One size does not fit all: Appreciating the diversity of Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs) and the Implications for Mental Health

Date: May 25, 2021
Category: Mental Health
By: Victoria Chau, Ph.D., M.P.H., Social Science Analyst, Office of Behavioral Health Equity and Perry Chan, M.S., Public Health Advisor, Office of Behavioral Health Equity

This May we celebrate Asian American and Native Hawaiian/Pacific Islander Heritage Month and Mental Health Awareness Month, a time to reflect on the diverse history and contributions from our Asian American, Native Hawaiian, and Pacific Islander (AANHPI) communities. AANHPIs are a heterogeneous group where one size does not fit all—they represent a wide range of socioeconomic statuses, geographic residence locations, primary languages, levels of English proficiency, nativity statuses (U.S. born or not), immigration statuses, religions, and more. The tendency to see all individuals in this group as one has negative implications for understanding and addressing the mental health issues of AANHPI individuals. Asian Americans alone are the fastest growing minority population in the U.S., with Native Hawaiian and Pacific Islanders (NHPIs) as the 3rd fastest growing minority population. Despite this growth, AANHPIs are often left out of data due to sample size limitations and reliability. The lack of data integrity fails to reflect the diversity of the populations and their needs. Asian Americans are often mischaracterized as a “model minority.” This stereotype has negative implications for policies, programs and resource allocations.

AANHPIs include people with ancestry from the continent of Asia and the Pacific Islands from over 50 ethnicities, with over 100 languages and dialects. There are distinct differences across the Asian and the NHPI ethnicities. Data disaggregation is necessary to split Asian Americans from NHPIs, and further disaggregation is needed to split each of these groups into their specific ethnic groups to gain an accurate picture of these sub-populations. Without data disaggregation, the variability in data is untold, making it likely that the needs of certain AANHPI ethnic groups are masked by the better outcomes from other AANHPI ethnic groups.

For example, for Asian Americans the spectrum is vast, with 45 percent of Vietnamese people in the U.S. who had limited English proficiency (LEP) in 2017 compared to only 13 percent of Japanese. Among Native Hawaiian/Pacific Islanders, 13 percent of Tongans had LEP compared to only 2 percent of Native Hawaiians (US Census Bureau, 2017). Nearly 6 percent of Cambodians and 42 percent of Asian Indians earned a graduate or professional degree compared to 3 percent of Tongans and nearly 8 percent of Guamanian or Chamorros. These differences in LEP and educational attainment affect access to culturally and linguistically appropriate mental health services.

Where AANHPIs live in the U.S. and the type of geographic location—rural, suburban, or urban—also greatly varies by ethnic group. For example, the metropolitan area with the largest Hmong community is Minneapolis-St. Paul compared to New York City for Chinese and Los Angeles for Koreans. Though most AAs live in urban areas, some live in rural settings. Although most NHPIs live in Hawaii or California, the 2nd largest population of NHPIs by ethnic group and state include the Marshallese in Arkansas, Tongans in Utah, and Guamanians or Chamorros, and Fijians in Washington.

Differences across AANHPIs exists when it comes to mental health as well. Understanding what “mental health” means to AANHPIs and how it is expressed and interpreted varies across these populations. Cultural beliefs and language contribute to how some communities perceive mental health issues. For example, Asian Americans are more likely to have their mental health symptoms manifest as physical symptoms, which can result in lower rates of detection, increased misdiagnosis, and lack of appropriate treatment. Although differences exist across AANHPI ethnic groups, similarities across ethnicities are also seen. Research on mental health of NHPIs is limited, but studies focused on AANHPIs in general suggest that mental health is highly stigmatized, with limited help-seeking from these communities. Social stigma, shame, religion, and lack of culturally and linguistically appropriate services, may prevent many community members from talking about mental health and seeking care when needed.

SAMHSA’s 2019 National Survey on Drug Use and Health shows that AANHPIs have the lowest level of receiving treatment for any mental illness compared to other racial/ethnic populations. Nearly 77% of AANHPIs who had any mental illness did not receive treatment, while data from the Centers for Disease Control and Prevention show that in 2019, Asian Pacific Islanders, ages 15-24 years old, was the only race/ethnicity group in this age category where suicide was the leading cause of death.

Existing mental health issues within this “racial” group and differences across these ethnic groups should be further studied. One particularly needed area of focus includes improving data efforts, such as collection of disaggregated data when possible, and addressing the recent rise in violence and hate crimes directed at AANHPIs. From March 2020 to March 2021, over 6,600 incidents of AANHPI discrimination were reported by Stop AAPI Hate. On January 26, 2021, President Biden issued the Memorandum Condemning and Combating Racism, Xenophobia, and Intolerance against Asian Americans and Pacific Islanders in the United States, which calls for the federal government to address this issue. Agencies across the U.S. Department of Health and Human Services – including SAMHSA – in coordination with the COVID-19 Health Equity Task Force, are working together to advance cultural competency, language access and sensitivity toward AAPIs within the federal COVID-19 response. In addition, on May 20, 2021, President Biden signed the COVID-19 Hate Crimes Act to reduce the number of hate crimes against AANHPIs by expediting the hate crime review process through the Department of Justice and providing additional federal grants to local enforcement agencies to address these issues. SAMHSA is committed to advancing behavioral health equity. We encourage partners, stakeholders, and communities to continue supporting efforts to enhance data disaggregation corresponding to recent Presidential Executive Orders (EO 13995, EO 13985, EO 13994) that have prioritized this issue.

To learn more about AANHPIs and mental health, please visit the resources below.

Data

AANHPI Mental Health Resources