“I was diagnosed with depression when I was 10 after my first suicide attempt, and that wasn’t changed to bipolar [my actual diagnosis] until I was 15. Bipolar disorder is notoriously hard to diagnose … Luckily I was in a long term residential treatment center surrounded by psychiatrists who had to make daily reports all the time. So when I was 15, they were able to see the patterns of bipolar behavior and change my diagnosis.”

That was the reality of adolescence for Jay Bansali (name changed to protect identity), whose Indian American roots brought a specific set of challenges to coping with bipolar disorder.

“There was this general attitude among Indians that if people knew, it would embarrass or shame the family,” he said.

But this aspect of Bansali’s story isn’t unique to the South Asian American community—in fact, this seems to be a common thread regarding mental illness in many Asian American communities. “For many of the people we serve, the concept of mental illness is unheard of … it’s just not talked about,” said Natividad Lamug, the Education Coordinator for the Asian Counseling and Referral Service (ACRS) in Seattle.

This is what makes Bansali, now in his mid-20s, so different – his family proactively helped him seek out and receive professional treatment at an early age.

Statistics suggest that Asian Americans have a lower rate of mental illness compared to other ethnic groups – but this can be misleading. Asian Americans are also less likely to seek help, thereby under-reporting mental health issues.  This is consistent with the fact that Asian American women have the highest suicide rate in the U.S. amongst females between the ages of 15 and 24.

“The labeling of Asian & Pacific Islanders with the false stereotype of the ‘model minority’ – highly successful, well-educated, and upwardly mobile – exacerbates the cultural stigma surrounding mental illness,” said Betty Hong, executive director of Asian Community Mental Health Services (ACMHS), in a news brief. “The stigma is so great that it prevents those who may need support from seeking treatment altogether.”

Bansali felt directly affected by the stigma attached to this stereotype: “I guess their [my family’s] expectations of me were immediately lowered from being someone great who excels in life to someone who could just function with their illness on a day to day level.”

It is this context that makes culturally specific counseling so important. But it also comes with challenges, like trying to address the vast diversity of Asia and Asian Americans. ACRS’s slogan is “Hope and opportunity in 30 languages,” offering services primarily to East and Southeast Asians. But they also see people from South Asia, and have the ability to work with interpreters when necessary.

But as Natividad Lamug points out, regardless of what part of Asia a client comes from, trying to understand their different needs is always a long process. For example, clients who are refugees from Vietnam and Cambodia may have higher rates of post-traumatic stress disorder, as a result of war in those countries. Similarly, Asian Americans will have a different cultural context to their treatment than Asian immigrants.

The training manual from the National Asian American Pacific Islander Mental Health Association (NAAPIMHA) addresses this in greater detail: “A clinician who is unfamiliar with the nuances of an individual’s cultural frame may incorrectly judge as psychopathology those normal variations in behavior, belief or experience that are particular to the individual’s culture.”

Lamug also notes that clinicians need to realize that their clients may seek alternative treatments. “Often, people might see mental illness as arising from a misalignment with the gods or because of spirits. They may seek help from religious leaders, rather than getting medical help,” she said.

In some ways, one’s cultural background can also play a role in treatment. For example, a study by UCLA on recovering from schizophrenia showed that having a strong, supportive home environment and community could help prevent relapse. The family values that are prevalent within many Asian cultures have the potential to help those who are struggling with mental illness – once the cloud of stigma is lifted and there’s openness to discussing the illness itself.

The root of combating these stigmas is education. ACRS and Sound Mental Health offer a variety of services and programs for people in the Puget Sound area who are living with mental illness, as well as for their families and communities. Gayle Johnson organizes a series of community forums at Sound Mental Health designed to raise awareness around mental illness. “We’re open to suggestions from the community about what programs might help – so if you have any ideas, please share them with us.”

For now, there are small, encouraging signs of change for Jay Bansali. “The men in my family don’t really ask me about my illness even though they know about it, like it doesn’t exist. But the women have learned to talk to me about it openly, like there is no stigma or shame.”

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