Barriers and Facilitators to Mental Health Service Use Among Asian American Youth: Perspectives from Youth, Parents, and Clinicians

Background and Purpose: Growing evidence indicates that Asian American (AA) youth are at higher risk for mental health disorders such as ADHD, depression, and anxiety, but least likely to utilize professional services among all racial/ethnic groups. Unfortunately, few studies so far have examined the help-seeking behaviors of AA youth with mental health disorders. This study aims to 1) understand help-seeking experiences of AA youth with mental health disorders, 2) investigating barriers and facilitators that influence their attendance and adherence to mental health services, and 3) provide recommendations for future mental health services research, practice, and policy. Methods: Between Nov. 2017 to Aug. 2018, 5 focus group discussions and 34 individual interviews were conducted with 50 participants in an outpatient mental health clinic in Queens, NY, including 16 mental health clinicians, 16 youths currently receiving treatment for their mental health disorders (mostly depression and anxiety), and 18 parents. On average, clinicians have provided bilingual services to AA families for 8.4 years. During the focus group interviews, clinicians shared their experiences serving AA families, their perceived facilitators and barriers to AA youth’s mental health service use, as well as suggestions on improving treatment engagement among AA youth. Face-to-face and phone interviews were conducted with youths and parents, including 10 parent/youth dyads. Youths were mainly interviewed about their experiences getting access and receiving treatments from the clinics. Similarly, parents were interviewed about their experiences sending their children to the clinic and receiving mental health treatments. All interviews were audio-recorded, transcribed verbatim, and coded thematically using Nvivo 12. Results: Participants in this study identified multiple sources of distress that were particularly salient among AA youth, including academic pressure, bicultural stress, dual identity struggles, social/ethnic isolation, language brokering issues, as well as satellite parenting/extended family caring and related attachment issues and conflicts with parents. Several barriers that uniquely influenced attendance and adherence to mental health services among AA youth with mental health disorders were identified, including parents’ concerns around treatment history and record, perceived irrelevance and unrealistic expectations for treatment, mistrust in clinicians’ experience and expertise, as well as stigma or “losing face” in the small ethnic community. Adolescents’ privacy/confidentiality concerns, non-compliance/resistance to treatment, misconceptions of treatment and medication use, and logistic barriers such as transportation and schedule conflict with school or extra curriculum activities were further noted as barriers to their attendance and adherence to treatment. In regard to facilitators, clinicians highlighted the importance of school and teacher referral, normalizing mental health service use, goal-setting and trust-building early in the treatment, as well as working alliance and youth/parent commitment during the treatment. Conclusions and Implications: Enhanced psychoeducation is needed in schools and AA communities to raise awareness of youth mental health problems and normalize professional service use. Expanded service capacity and community outreach programs that meet the mental health needs of low-income AA families hold promise for engaging them into treatment. Bilingual clinicians with adequate cultural competency are also warranted in order for better services and treatment outcomes.