Asians Less Likely To Seek Therapy

Asians less likely to seek therapy

Complex questions in wake of killings

Heidi Benson, Chronicle Staff Writer
The San Francisco Chronicle
Friday, April 20, 2007

Though experts warn against assigning too much importance to the ethnic background of Virginia Tech killer Cho Seung-Hui, they do attest that Asian Americans are less likely to make use of mental health services than members of other ethnic groups.

“Regardless of age, gender or the specific Asian group they belong to, Asian Americans tend to underutilize these services,” said Dr. Stanley Sue, a psychology professor at UC Davis and one of the authors of a January study — financed by the National Institute of Mental Health — on immigrants' use of mental health services.

The actions of Cho, a Korean American, are not representative of his race or culture, said Alvin Alvarez, president of the Asian American Psychological Association. “This behavior is representative of mental illness,” said Alvarez, who is an associate professor at San Francisco State University and head of the school's counseling program.

According to Sue, there are several key reasons that mental health services are underutilized by Asian Americans.

In many Asian cultures, he said, mental disturbances are believed to be due to “organic” rather than psychological factors. Interventions such as acupuncture are more likely to be sought.

“Here in the United States, we have quite articulated terms for mental health,” Sue said. “Other cultures don't use the same terms.”

Another problem is that mental health services in the United States are often not geared toward Asian Americans. “Some of the services are very insensitive to the language and culture of various Asian groups, which is a major problem,” Sue said.

Also, in the Asian American community, a stigma is often attached to any discussion of personal problems. Seeking counseling can be seen as a public admission of a mental disorder.

“Things are getting better incrementally,” said John Fong, interim director of Asian Community Mental Health Services in Oakland. “We are seeing more clients open to counseling.”

Still, he added, just as Cho appears to have fallen through the cracks of the mental health system, many other young Asian Americans fail to get help, even when they are referred for counseling.

“Even the younger generation, which might be more Americanized, inherit the idea that if you or anyone in your family is seeing a therapist, the whole community is going to look down on you.” A significant number of the high school students referred to the Oakland organization — by a parent, teacher or counselor — don't show up for their appointments, Fong said.

A 2005 Asian American Psychological Association study of the use of counseling services by university students of color showed that when Asian Americans do come in for counseling, they show a higher level of psychological distress compared to other groups. This is likely due to their reluctance to meet with a counselor. And Asian Americans spent the least time in treatment — two sessions, on average — relative to other groups.

This study and others like it will aid in the development of more “culturally competent” mental health services, Alvarez believes.

“Until you have a study like this, everything is based on guesses and anecdote,” Alvarez said. “This gives us a more rigorous understanding of what is going on in these communities.”

On Wednesday, the Asian American Psychological Association issued a press release in response to Monday's killings that emphasized the need to make services more sensitive and easily available to members of all communities.

“We believe,” read the statement, “that this incident highlights the critical value of mental health services both as a step toward prevention and in response to tragedies such as this.”

E-mail Heidi Benson at

This article appeared on page A – 11 of the San Francisco Chronicle