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Socioeconomic Barriers
 The Asian community doesn’t emphasize on the importance of mental health - they pay attention to the importance of physical health, but taking care of your psyche isn’t taught.

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(Jamie Won, personal communication, July 12th, 2020)

Inadequate Health Insurance and High Costs of Mental Health Services

 

Lack of, or inadequate, health insurance and the high cost of mental health services can increase the challenge for Asian Americans seeking mental health treatment (American Psychiatric Association). Although the rate of insured nonelderly Asian American adults fell from 15% to 8% from 2013 to 2016, many Asian Americans still remain uninsured or underinsured (Kwon et al., 2018). Currently, 7.4 percent of Asian Americans lack health insurance, which can prevent them from seeking treatments for mental health (Mental Health Association [MHA]). Furthermore, even for Asians who had health insurance, the expensive payment required of individuals sometimes can serve to be too much (Lee et al., 2010).

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Additionally, other contributing factors include a deliberation between the value of therapy and the Asian archetype of saving money.  As healthcare costs can run high and are more often not covered by standard health insurance, the issue of incurred costs indirectly contributes to the hesitancy to seek treatment due to the additional financial stress.

 

A recent college graduate agreed with this, stating, “I’m starting therapy, and even going forward this was extremely difficult.  I felt that I’d be wasting money on something [therapy] that wouldn’t even guarantee me improvement...I thought to myself, ‘$100’ a month?! That’s 20 bobas!”  (AL., personal communication, July 13th, 2020).  Not only this, but another problem also emerges in the increasing rise of healthcare costs: a lack of understanding and accessing resources.  “Even though it [the cost I’m paying for therapy] is much more affordable than other options, I was still hesitant - it felt like a waste of money” (FL., personal communication, July 19th 2020).  These two graduates would later realize that “Asian culture doesn’t teach you the importance of mental health - just because it’s not physical, doesn’t mean it’s not real.  My parents don’t understand that.”

 

Unawareness of Accessible - and Alternate Methods of Treatment 
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There's a bigger systemic [healthcare] barrier in place...also a challenge where we [American] centers on a purely western standard of talk therapy and prescriptions...there are other holistic [alternate therapy] ways to seek support in wellbeing, especially for Asian-Americans who come from a community that is often averse to something like medications"

- (Dr. Ellen Jia-Ling Lin, personal communication, July 13th)

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Another underlying obstacle is also uncovered: the unawareness of accessible (and sometimes cheaper) alternatives to treatment. In one interview, Alina* shared a common dilemma of many AAPI’s: “I didn’t have health insurance that covered the cost of therapy and psychiatry (medication) - I also wasn’t aware of any cheaper alternatives for therapy.”  While the Affordable Care Act mandates that all insurance plans must cover mental health care, limitations include only choosing a therapist within their network, being required a mental health diagnosis, meeting a deductible, or getting a referral for treatment  - which may incur additional costs not covered by insurance.  Consequently, even people with insurance may opt to pay for their therapy out-of-pocket. Without insurance, an out-of-pocket cost for an one-hour therapy session ranges anywhere between $100 to $250. On top of this, medication incurs an even higher additional cost. “I had searched hard for cheaper out-of-pocket options for therapy, and rely on word-of-mouth, ” one student said. 

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There are also other, lesser-known alternatives in seeking mental health treatment.  It is known as CAM, or Complementary Alternative Medicine and is sometimes referred to as TCM (Traditional Chinese Medicine), due to the incorporation of Eastern practices such as acupuncture and meditation.  However, healthcare professionals also face challenges in incorporating CAM due to the lack of in-depth studies in "integrative medicine" and systematic barriers.   It remains, however, a more viable option for those in the Asian American community who may have limited access to treatment.

 

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It’s not that resources aren’t available; the issue is that the burden lies in the person seeking treatment to find resources, and those cheaper alternatives, such as online therapy through an organization like ‘BetterHelp’ or ‘Talkspace’ aren’t promoted in general - I found out about 'BetterHelp' only because I had a friend using it"

- (AL., personal communication, July 13th)

 

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From this, we are able to conclude that a variety of socio-economic barriers include, but are not limited to, complications with health insurance and out-of-pocket costs, the feeling that no physical difference can be shown and is therefore ‘not worth the money,’ and a lack of knowledge about available - and potentially cheaper - resources.

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*Alina is a psyodeum for the person wishing to remain anonymous

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© 2020 by Phoebe Pham, Asian Pacific American Leadership Institute Summer Intern

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