Mental Health: the
hidden face of the
model minority
Howard Liu, M.D.
Resident Psychiatrist
University of Michigan
January 2007
Why should you listen
to this talk?



Mental illness is common
APA community has specific needs
You will be in a position to help
What does it mean to be
a model minority?
SAT scores?
Precocious musical
skills?
Medical breakthroughs?
Dr David Ho - Times
Man of the Year 1996
Model minority myth



Highlights the superlatives
Propagated not just by media, but
by APA community itself
Narrow definition
Headlines which did not
make the cut …

Published May 8, 2001
BBC News April 2, 2004
BBC News November 22, 2004
Overview



Mental Health needs
Barriers to care
Solutions
I. Mental illness is not exotic

National Latino and Asian American Study (Takeuchi)

2095 Asian Americans nationwide

Overall lifetime rate of any disorder = 17.3%

12 month rate = 9.19%


Men – poor English proficiency had higher rates
Women – native born had higher rates than immigrants
of most disorders
Source: Takeuchi, DT et al. Immigration-related
factors and mental disorders among asian americans.
Am J Public Health; Jan 2007; 97, 1.
Depression

CAPES Study – 1993-1994
1700 Chinese Americans LA
 6.9% lifetime prevalence dep.
 16.9% in national sample adults

Source: Mental Health: Culture, Race, and Ethnicity
US Dept Health Human Services 2001.
Suicide

Lester 1994: suicide rates per 100,000


Caucasian 12.8
Asian Americans overall 7.0




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Japanese American 9.1
Chinese American 8.3
Filipino American 3.5
1999 DHHS - APA women > 65 have
highest suicide mortality rate of all
groups
Young women from southern India?
Source: Mental Health: Culture, Race, and Ethnicity
US Dept Health Human Services 2001.
Suicides in young people in
rural southern India


Worldwide suicide rate in 2000:
14.5 per 100,000
Vellore India– population 108,000
10 year mortality rates 1992-2001
for age group10-19
 Female suicides: 152 per 100,000
 Male suicides: 69 per 100,000

Source: Aaron et al. Suicides in young people in rural
southern India. Lancet 2004. 363:1117-18.
PTSD

Southeast Asia

Cambodia Khmer Rouge
>
1.5 million deaths
 1975-1979

Vietnam War 1965-1973
 US
soldiers: > 58,000 killed
 ~5 million dead – all sides
 50% population homeless
 1/5 farmland & forests devastated
Source: Beiser, Psychological Medicine, 2004
PTSD in SE Asian
Refugees

Blair 2000 – Cambodian American
community sample N = 124
 45%

PTSD
Kroll et al. 1989: 404 SE Asian
refugees initial psych eval
 73%
major depression
 14% PTSD
 6% anxiety & somatoform
disorder
December 26, 2004
Tsunami
150,000
New PTSD generation?




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Indonesia
Thailand
Sri Lanka
Maldives
India
Intimate Partner Violence


China – 13% of new moms had
experienced IPV
Boston Chinese Am. Women
181 women survey 1996-1997
 42% knew an abused Chinese
woman
 14% had experienced IPV
themselves
 Conflicts with relatives, alcohol

Source: Hicks, Madelyn Hsiao-Rei. Prevalence and characteristics of intimate partner
violence in a community study of Chinese American women. J Interpersonal
Violence Vol 21 No 10, October 2006, 1249-1269.
IPV: South Asian Women

How common?
2 in 5 ever had sexual/physical IPV
 208 Boston S.A. women (91%
immigrant)

 21%
reported IPV in current
relationship

Victims at higher risk of:
Poor physical health
 Depression & suicidal ideation
 Anxiety

Source: Himelfarb Hurwitz, EJ et al. Intimate partner violence associated with poor
health outcomes in US South Asian Women. J of Immigrant & Minority Health, Vol. 8,
No. 3, July 2006.
II. Underutilization

Underrepresented in mental health
clinics



Seattle 1977 – 1st documented
LA County 1991 – similar results
Treatment delay? Controversial


1982 study longer treatment delay than
African Americans & Caucasians
2000 study by Okazaki in LA – average
delay 17.34 months
III. Barriers to Care



Language
Lack of culturally competent
practitioners
Stigma
A. Language Barriers



61.9% of APA are foreign born
APA population speaks over 100
languages and dialects
Linguistically isolated households
Definition
 Breakdown: 35% Asian Americans

 61%
Hmong, 56% Cambodian,
52% Laotian, 44% Vietnamese,
41% Korean, 40% Chinese
B. Culturally competent
practitioners


1998 study: 70 APA mental health
providers available per 100,000
Asian Americans in US (1/2 ratio
caucasians)
Utilization rates increased in
outpatient centers tailored to Asian
Americans
C. Stigma

Stigma against mental illness in
APA community
Leads to lower utilization
 May delay treatment

IV. Solutions

Language – CLAS guidelines
1964 Civil Rights Act Title VI
 CLAS standards 2000

 Free
 Written
& verbal rights
 No minors


Stigma – Education
More culturally competent mental
health practitioners
V. What you can do

Remain culturally sensitive
Attitude
 Knowledge
 Skill


Advocate in your family and
your community
Use the model minority
 Educate others
 Refer

In conclusion

Confucius says:
“I hear and I forget
 I see and I believe
 I do and I understand”

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