Informal Mental Health Support in the Asian American Community and Culturally Appropriate Strategies for Community-Based Mental Health Organizations

Background:  Widespread disparities in mental health service utilization and outcomes persist among Asian Americans.  Although ethnic-specific service delivery shows promise for reducing disparities, cultural and linguistic concordance are not widely available, particularly in non-traditional settlement areas (e.g., Midwest, South) where the Asian American population is currently growing most rapidly.

In the absence of ethnic-specific services, evidence indicates that Asian Americans rely on informal supports in times of need.  Little is known about the nature and scope of such support or the experiences of informal helpers.  Guided by the strengths perspective, this qualitative study sought to learn from informal helpers to whom Asian Americans turn to address their unmet mental health needs.  By exploring the provision of informal support, this study fills a gap in the research and provides mental health organizations with strategies for collaborating with the Asian American community to provide more culturally appropriate services.

Methods:  Using purposive sampling, semi-structured interviews were conducted in person or over the telephone with 32 participants, including 18 females and 14 males.  Most participants (n = 29) were Asian Americans, and three were European American.  The Asian Americans’ ethnicities were Bangladeshi, Bhutanese, Burmese, Cambodian, Chinese, Filipino, Indian, Korean, Laotian, and Vietnamese.  Participants’ education level included five doctoral degrees, three medical degrees, 14 master’s degrees, and ten bachelor’s degrees.  Most participants (n = 24) did not have any human service training.  All participants occupied formal and informal roles in Asian specific organizations and had been informally assisting community members with their mental health needs for two to eight years.

Data were analyzed following Dudley’s (2011) guidelines for thematic analysis.  Each interview was transcribed verbatim and read multiple times to gain familiarity.  Data were broken down into units and then organized into categories.  Upon ensuring fit of units, categories were merged and sub-divided based on content.  Finally, the consistent points and connections within categories were analyzed to form themes.

Results:  Data analysis revealed four themes.  Study participants reported that individuals with mental health problems and their family members seek informal assistance from trusted members of their community, who they believe can and will help them.  Usually this assistance entails listening.  Participants also indicated that mental health organizations need to work with the community to cultivate relationships that will create new opportunities to educate the community about mental health issues and service options.  Participants also highlighted the necessity of gaining trust in order to reduce service barriers.  Finally, participants emphasized that language and cultural appropriateness are critical to making mainstream mental health service more accessible. 

Conclusions and Implications:  Findings point to the need for mainstream organizations to provide person-centered mental health services that involve family members in decision-making and allow flexibility in the selection of services and providers.  Findings also highlight the importance of cultivating trusting relationships with the community and its leaders to facilitate culturally appropriate outreach and referral pathways.  This might be accomplished by training existing informal helpers to serve as community ambassadors to bridge cultural and linguistic gaps.