What Are the Key Components and Characteristics of Culturally Competent Mental Health Services for First-Generation Young South Asian Immigrants?

Background and Purpose
First-generation young South Asian immigrants in the United States face unique mental health challenges shaped by cultural stigma, intergenerational conflict, acculturative stress, and structural barriers to care. Prior studies highlight the underutilization of mental health services among South Asians due to stigma, lack of culturally congruent providers, and fear of community judgment. Despite the growing presence of South Asian immigrants in the U.S., there remains limited research on what constitutes culturally competent care for younger, first-generation individuals navigating identity development, parental expectations, and sociocultural adaptation. This study seeks to explore clinicians’ perspectives on the characteristics of culturally competent mental health care for this group, with the goal of informing more inclusive and effective models of service delivery.

Methods
This qualitative study employed snowball sampling to recruit licensed mental health professionals with at least one year of experience providing care to first-generation South Asian immigrants aged 18–30. Eligible participants included clinical psychologists, social workers, counselors, marriage and family therapists, and psychiatrists practicing in settings that serve immigrant or culturally diverse populations. All participants demonstrated formal or experiential knowledge in culturally competent care and were fluent in English. Recruitment was conducted through professional networks, clinical organizations, university counseling centers, and social media. Eligibility was determined through a pre-screening questionnaire, licensure verification, and informed consent. Semi-structured interviews, lasting 45–60 minutes, were conducted to gather insights into clinicians’ experiences, challenges, and observations. Interviews were transcribed and thematically analyzed to identify patterns in clinical needs and generational differences.

Results
Findings reveal notable distinctions between first- and second-generation South Asian immigrant clients. First-generation clients often face systemic challenges such as difficulty navigating the U.S. healthcare system, unfamiliarity with insurance and therapy models, and a shortage of culturally responsive providers—especially outside urban centers. These clients frequently present with concerns related to acculturation stress, adjustment difficulties, and social isolation, with cultural themes emerging alongside concrete stressors. In contrast, second-generation clients more commonly present with identity-based concerns, including bicultural conflict, intergenerational tension, and internalized expectations tied to familial and cultural obligations. While anxiety was a common presenting concern across both groups, the sources of distress and therapeutic needs varied significantly. Clinicians reported that their ability to address these complexities stemmed primarily from lived experience rather than graduate training, noting a significant gap in formal education on immigrant mental health.

Conclusions and Implications
This study underscores a pressing need for more accessible, culturally competent mental health services tailored to first-generation South Asian immigrants. Interventions must address systemic access barriers, language needs, and culturally relevant engagement strategies. Clinically, the generational differences in presenting concerns and identity development signal a need for personalized approaches rather than generalized multicultural models. These findings highlight the importance of incorporating immigrant mental health frameworks into clinical education and training, diversifying the mental health workforce, and advancing policies that support culturally responsive care. Without such efforts, first-generation South Asian clients remain at risk of being underserved in mainstream mental health systems.