What prevents more Native Hawaiian, Pacific Islanders, and Asian Americans from seeking mental health care?

Correction: This page was updated on March 8, 2024, to remove a sentence about which subgroup was most asked where they were from.

Despite facing frequent experiences with discrimination and rising fears of hate crimes and gun violence, only 24% of Native Hawaiian and Pacific Islander adults and 16% of Asian American adults in California say they need mental health support.

Among adults who sought mental health care, 42% of Native Hawaiians and Pacific Islanders and 31% of Asian Americans had difficulties accessing services, citing cost, lack of insurance and not knowing their options.

To help increase the use of mental health care services among Native Hawaiian, Pacific Islander, and Asian American adults, a new report from the UCLA Center for Health Policy Research and AAPI Data, based at UC Riverside, recommends using more culturally relevant outreach specified for nationalities and languages.

“The goal of the report is to spur a more nuanced discourse on mental health for Native Hawaiian, Pacific Islander, and Asian American communities,” said Ninez Ponce, director of the UCLA Center for Health Policy Research, or CHPR, and one of the report’s authors. Despite the need, research suggests that the Native Hawaiian, Pacific Islander, and Asian American population have some of the lowest rates of mental health service utilization compared to other racialized and minoritized populations.

This underutilization of services was exacerbated by how AANHPI communities bore the blame for the pandemic. Adding the stressors from stay-at-home orders, social isolation, anti-Asian hate incidents, and gun violence, to more common worries about finances, housing, jobs, fitting in, and relationships, was a recipe for increased mental health problems.

Putting data in a new context

In their report, the researchers used a novel approach. They began with data about Native Hawaiian, Pacific Islander, and Asian American mental health from the UCLA CHPR’s California Health Interview Survey, or CHIS, from 2020 through 2022. In addition, AAPI Data and the UCLA Center for Health Policy Research initiated the California AANHPI Community Needs Survey — a 15-minute follow-on survey for Native Hawaiians, Pacific Islanders, and Asian Americans who responded to the 2021 and 2022 CHIS.

This rigorous survey data was combined with historical community experiences as influenced by cultural factors, U.S. foreign policy, and intergenerational trauma, and feedback from an intentional sample of leaders in various NHPI and Asian American communities.

Native Hawaiian, Pacific Islander, and Asian people have endured a long history of U.S. colonization, notably in Hawaii, Pasifika nations, and the Philippines; the resettlement trauma of Southeast Asian Americans; and racist policies, such as the Japanese American internment during World War II and the Chinese Exclusion Act.

“Community-informed research is foundational to addressing the distinct mental health needs of Asian American, Native Hawaiian, and Pacific Islander communities,” said Karthick Ramakrishnan, founder and director of AAPI Data and professor of public policy at UC Riverside. “This report goes a long way toward piecing the puzzle of AANHPI mental health by uplifting new data on mental health indicators, barriers to receiving care and recommendations to overcome them. We are incredibly grateful for key investments from the State of California, our partnerships with the UCLA Center for Health Policy Research and California Health Interview Survey, and insights from community partners to produce research that is insightful, timely, and solutions-oriented.”

Ramakrishnan said that for decades, community leaders have noticed a dichotomy between low rates of self-reported mental health needs and the pervasive mental health struggles they see in their communities every day.

“Asian Health Services, a federally qualified health center, witnessed how the dual pandemic of COVID-19 and anti-Asian violence has exacerbated the need for mental health among our Asian American, Native Hawaiian, and Pacific Islander patients by over two-fold,” said Thu Quach, president of Asian Health Services. “Yet, in the midst of the greatest demand for such services, there is a severe mental health workforce shortage across the state and nation, particularly for bilingual and bicultural providers.”

Zeroing in on specific subpopulations reveals insights

The report also provides a more granular examination of mental health experiences for eight subgroups within the Native Hawaiian, Pacific Islander, and Asian category: Native Hawaiian and Pacific Islander, Vietnamese, other Southeast Asian (excluding Vietnamese), Filipino, South Asian, Korean, Japanese, and Chinese.

“Historically, Native Hawaiian, Pacific Islander, and Asian people have been viewed as a monolithic group, which mistakenly led others to generalizing their experiences,” said Ponce, principal investigator of the California Health Interview Survey and who also serves as the Fred W. and Pamela K. Wasserman Chair in Health Policy and Management at the UCLA Fielding School of Public Health. “By disaggregating the data for the different groups, we’re learning important information that could help lawmakers craft policy that does a better job reaching the people who need it.”

While 45% of Native Hawaiian and Pacific Islander and 46% of Asian American adults said they are “very or somewhat worried” about being a victim of gun violence, which exceeded the California population overall (30%), examining the data by the more precise subcategories uncovered insights.

For example, CHIS data showed that 62% of Japanese adolescents worried about being shot by a firearm, compared to 26% of adolescents in California. Recent mass shootings targeting the Asian community, such as the Atlanta spa shooting (March 16, 2021), Monterey Park (Jan. 21, 2023) and Half Moon Bay (Jan. 23, 2023), have likely contributed to AANHPI’s heightened worries, the report said. 

Nearly half of Asian American, Native Hawaiian, and Pacific Islander adults reported everyday experiences with discrimination, and 20% of Asian American adults said they were the victim of a hate crime or incident.

Additionally, 48% of Asians as a whole said they were asked where they were from, with those asking assuming it was not the United States.

The report also spotlights the roles of culture and language in influencing whether people seek help with their mental health issues.

• Native Hawaiians’ approach to health and well-being integrates physical, spiritual, emotional, and mental aspects; approaches to mental health care need to be mindful of the balance of these factors.
• In Vietnamese culture, mental health is seen as a consequence of past misdeeds or ancestral sins. Linguistically, mental health concerns have a negative connotation and are labeled as điên (meaning “madness or crazy”) and can bring disgrace and shame to the family.
• With more than 100 languages and dialects spoken in the Philippines, language barriers pose a challenge, particularly when there is a lack of staff and clinicians fluent in Tagalog and other Filipino languages.

Based on the findings gathered in this report, the researchers provided the following policy recommendations:

• Create culturally specific awareness campaigns about mental health care.
• Expanded training and support on culturally and linguistically aligned care for the existing mental health workforce.
• Develop a pipeline of Native Hawaiian, Pacific Islander, and Asian American mental health providers.

“Though they’re all unique, Native Hawaiian, Pacific Islander, and Asian American communities share a common thread — resilient cultures that survived trauma and oppression, a deep-rooted recognition of the sacrifice of those who came before them and an empathy in supporting communities as they toil through victimization and adversity,” Ponce said.

Ironically, while these strengths have enabled many members of these communities to thrive in the United States, they’ve simultaneously contributed to mental health problems.

“Narratives of community resilience can mask individual struggles and serve as a barrier to care. The message to our communities should be clear: getting the care you need is a sign of strength,” Ramakrishnan said.