Exploring the Experiences of Asian American Family Members That Contribute to Inequities in Treatment Access for Their Loved Ones with Serious Mental Health Conditions

BACKGROUND: Ethnic/racial disparities in access and use of mental health care is a major public health issue in the US. An equal to higher prevalence of mental illness has been documented among representative samples of Asian Americans, compared to non-Hispanic Whites (Alegría et al., 2008), yet Asian Americans disproportionately underutilize mental health services (Abe-Kim et al., 2007). In the absence of awareness of culturally and linguistically appropriate services, family members often provide support and care. While informal care appears to be normative across Asian ethnic subgroups, there is limited data depicting challenges from the view of family members. This study aimed to elicit personal perspectives of a diverse sample of Asian American family members and characterize their challenges accessing mental health information and services in their local community to meet the needs of loved ones with serious mental health conditions.

METHOD: The sample consists of 46 Asian American family members, 18 years or older from six ethnic subgroups: Korean, Chinese, Cambodian, Filipino, Vietnamese, and Japanese in Los Angeles county. The participants are predominantly female (80%), older adults (65%), and mothers (67%) of a child experiencing serious mental illness.

Participants were recruited from community mental health centers with designated services targeting Asian Americans. Focus groups were conducted with each subgroup ranging from 5 to 10 members, using interpreters when necessary. Data were analyzed using qualitative methods based on coding consensus, co-occurrence, and comparison (Willms et al., 1990). Based on the interview guide and emergent themes, transcripts were independently coded with a final list of codes constructed through a consensus of two investigators. Categories were further condensed into broad themes regarding family-identified challenges and proposed solutions.

RESULTS: Across the six Asian ethnic subgroups, there was a remarkable consistency in the challenges experienced by family members supporting the recovery of Asian Americans experiencing serious mental illness. Three themes emerged. The first theme reflects lack of knowledge of treatment options due to difficulty navigating English-only resources to locate accurate information and appropriate care. The second theme reflects perceived lack of housing and employment opportunities leading to extensive energy and time to find supportive living and work that meet individual needs and cultural expectations. The third theme reflects the stress and stigma experienced caring for a family member living with mental health conditions, particularly given the stigma and shame endemic in Asian American culture.

IMPLICATIONS: The findings illustrate the challenges experienced by Asian American family members of loved ones with serious mental health disorders. These difficulties have implications that contribute to inequities in illness severity because they often result in delayed treatment. Solutions to mitigate some of the concerns shared by participants include engagement and outreach campaigns, bilingual education, and advocacy. Interventions to strengthen social networks and ethnic identity (modifiable protective factors) could increase family members’ resiliency to cope with stress. Also, developing multilingual digital educational materials might increase timely access to mental health services and provide resources to Asian American families struggling to support their loved ones.