By Arianna Abalos
NORTHWEST ASIAN WEEKLY
Did you know that only 3.3% of U.S. psychologists are Asian, and fewer than 1% are Native Hawaiian or Pacific Islander? During Mental Health Awareness Month and AAPI Heritage Month, this startling statistic highlights a major gap in the mental health field.
Beginnings
Noelani Sagapolutele
Noelani Sagapolutele, founder of the Wa’a Collective, an organization of mental health professionals dedicated to serving Hawaiian, Pacific Islander, and diaspora communities, detailed her start in the mental health field to help serve her community.
“I graduated in 2003 from UH Mānoa, and then I worked for 20 years in Waianae…one of the hardest communities but easiest communities to work in… native Hawaiian concentration, [and] the highest rate of violence and homelessness. […]
“So many names out there saying don’t go to Waianae, but that’s where I started my career…20 years later, I got to know the people, and that was life changing.”
“I like to say mahalo ke akua, or thank you Jesus, that I had the privilege of working out there because they say that in Waianae, you’re going to see what you want to see, you’re going to see the drugs, the violence, the homelessness, the poverty, or you’re going to see the most beautiful sunset, the most resilient and resourceful people.”
“Because of my 20 years out there […] I became really familiar, and may I say just comfortable working with the […] poor, native Hawaiians, the underserved community, and that’s what I love the most.”
Lack of culturally comprehensive care
The lack of culturally comprehensive care in the field is a large contributing factor to the representation disparity. AANHPIs make up over 50 ethnicities, over 100 languages, and even more dialects, which makes individually tailored care very challenging. The curriculum and licensing models for mental health professionals are very Eurocentric, failing to accommodate for mental health professionals who wish to cater to certain ethnic groups.
Yuxin Sun
Dr. Yuxin Sun, psychologist and founder of Sunburst Psychology, a mental health group practice based in Seattle, commented that there is “too much umbrella training versus teaching clinicians to be more curious about this particular person, what’s their lived experience, what do they get from it, how do they interpret it, how does it show up in their mental health concerns.”
Sagapolutele stressed the importance of culturally comprehensive care, especially for Native Hawaiians and Pasifika people.
“We are such connection-based people […] we need to be connected before we can even start ‘treatment.’” Sagapolutele stressed the comfortability patients are able to feel when patients hear their name said correctly and clinicians understand cultural practices that allow them to “unload their stories with things that hold weight.” The Wa’a Collective even offers lā’au lapa’au, or traditional Hawaiian healing, with certain mental health professionals but ultimately allows patients to decide which health care provider might suit their needs and desires for the type of care.
Lack of representation in the mental health field
A lack of representation in the field, or the notion that one might not be understood, also prevents people from seeking care in the first place. A study by KFF reports that among those that reported mental illness, only 25% of Asian adults received care. Hesitancy to seek care can exacerbate health outcomes, concerning physical condition, decreased quality of life, and potentially substance abuse, depending on personal coping mechanisms.
Personal mental health stigma
Mental health stigma among AANHPI communities already disproportionately affects health outcomes for individuals who don’t receive mental health care.
One contributor to this disparity is the stigma against mental health in many AANHPI cultures and within one’s family. Many AANHPI cultures are focused on collectivism, or group priority over individual aspirations, so many mental health issues arise from a lack of being able to discuss personal struggles. Potentially poor reception of pursuit into this career by one’s family can prevent one from entering into the mental health field. However, following a mental health profession depends on the individual’s experience with mental health, their comfort level with discussing mental health topics, and subsequently analyzing their own mental health.
Financial burden
Another significant factor is the financial burden placed by education, training, and earnings even after entering the field. Pursuit of a career in the mental health field places a heavy financial burden because of the requirement of a graduate degree. The cost of a Master’s degree in psychology ranges from $10,000 to $30,000. Even when educational attainment is achieved, the salary of psychologists is less compared to others in the healthcare field. The average salary of a mental health therapist in Seattle is about $86,813, while physician assistants earn $144,262.
Sagapolutele highlighted the high rates of poverty for Native Hawaiians that create a disparity in achieving educational attainment. In comparison to the 5.9% of non-Hispanic white families, Native Hawaiian/Pacific Islander families had a poverty rate of 13.5%.
“Probably at the root of it is because of colonization, because of the way we lost land, language, and culture. So today, we disproportionately afford college, it’s out of reach for a lot of families. […] It’s hard to think of college when you’re just trying to feed yourself for the next day.”
Generational patterns
Generational patterns also have an impact in one’s ability to perceive a mental health career, or primarily an education, as a viable option for them. “There needs to be a lot more work done to help Native Hawaiians get into a space of college, of thinking about college, of even identifying that it’s a possibility,” Sagapolutele clarified.
Creating more representation in the mental health field
To combat these disparities, both mental health professionals recommended more inclusive, accessible training and more funding to mitigate the costs for those seeking careers in the mental health field. Changes in the incorporation level of theory to decolonize practices can help people receive care and how clinicians see themselves represented in the field.
Sun sees the potential for more representation through inclusive training.
“Incorporating things is like, ‘I see the fundamental value of certain things, and I’m going to see how I bring the value […] into my theory.’” “ I’m seeing a lot of effort from BIPOC clinicians to decolonize therapy. [They ask] how do I make it more of a place that’s more authentic and inclusive for clinicians and clients from all cultural backgrounds?”
From the financial side, Sun offered, “If we are able to make graduate programs more accessible for API folks and to increase mental health awareness enough to the point where stakeholders and investors are willing to increase the pay for mental health professionals, I think that would be very helpful.”