Ali Khawar: The Importance of Mental Health, AAPI Heritage Month

According to data from HHS' Office of Minority Health (OMH), Asian Americans are 60% less likely to utilize mental health services,¹ even though 16.8% of those in the community experience mental illness.²

In honor of Mental Health Awareness Month and Asian American, Native Hawaiian, and Pacific Islander (AAPI) Heritage Month, Ali Khawar, principal deputy assistant secretary with the Employee Benefits Security Administration (EBSA), US Department of Labor, joined The American Journal of Managed Care^® to discuss the need to address the barriers preventing the AAPI community from accessing mental health care.

Transcript

Data highlight a significant gap in accessing mental health services among Asian Americans despite a considerable portion of this population experiencing mental illness. Can you speak to the primary barriers contributing to this disparity and any potential efforts to address them?

That is a little bit of a complicated situation. I would love to tell you that there's just one thing that's driving it, but the reality is it's multifaceted. But let me talk about some of the issues that we have.

I think one problem, frankly, is that within the AAPI [Asian American and Native Hawaiians/Pacific Islander] community, not to stereotype, but there can be a little bit of a stigma—as there is in most communities in the United States—against receiving mental health treatment that can make people less willing to admit that they need medical treatment, less willing to seek that treatment. And if you are not really going to share with your loved ones that you're experiencing a certain kind of condition, you're less likely to seek treatment; you're less likely to have positive outcomes. There's all of those kinds of things. But I would put those in the bucket of stigma.

That's not even talking about if you are open, the ways in which you may face discrimination because your community, your employer, and others may treat you differently. And I'm not speaking to the legality because there are certainly practices that are illegal that happen. I'm just kind of speaking to the fact that all of those things go to making people less likely to actually seek mental health treatment.

A second problem is awareness. I mentioned that there are things that happen in a stigma bucket that are illegal, but if people don't even know that they have legal rights, that they're being discriminated against in a way that violates the law, that's not always something that the government—at whatever level—is going to be able to catch, absent a complaint. Sometimes it requires people to flag those things for us. Other times, we might find something where someone doesn't know that they were discriminated against or that there was a problem and we're able to resolve it nonetheless.

But that awareness, which I would say both about your legal rights and those kinds of things, but also awareness of mental health—that the symptoms that you're experiencing are the result of a disease, and not just, you know, “I'm feeling a little different today than I was yesterday,” or “I felt different for a few weeks,”—that those things actually could signify the mental health condition. And then there's an appropriate treatment for that. Lacking that awareness, obviously, you're not going to necessarily seek medical treatment from a professional if you don't even understand that you have a mental health condition.

A third problem is that there is a lack of access to mental health treatment, which I would put in a couple of different kinds of subbuckets since I’m using this bucket analogy. So, one problem is that mental health careers for individuals who are in educational institutions are not necessarily as attractive as they could be. We don't have enough people in the pipeline going into those fields. We don't have enough people in those fields right now; just as in many other areas of the health care profession, there are provider shortages. And I think that is also exacerbated by the issue that's probably most germane, kind of directly germane to our work, which is that when it comes to coverage of health conditions, that parity is often not being realized in letter, let alone in spirit.

What I mean by parity is there's a federal law that's been on the books for over 15 years that essentially stands for pretty basic proposition. That proposition is that when you're receiving treatment for a condition—it shouldn't matter whether that's a traditional medical surgical condition or a mental health or substance use condition—that you shouldn't be discriminated against on that basis, the coverage really should be equivalent across the board.

You can think of it as things like if I sprained my ankle, and I get 15 visits, do I also get 15 visits for something that's equivalent, right? Outpatient treatment, meeting with a therapist for mild depression, right? Do you say that it's 15 visits for the sprained ankle with the PT [physical therapist], but it's only 5 with an LCSW [licensed clinical social worker] for your mild depression? That's a very basic example of what it looks like when parity is not being met, just to illustrate the concept.

May is Mental Health Month and Asian American, Native Hawaiian, and Pacific Islander Heritage Month. What’s important about this convergence?

When you look at the data, it's not that Asian Americans and Pacific Islanders have no prevalence of mental health in that community. But there is a significantly lower likelihood that they're going to seek mental health treatment. So part of what we're trying to address this month, in particular, but throughout the year, is any kind of sense of stigma that people have around mental health or substance use conditions. I don't think any of us view it as a character flaw. We don't view it as something to be ashamed of. We believe very deeply that just like any other health condition if it's covered by your insurance, you deserve to get the treatment that you are promised. And the mere fact that it is a mental health or substance use condition should not shy you away from exercising your rights.

References

1. Mental and behavioral health - Asian Americans. HHS Office of Minority Health. Accessed May 25, 2024. https://minorityhealth.hhs.gov/mental-and-behavioral-health-asian-americans

2. Duszynski-Goodman L, Henderson L. Mental health statistics and facts. Forbes. February 21, 2024. Accessed May 25, 2024. https://www.forbes.com/health/mind/mental-health-statistics/