Since the onset of COVID, anti-Asian sentiment and racism has been an ongoing issue worldwide. Between March and December 2020 alone, there were almost three thousand hate crimes against Asians domestically–and many more go unreported. In the past weeks since 2021 began, there has been a significant spike in violent attacks against Asians and Asian Americans. Many of the victims are women and the elderly, and in several instances, deaths have occurred. These events have caused great fear and anxiety to echo within Asian communities across the country.
While some Asian patients may report changes to their mood or mental health voluntarily, the vast majority will likely remain silent. Within the Asian culture, there is a heavy emphasis on appearance and reputation. Many Asians–particularly first-generation or recent immigrants–are taught that personal struggles must remain hidden from others, and that revealing them would bring great shame to the family. In addition, there is still a strong belief that mental illness is a character defect or weakness. As such, many Asians will turn to family members or spiritual counselors first. Even in the face of major deterioration or dysfunction, many are reluctant to seek medical help.
When Asian patients do present to the office with mental health issues, it’s often framed in the context of psychosomatic symptoms. This complicates the clinical picture, as they often endorse issues with sleep, appetite, energy level, or concentration rather than mental distress. A patient coming in with these complaints may score lower on something like the PHQ-9, as they will not necessarily report (either consciously or unconsciously) any mood related changes. If asked about potential etiologies, they will often minimize the impact stress or trauma have on their current situation. Additionally, providers often encounter resistance to the use of prescription medications.
When faced with all these challenges, what can you as a provider do to evaluate and care for your Asian patients? One way is to be proactive. While you are in the visit with them, inquire into whether they’ve encountered any episodes of racism or anti-Asian sentiment. Ask if they feel safe at home, in their neighborhoods, or during their daily activities. These questions can be a great way to encourage disclosure, particularly if you are not of the same racial background. It lets your patient know you are aware of the situation and that you’re open to talking about it further. It also removes the pressure of the patient having to initiate the conversation, which can be a major impediment.
Should they be amenable to treatment, it will be helpful to approach it at their level. As mentioned before, given the stigma around mental illness and the tendency to endorse only endorse physical symptoms, it might be easiest to frame any interventions in the context of how it will improve their functioning rather than their mental state. For example, if having a conversation with a patient regarding insomnia, one can frame use of meditation, journaling, or other relaxation techniques to improve sleep (if patient is not open to medication) rather than reduce anxiety.
Should you encounter an Asian or Asian American patient in distress, CPAN can be a great resource. We have experienced Asian American mental health providers who are ready with resources and treatment consultation. Should medical intervention be needed, our psychiatrist is available to discuss potential options and provide support. As a reminder, if you need a psychiatric consult, you may schedule the call at a time that is more convenient for you.
Resources for Asians and Asian Americans Dealing with Hate Crimes and Racism
There are several resources for Asian and Asian American patients and families who are facing discrimination and hate due to COVID. Asian Americans Advancing Justice, or AAJC, is a non-profit organization that provides education and resources on COVID, as well as legal assistance and reporting of any anti-Asian hate crimes. Much of the information is available in multiple Asian languages and are free to access. Patients can learn more here.
Written by: Jennifer Yen, MD