is also sometimes seen as a weakness culturally, particularly in collectivist cultures, where ‘saving face’ is a common practice to preserve familial dynamics. This means that modalities of care that assume a patient’s willingness to open up in order for the treatment to be effective may not be the right fit for Asian Americans.
Language difficulties
Many languages have limited vocabulary to describe emotions, which can make it difficult to communicate complex mental health topics. An example in the Asian community is when a therapist says to “set boundaries” which can feel to Asian communities like “cutting off loved ones.” This shows that “common
treatment language” may need to be adapted for cultural context so that it doesn’t pathologize or ignore core values such as family.
Provider incompatibility
Although finding a provider with the same cultural identity does not necessarily result in culturally responsive care, it can help POC at the very least feel more understood and less exhausted by having to explain their cultural context. However, in 2015, approximately 86% of psychologists were white, presenting an obvious challenge for POC looking to access providers with a similar cultural background.
Misdiagnosis
POC have a long history of misdiagnosis due to stereotypes and prejudices that have infiltrated the mental health care system. According to a study from Suffolk University, “the mental healthcare system continues to do harm through the pathologization of culture, race, and ethnicity”. This research calls on previous studies wherein Black populations report mistrust of mental health providers, which discourages them from seeking mental health services to begin with.
Plus, while certain illnesses, like schizophrenia, are overdiagnosed in POC, other affective disorders which cause psychological distress, such as depression, are underdiagnosed – this points to a wider erasure of the pain and distress experienced by POC individuals).
AAPI communities, in particular, tend to mask psychological decline with physical symptoms that have no organic cause due to societal pressure to adhere to the model minority bias. Discussion of physical symptoms, such as headache, fatigue and back pain caused by psychological distress, is relatively more accepted, often leading to mis- or under-diagnosis of the underlying condition.
Lack of research
The APA also points out that a lack of knowledge surrounding ethnopharmacology and lack of representation in clinical trials for evidence-based psychology puts Asian-Americans and Pacific Islanders at risk. Combined with guidelines such as those in the Diagnostic and Statistical Manual of Mental Disorders (DSM, the most frequently used criteria for diagnosis), which are inherently culture-bound, the current mental health care system largely fails to sufficiently address mental health in the AAPI community.
Intergenerational trauma
Jeannine Cicco Barker, PsyD, focuses her Philadelphia-based practice on supporting immigrant and marginalized communities, and told the APA that, “children of immigrants are often supporting their families in unexpected ways, from taking care of younger siblings to translating for parents.”
A study in the Journal of Psychological Trauma found that children and families in the US who have experienced migration-related trauma experience significant barriers to receiving mental health care. These include the aforementioned distrust of healthcare systems, as well as cultural and linguistic differences. Additionally, a study in American Psychologists points out that the field of psychology has not historically considered the cyclical trauma involved in immigrant communities.
Affordability
A study in the American Journal of Health Behavior showed that Asian American communities also face financial barriers to health care services due to lack of insurance. One study participant said, “Many people are older, like at my age God forbid if I’m laid off, I’m not qualified for Medicare, but I’m not qualified for any health insurance.” The study also highlighted that a large portion of young POC work low-wage jobs that don’t enjoy health care benefits from their employers.
It’s clear, then, that cultural competence is vital in addressing the disparity in access to quality, and effective healthcare, helping communities of color receive better support.
What does culturally responsive mean?
“Culturally responsive” refers to the care that acknowledges the role of cultural context and is tailored accordingly to provide specialized support. This is an evidence-based approach to providing therapy and/or coaching, recognizing the rich variety of experiences that each of us confronts due to our unique cultural heritages and contexts.
As a result, clients from all backgrounds can both feel understood, and receive a style of mental health care that suits them.
Does my provider have to be the same ethnicity as me to provide culturally responsive care?
The most important factor of culturally responsive care is that the provider has been trained in the modality. Rather than focusing on only seeing your identity represented in your providers – e.g. a Black therapist is matched with a Black patient – it focuses on your best interest and a deep understanding of your experience being represented by your therapist or coach.
This means that culturally responsive providers don’t have to be from the same demographic as you in order to support you best – any provider of any background can be trained to deliver effective care for individuals with intersecting cultural identities.
Equally, just because you share an identity with your provider, does not mean the care that they deliver will necessarily be culturally responsive. Your instinct as an Asian patient could be to seek an Asian provider for your first therapy experience, to reduce your workload of having to “educate” them and explain the context within which you exist. While this may result in more effective therapy, it is by no means a guarantee.
If an Asian therapist isn’t trained in culturally responsive care, they could equally be bringing their own biases, stereotypes, and triggering behavior into the appointment, which could exacerbate, rather than alleviate, your distress. This phenomenon could even further contribute to the high dropout rates POC experience today.
How does Anise’s culturally responsive mental health care work for Asian Americans?
Culturally responsive care is not just about ensuring your providers understand what you’ve experienced; it is also about being offered tools that speak to your way of thinking and your values.
The Anise care model has adapted traditional methods to be more sensitive to cultural context. All of our providers undergo training on cultural stressors to save you the effort of reliving and explaining your lived experiences in order to feel understood.
Asian Americans also often use cerebral thought processes in therapy, instinctively rationalizing their experiences with logic, as opposed to tuning into their bodily feelings and emotions. Our providers are trained to use anecdotes and analogies that may resonate with you better, since emotional language is not often modeled in Asian homes.
Additionally, we blend therapy with behavioral coaching in order to satisfy the desire for concrete goals and actionable steps to take that can put what you learn in therapy into practice, so that you can experience both profound self-reflection and a quantitative sense of achievement.
You may also find that, coming from an Asian household, you feel protective over your family – especially your parents – even if their caregiving styles may not have been ideal. Many Asian Americans don’t want to criticize their parents and appear ungrateful for what they provided, which can make them resistant to emotional vulnerability. Our providers understand this, and undergo culturally responsive training with Anise to help them build a trusting relationship with their clients, so they can feel comfortable opening up to them.
Through our digital platform, you can also access curated psychoeducation resources, content, alternative forms of medicine, and support groups – so that your mental wellbeing extends far beyond your individual sessions in a holistic way, and seeps into your day-to-day life.
Signs you could benefit from culturally-responsive care
You feel like your therapist doesn’t “get” you
You experience certain stressors that you are starting to suspect are due to your cultural context, and unique to being a POC
You’ve tried therapy before but felt you didn’t know how to “apply” it to your life – it was too much talking about the past and not enough forward-looking progress for you
You’ve felt judged when talking about your culturally-related experiences in the past
You struggle to bridge the demands of the culture you live in with the culture you inherited at home
Final thoughts
At Anise Health, we believe culturally responsive care is more than an added bonus in mental health care – it’s a right. It’s a way of ensuring that individuals from all backgrounds can feel supported and understood, and have access to the same quality of care. Through our blend of therapy and coaching for Asian Americans, and our relentless commitment to ensure access to inclusive mental health, Anise is here to help you flourish.
Sign up to feel the difference for yourself.
