Asian-identifying college students in the US have long been under-utilizing mental health services. This is an especially salient problem that the COVID-19 pandemic only exacerbated. Although colleges have been pursuing more strategies to improve student mental health, Asian-identifying college students are still underutilizing these resources compared to the general population. A culturally-informed approach should be implemented in response. Solutions should take the unique needs of this community into account. Recommendations include : 1) increase awareness campaigns 2) acknowledging racism and discrimination as part of mental health screenings 3) implementing culturally/linguistically relevant services 4) investing in Asian-identifying health providers 5) increase funding for research on the mental health of Asian-identifying college students.

Asian-identifying college students are under-utilizing mental health resources.

As mainstream culture in America continually shifts to recognize mental health as an issue worth discussing and addressing, college campuses are introducing new programs to meet student needs. Today, mental health resources on college campuses include group therapy, telehealth, sleep and stress management workshops, free subscriptions to apps such as Calm and Headspace, and more (Abrams, 2022). However, despite the introduction of more mental health resources, Asian-identifying students are under-utilizing them. At the same time, the need for support is growing.

In the United States, Asian-identifying people are amongst the least likely to seek out mental health services. A nationwide study reveals that 8.6% of the Asian-identifying population sought out mental health services in comparison to almost 18% of the general population (Abe-Kim, et al., 2007). This is a trend that extends to college campuses. Compared to 45.5% of non-Hispanic white students with mental health needs, only 18.9% of Asian students with mental health needs received treatment in the past-year (Kodish, et al., 2022).

Increasing anti-Asian discrimination during the COVID-19 pandemic exacerbated this issue.

The U.S. Department of Justice found that “the number of anti-Asian hate crimes in the U.S. sharply increased by almost 80% nationwide” (2022). The effects of this increase in discrimination on the mental health of the Asian community is two-fold:

1. Experiencing discrimination has negative implications for an individual’s mental health. A 2021 study reported that “those who directly experienced discriminatory incidents were significantly more likely to show symptoms of possible generalized anxiety disorder and depression” (Kormendi & Brown). During the pandemic, increased anti-Asian discrimination meant that the Asian community was especially at risk for decreased mental health.

2. Discrimination impacts the way Asian-identifying individuals experience mental health services. Research has found that “higher levels of perceived discrimination are associated with lower mental health service use as well as lower levels of satisfaction with care” (Chae, et al., 2012). Thus, the effects of anti-Asian discrimination are insidious because it amplifies distress, yet discourages individuals to seek support.

Both of these trends played out during the pandemic. Asian-identifying college students saw a 17% increase in severe depression, a 30% increase in severe anxiety, and a 26% decrease in mental health treatment utilization (Zhou et al., 2023). These statistics emphasize that bridging the gap between Asian-identifying students and mental health resources provided by colleges is an urgent need. Before addressing this issue, colleges should carefully consider how culture currently informs barriers involved.

1. Stigma: Cultural pressures discourage seeking mental health support

Asian cultures tend to be collectivistic cultures — individuals are seen as a representation of their family, extended family, and broader community (Kawamura, 2012). In these cultures, there is an emphasis on maintaining a positive image on behalf of not just the self, but also of the people with whom they are connected. This is where stigma arises. Many Asian-identifying college students feel pressure to “keep their problems to themselves or within the family” in order to upkeep a positive image for their family (Nguyen, et al., 2023). As a topic, mental health is viewed as bringing shame onto a family. It is viewed as an issue that takes away someone’s ability to take care of the people around them, which is one of the most significant values in Asian cultures (McLean, 2023). Investing in one’s mental health also takes away time from other efforts to take care of one’s family, such as career development. This pressure acts as a barrier to reaching out for mental health support. When there is risk of bringing shame to oneself and one’s family, Asian-identifying college students may avoid seeking mental health services.

2. Awareness: Lack of cultural relevance leads to lack of mental health literacy

Lack of awareness around mental health is consistently cited as a barrier to seeking mental health support for Asian-identifying college students. Because mental health is considered a taboo topic, it is not a common discussion in many Asian cultures. This has resulted in a trend for students to “dismiss, deny, or neglect their symptoms” (Nishi, 2012). A lack of understanding of both mental health conditions and services influences the support-seeking behavior of even those who could be benefiting the most from mental health services. Within the Asian community in America, only “34.1% of individuals who had a probable diagnosis sought any services” (Abe-Kim, 2007). This is the result of both stigma and a lack of awareness.

3. Salient Topics: Current services don’t always meet specific needs for the community

For Asian-identifying college students, the existence (or lack of) culturally-informed mental health services is critical for providing quality care. Culturally-informed therapy for Asian-identifying college students addresses topics such as navigating the tension that can occur when trying to balance two different cultures, family dynamics, and facing discrimination. Topics like these are important because they are tied to the mental health of the Asian community. For example, the emphasis on family and group affiliation in Asian culture translates to a correlation between family conflict and depressive symptoms (Chae, et al., 2012). When these experiences go unacknowledged, it prevents the Asian community from benefiting from services. A 2021 study discovered that when mental health providers do not acknowledge anti-Asian discrimination as a systemic issue, it negatively impacts the way Asian patients view themselves and their mental health services (Kormendi & Brown). Considering the rise in discrimination that Asian-identifying college students faced during the pandemic, culturally-informed services are a key part of providing mental health support that is both 1) effective and 2) sought out by Asian-identifying college students.

1. Create public awareness campaigns to promote mental health literacy

These public awareness campaigns should be engineered with the Asian community’s cultural values in mind. The focus on collectivism instead of individualism means that current popular messaging around mental health, such as “your feelings matter” may not resonate with Asian-identifying college students. This is just one of many examples of cultural differences acting as a barrier between Asian-identifying college students and benefiting from mental health services.

2. Acknowledge racism and discrimination as part of mental health screenings

Currently, hate crimes and their effects are generally not explicitly asked during mental health visits. If they’re not asked, it may not come up. Having this codified would mean increased visibility for this matter.

3. Implement culturally and linguistically relevant services

Language barriers between patients and mental health providers can provide significant issues as far as what gets communicated and what gets communicated effectively. Studies involving Asian-Americans have also shown that they rely on peer networks, including friends, family, and other community members, for support rather than seeking professional help. Thus, involving and collaborating with community-based organizations can function as a means to ensure culturally relevant services.

4. Invest in Asian-identifying health providers

Mental health providers who come from the same cultural background may more easily and more accurately recognize the difference between a cultural norm and an indicator of adverse mental health. Investing in health providers who come from the same community not only provides more representation, but also means that practitioners who provide culturally relevant services can be supported by the healthcare system. Take for example, tai chi and reiki. These methods for healing are not typically found in the American mental healthcare system, however, they may serve as important collaborators in taking care of the Asian community’s mental health. Involving them in mental healthcare can serve as a gateway and reduce or eliminate barriers that stem from cultural misunderstandings.

5. Increase funding for research on the mental health of Asian-identifying college students

Colleges have a unique opportunity to invest into funding research projects that further elaborates on this topic. Overall, there is still much to be discovered about the way Asian-identifying college students understand and approach their mental health. For example, investing in research to expand upon specific cultural groups within the Asian diaspora benefits public understanding of the nuances between them. Although there are trends across Asian cultures, specific cultures have variances amongst them that cannot be ignored. This is a gap in current research, where many studies group multiple cultures together under one label despite having specific trends amongst them. Research should also acknowledge the differences between the international Asian community and the Asian-American community, as these two groups have unique needs. Finally, more research is needed on which solutions are most appealing and most effective. Increasing funding would also require buy-in from federal agencies,