Courtesy of Marie Eriel Hobro Marie Eriel Hobro, 21, said her parents didn't want to talk about the family's history of mental illness.

When Sandy Tran, 24, was in seventh grade, she locked herself in a bedroom on her birthday. Her mom became angry, and things quickly escalated to a shouting match. At the end of the night, Tran stood in the doorway of the kitchen and said, “I think I might be depressed.”

Her parents just stared, not saying anything, she recalls.

“That was that first experience of coming out with mental health issues. It was shot down quite quickly,” Tran said.

Years later, she realized most of her family members suffered from symptoms of depression. One night, her brother had to go to the hospital after months of undereating. Her family was worried about his physical condition, as he was severely underweight. But when doctors attempted to give him a psychological evaluation, Tran’s parents declined.

Looking back, Tran says, “My parents didn’t take into account that it was a mental stress situation. They were just like, ‘You need to eat.’”

“Being Asian, especially from an immigrant Asian family, we avoid these things,” Tran said. “There’s ... a cultural idea that if you have a mental illness, you’re kind of like a person in the family that needs to be hidden away.”

“My family has always been like, ‘You’re just sad.’ It took them a long time to understand.” - Marie Eriel Hobro, 21

When it comes to seeking help for mental health, the Asian-American community lags behind other groups, including by avoiding it completely. In fact, research shows Asian-Americans are three times less likely to seek mental health help than white Americans.

In the case of Asian immigrants like Tran’s family, many come from cultures that do not see mental illness as a legitimate illness, leading to stigma.

But a new generation of mental health care providers is trying to change that. They’re offering services like family-directed therapy and employing specialists who speak different languages to help immigrants who can’t comfortably express themselves in English.

Dr. Samantha Liu of Asian Community Mental Health Services has seen the effects of mental health stigma firsthand in her 20 years as a psychiatrist. She specializes in working with Asian-American patients, especially Chinese-Americans.

“When I see them, a lot of these patients come to me in severe conditions compared to patients of other ethnicities,” Liu said. “By the time they go to the doctor or psychiatrist, they are already in bad condition. It’s very hard for them to recover.”

Marie Eriel Hobro, 21, felt constantly paranoid throughout most of her life. But it wasn’t until college that she was diagnosed with depression and obsessive-compulsive disorder. Although she tried therapy a few times, she would “run away” from it, she said.

A turning point came when her uncle died by suicide, and Hobro realized she needed to get help. Now, she’s been on medication and therapy for almost a year.

Although Hobro’s family supports her decisions, her parents are still unwilling to talk about the family’s history of mental illness. After her uncle’s suicide, Hobro’s dad denied that he had killed himself. Her parents would often say that anxiety and depression is “just in the mind,” she said. And initially, Hobro had resisted seeking help herself, because she felt too prideful.

“As a Filipina woman, it’s very hard for people in my culture to talk about mental illness,” Hobro said. “Now they’re opening up to it, and they’re happy that I’m getting ahold of myself. My family has always been like, ‘You’re just sad.’ It took them a long time to understand.”

Struggling To Bring Up Family Secrets

Liu said Hobro’s experience is common. People with mental health issues often resist their family members’ suggestions that they seek help, she said, but it’s the patient who must give consent for treatment.

“There is a fear among the community that if anyone finds out, they will be ostracized,” said Dr. Vasudev N. Makhija, founder and president of the South Asian Mental Health Initiative and Network. “They will be worried about what others think and might say. Even for seeking emotional support, they just keep quiet and just suffer in silence instead.”

Many psychiatrists who focus on Asian-American communities believe it’s most effective to educate the entire family while treating the patient.

One approach that works is informing the immediate family, said Dr. Albert Gaw of Asian Community Mental Health Services, who has written about best practices for working with Asian-American patients. Makhija agrees, saying that when he sees Asian-American patients, the family often accompanies the patient to the interview room ― with the patient’s consent.

Using this strategy, doctors will fully inform the family about the medications and treatment, as well as what symptoms to watch out for.

“You cannot divorce the family from individual care,” Gaw said, “but in the American culture, usually patients are being treated as an individual.”

Community Outreach Is Slow, But Improving

To spread awareness about mental health in Asian-American communities, some organizations host public workshops, health camps and community outreach events that offer screenings and discussion of common conditions like depression and substance abuse.

It can be difficult to get people to attend these events, Makhija says, but it helps when patients work with doctors who have similar backgrounds or who speak the same language. Getting help from a native speaker can help immigrants feel like they’ll be understood.

“In psychiatry, people have to explain their deepest emotions,” Liu said. “It’s not like other types of illness, like saying, ‘My chest hurts’ or ‘My leg is broken.’ People often need their native language to be able to comfortably express how they feel.”

Likewise, it helps to hear from other people in the community who have sought treatment and are open about their experiences with mental illness. This type of visibility helps decrease stigma.

Roopak Desai, 44, who moved to the U.S. from India, started seeing Makhija earlier this year. Since then, he has decided to volunteer with the South Asian Mental Health Initiative and Network, hoping to spread awareness to other South Asian immigrants that mental illness is nothing to be ashamed of. Although he just started volunteering, he plans to participate in presentations, panel discussions and other events.

Courtesy of Roopak Desai Roopak Desai, 44, wants to encourage other people in his community to seek mental health help. He's now a volunteer with the South Asian Mental Health Initiative and Network.

Desai recalls attending therapy with his family after he had his first anxiety episode in high school. Although his parents were supportive about him seeking treatment, they did not want it out in the open.

Throughout his life, Desai would receive therapy and medicine on and off, usually after an anxiety episode occurred. Before, he would stop taking his medicine once he started to recover, but he’s since learned that he needs to keep taking it.

“People say I’m suffering from diabetes, I’m suffering from this disease or that,” Desai said. “But [mental illness] never came to the open. You don’t hear, ‘My son, my husband, has certain conditions and has depression.’”

For Asian-Americans who may be in a similar situation, Desai has two pieces of advice.