Mental health problems within Houston's Asian community grow more prevalent

From the Houston Chronicle:

When Asian American Family Services opened 12 years ago, the Houston area had no social service agencies offering mental health services targeted to Asians and just a few bilingual mental health professionals.

The situation hasn't changed much since then, but mental illness in the growing Asian community has — it's more severe than ever before, say local mental health experts.

Asian-American women, for example, have the highest rate of suicide among women 65 and older and the second-highest rate for women between 15 and 24, according to a 2003 national study by the Ford Foundation. And Chinese immigrants have a depression prevalence rate of 34 percent, compared with 9 percent in the general population, based on a 2006 study by Asian American Family Services. Yet, Asians are less likely than the general population to seek treatment for mental illness, studies show.

Cultural and language barriers are major factors that keep Asians from getting help. Add the lack of available and accessible mental health resources and the result is a woefully underserved community, mental experts said.

"We have been grappling with the issues since day one," said Kim Szeto, a founder and director of Asian American Family Services, which began providing services in 1998.
'Model minority myth'

Experts say mental health issues in the Asian community often evolve around family and social status. A high priority is placed on income level, profession and family respect because they contribute to a sense of success. However, the pressure to live up to those cultural expectations or the "model minority myth" sometimes leads to emotional problems and conflict within the family, they said.

But for many Asians, talking about emotional problems is socially and culturally unacceptable. They believe the stigma will shame their family and make them appear weak. Additionally, mental illness is a Western concept that some Asians do not fully understand. Some Asian cultures don't even have a term for mental illness in their language.

When Asians have mental health issues, they're likely to go to a medical doctor or rely on alternative medicine to treat physical symptoms, such as insomnia or stomach aches, which are usually indicative of depression, anxiety or other mental disorders, experts said.

"There is a misconception about mental illness in the community," said Dr. Venus Tsui, assistant director of Asian American Family Services. "Some Asian cultures associate mental illness with something bad a person did in a past life, like Karma. Public education is very important."

But even with awareness, Asians have few places to go for help. The Houston area has only a handful of Asian mental health clinicians and even fewer who speak the different languages of a diverse Asian community, which mirrors what's happening nationwide, local experts said. Asian American Family Services is still the only social service agency in Houston with mental health services and Asian and bilingual staff, Szeto said.

Located in the heart of Houston's Asian community on Bellaire, the agency tends to see an increase in clients when it has a high number of bilingual clinicians, representing different cultures on staff, she said. They come because they feel comfortable talking to someone who knows their culture and speaks their language. But they don't come on their own. They're usually referred by schools, hospitals and medical doctors, she said.

"We're the last resort," Szeto said. "When they come to us, they're in a crisis situation."

The counseling center, which offers treatment based on sliding scale fees, sees many cases of depression, anxiety and post-traumatic stress triggered by cultural adjustment,cultural isolation and refugee experiences. Recently, it has seen an increase in mental problems related to domestic violence, particularly against Asian men.
Torn between cultures

Last year, the agency formed a therapy group for Asians between 18 and 24 dealing with cultural adjustment issues. Many of the young adults feel torn between their parents' culture and the American culture. Dr. Phuong Nguyen, the agency's director of clinical services who leads the group, said they don't feel they belong in either culture and it affects their mental health.

According to a study funded by the National Institute of Mental Health, Asians born in the U.S. or who come at an early age have higher rates of mental illness because they're more exposed to peer pressures and different institutions.

A 23-year-old patient of Dr. Nguyen's, whose name is being withheld to protect her identity, said she often complained about having insomnia and a friend recommended she see a doctor. She was diagnosed with bipolar disorder last year after she graduated from college. Around that time, she had no job prospects and no plans to continue her education, and the cultural expectation to be a high achiever, she believes, contributed to her problems.

A few months later, however, she had a bizarre episode that landed her in the hospital because her parents didn't know where else to go for help. That's when she learned she also had schizophrenia.

She said her parents were not familiar with mental illness and had no clue about what was wrong with her. Though supportive, they've had some difficulty accepting her illness and are uncomfortable with the idea of her taking medication, she said.

She said she is thankful to have an Asian therapist and psychiatrist. "They could understand what I was going through and I could identify with them," she said.

With continued therapy and medication, she said she feels better and is preparing to go back to school.