CHAPTER 5

Mental Health Care for Asian Americans and Pacific Islanders

Appropriateness and Outcomes of Mental Health Services

Limited evidence is available regarding the response of Asian Americans to mental health treatment. One study of outpatient individual psychotherapy in a San Francisco clinic found that Asian American clients had poorer short-term outcomes and less satisfaction with care than white Americans (Zane et al., 1994). In a recent pilot study using cognitive-behavioral therapy to treat depressive symptoms (Dai et al., 1999), older Chinese Americans appeared to respond in the same manner as a previously studied multiethnic population had. In two large-scale studies of mental health systems, there was evidence that the treatment outcomes for Asian American clients were either similar to, or poorer than those for whites (Sue, 1977; Sue et al., 1991).

Researchers have not compared the relative likelihood of Asian Americans and others to receive appropriate psychiatric care. One study suggested that primary care doctors may not identify depression in their Asian American clients as often as they identify depression in white clients (Borowsky et al., 2000). However, the study sample was too small to draw strong conclusions.

The fact that further research is needed on treatment outcomes for AA/PIs is especially evident in the use of psychotropic medicines. Recent research indicates that Asian Americans may respond clinically to psychotropic medicines in a manner similar to white Americans but at lower dosages (Lin & Cheung, 1999). These studies are based on very small samples and should be considered preliminary. However, consistent findings are appearing with regard to Asian Americans’ response to neuroleptics, tricyclic antidepressants, lithium, and benzodiazepines (Chin, 1998; Lin et al., 1997). These findings suggest that, in the treatment of mental disorders among Asian Americans, care must be taken not to over-medicate. Initial doses of medication for these individuals should be as low as is appropriate, with gradual increases in order to obtain therapeutic effects (Du & Lu, 1997).

Under the assumption that AA/PI clients may respond better to therapists of the same ethnicity because of a better cultural match, Sue and colleagues (1991) examined whether treatment outcomes were better with ethnically matched versus unmatched therapists. They found that Asian American clients who are matched with Asian American therapists are less likely to leave treatment prematurely than Asian American clients who are not matched ethnically with their therapists (Sue et al., 1991). Ethnic match also increased length of treatment, even after other sociodemographic and clinical variables were controlled. Not surprisingly, an ethnic and linguistic match between the client and provider was more important for clients who were relatively less acculturated to U.S. society than for those clients who were more immersed in American society.

Hu and colleagues found that Asian Americans used services at a higher rate in Santa Clara County and San Francisco County where community mental health out-patient service centers specifically oriented to Asian Americans and Latinos had been established (Hu et al., 1991). Likewise, Yeh and colleagues found that Asian American children who attended Asian-oriented mental health centers in Los Angeles received more care and functioned better at the end of care than Asian American children who attended mainstream centers (Yeh et al., 1994).

These Asian-oriented or ethnic-specific services provide cultural elements that may welcome AA/PIs, such as notices or announcements written in Asian or pacific Island languages, tea served to clients in addition to coffee, and bilingual and bicultural therapists. Thus, matching the ethnicity of the client and the mental health care provider and providing care within settings specifically developed to treat this group may be important aspects of providing appropriate care for Asian Americans. Speaking the Asian language of patients whose English is limited, understanding the cultural experiences of clients, and having bicultural skills (i.e., being proficient in working with Asians who have different levels of acculturation) are also important.

Finally, in view of the shame and stigma felt by AA/PIs over mental health problems, and the lack of health care coverage that many AA/PIs experience, it is important to intervene at other levels. For example, community education about the nature of mental disorders may help to reduce shame and stereotypes about the mentally ill. Increasing health insurance coverage for mental disorders is important to increase the accessibility of services. Also, the introduction of prevention efforts in AA/PI communities is beneficial. A number of newer programs are working to promote mental health. For example, parent training programs, bicultural adjustment strategies, and culturally oriented self-help groups have been initiated to promote mental health and well-being in AA/PI communities.