To the Editor: In the June issue of Psychiatric Services Barreto and Segal reported findings regarding the use of mental health services by Asian Americans in California (1). They examined data from the California Department of Mental Health's client and service information system and concluded that "East Asians make more extensive use of public mental health services in California than do members of other ethnic subpopulations." However, this conclusion may be somewhat misleading in that the data reported are based on a clinical sample—that is, the sample included only individuals who had at least one episode of service. So, more precisely, their data show that East Asians who are already enrolled in the public mental health system make more extensive use of these services than do other ethnic subpopulations. The data do not indicate how likely Asians in nonclinical samples are to seek and use mental health services compared with other ethnic groups.
I work in a mental health agency in Los Angeles County that focuses its services on the Asian community. The daily experiences of my colleagues and I would lead us to conclude that Asians living in California continue to encounter significant barriers—both systemic and culturally based—that decrease the probability of their seeking and obtaining mental health services for the first time. Consistent with previous reports, we have noted that many Asian families are still reluctant to seek mental health services because of the shame and stigma associated with mental illness, lack of awareness about the causes and treatments for mental illnesses, lack of health insurance, and lack of mental health professionals fluent in Asian languages (2). Asian Americans often seek treatment late in the course of their illness, which frequently results in more severe and chronic symptoms at the time of first contact with mental health services (3). Furthermore, recently published data show that high-risk Asian American youths remain much less likely than youths from other ethnic groups to receive formal mental health services (4).
Barreto and Segal's data are encouraging in that they suggest that Asians are becoming more accepting of mental health services once they are enrolled in the mental health system. This finding may be due to the increasing availability of culturally and linguistically competent mental health services (3), simultaneous access to case management services, demographic changes—including increasing acculturation—in Asian communities in California, or greater awareness of the effectiveness of psychiatric treatment. But given the public policy implications of such data, it is critical that they not be misinterpreted in ways that could jeopardize continued adequate funding of mental health services and outreach efforts for Asian-American communities.
Dr. Sevilla is medical director of children's services at Asian Pacific Counseling and Treatment Centers in Los Angeles.