STUDENT VOICES | THE 2025 CHYNN ETHICS PAPER PRIZE second place WINNER
Shadows of Stigma in Asian American and Pacific Islander Mental Health
By Malia Coghlan, Fordham College Lincoln Center 2025
I can remember the stuffy plane rides to Columbus, Ohio, the artificial chill of recycled air, and how my parents whispered in hushed tones when we arrived at that strange building. We made this journey every few months, and yet I was never allowed inside. My family shielded me from the reality behind those walls. What lay within them was an underfunded, overcrowded facility that boasted a promise of care and compassion. Instead, it became a place of quiet suffering.
My aunt was relocated to this facility in hopes of better resources, but they were never enough. Diagnosed with schizophrenia as a young adult in Hawaii after immigrating from the Philippines, she faced not only the challenges of her condition but also the limitations of an inadequate mental health system. Over time, a lack of responsive care led to additional health complications. Cultural stigma, systemic gaps in support, and a broader misunderstanding of her needs all contributed to her suffering. My family made the difficult decision to move her closer, believing it would offer her better care, but the institution entrusted with her well-being struggled to meet her needs. The place meant to provide safety fell short, not out of malice but out of a system that was never fully equipped to support her. Because of all this, I never had the chance to meet her – a loss shaped not by one failing but by many.
Her story is not an anomaly. The barriers that kept my aunt from receiving the care she needed are the same ones that continue to hinder mental health access for many Asian American and Pacific Islander (AAPI) individuals today. The interplay of cultural stigma, lack of resources, and systemic discrimination creates a landscape where seeking help is not only challenging but often seen as an impossibility. In Hawaii, where colonial legacies continue to shape healthcare infrastructures and attitudes toward mental illness, these barriers are even more pronounced. Mental health is deeply entwined with social, historical, and political forces, and understanding these factors is crucial to addressing persisting disparities.
At its core, this is an ethical issue. A just society does not allow suffering to persist in silence nor permit entire communities to be denied care due to systemic neglect. The failure to provide equitable mental health care raises profound ethical concerns regarding justice, beneficence, and nonmaleficence. Healthcare systems that neglect culturally diverse populations violate the principle of justice by perpetuating health disparities and denying care based on cultural and linguistic barriers. The lack of culturally competent care also contradicts the principle of beneficence, which requires healthcare providers to act in the best interest of patients and maximize their well-being. Moreover, systemic inaction can be seen as structural violence – an insidious harm stemming from social and institutional inequities (Farmer, 2004). The ethical imperative is clear: the healthcare system must be held accountable for addressing disparities in mental health care for AAPI populations.
Studies show that AAPI individuals underutilize mental health services compared to other racial and ethnic groups despite experiencing significant psychological distress (Leong et al., 2011). Several factors contribute to this disparity. The cultural stigma surrounding mental illness discourages many from acknowledging their struggles or seeking professional help. Many AAPI cultures emphasize collectivism and familial reputation, leading to fears that admitting to mental illness could bring shame to the family (Ng & Park, 2019). Additionally, traditional beliefs often frame mental illness as a personal failing or spiritual imbalance rather than a condition requiring medical attention (Javier et al., 2022). This leads to internalized shame and avoidance of formal treatment options.
Beyond cultural factors, systemic obstacles also play a critical role. In Hawaii, where Indigenous and immigrant communities intersect, mental health care has been historically underfunded and inaccessible. According to a report by the Hawaii State Department of Health (2021), there is a severe shortage of mental health providers, particularly those trained in culturally responsive care. Many AAPI individuals, especially first-generation immigrants, face linguistic barriers that make navigating the healthcare system difficult (Sentell et al., 2013). Moreover, financial constraints further limit access, as mental health services are often expensive and not fully covered by insurance.
Addressing these disparities requires a multifaceted approach integrating culturally responsive therapy, community-based interventions, and policy reform. One promising strategy is the implementation of transtheoretical approaches to therapy, which emphasize flexibility in treatment modalities and the integration of culturally relevant interventions (Prochaska & DiClemente, 1983). For AAPI populations, this could mean incorporating traditional healing practices alongside evidence-based psychological treatments, thereby bridging the gap between cultural beliefs and clinical care. For example, some interventions integrate mindfulness practices rooted in Buddhism or Confucian-based family therapy models to align with cultural values.
Community-based interventions also hold promise. Grassroots organizations in Hawaii and beyond have begun developing programs that provide mental health education in culturally sensitive ways. Peer support networks led by individuals with shared cultural backgrounds can help normalize conversations about mental health and reduce stigma (Matsumoto et al., 2020). Additionally, outreach programs that provide mental health literacy in multiple languages can help first-generation immigrants and non-English speakers navigate available resources more effectively.
Technology offers another avenue for improving access. Teletherapy has emerged as a viable solution, particularly for individuals who face geographic or linguistic barriers (Chen et al., 2021). Expanding telehealth services tailored to AAPI populations could significantly improve access to mental health care, particularly in regions like Hawaii, where provider shortages persist. In addition, policy changes are needed to increase funding for mental health services in underserved areas and to train more providers in culturally competent care. Government initiatives that subsidize therapy costs for low-income AAPI individuals could also help bridge financial gaps.
My aunt’s story is one of many, but it is a powerful reminder of the urgent need for systemic change. The intersection of cultural stigma, historical trauma, and inadequate mental health infrastructure continues to shape the experiences of AAPI individuals, particularly in Hawaii. However, we can begin dismantling these disparities by acknowledging these barriers and implementing targeted interventions such as transtheoretical therapeutic models, community-led initiatives, and expanded telehealth services.
The moral imperative is clear. Cultural acceptance, language proficiency, or historical inequities should not dictate access to mental health treatment. It is a fundamental right. As a future clinician and researcher, I want to be theadvocate who would have fought for my aunt and will fight for those like her, ensuring that no one is ever abandoned by the system meant to care for them.
For more information about the prize, past winners, and submission requirements for 2026, please visit the Chynn Ethics Paper Prize webpage. The deadline to submit is TBD and is open to ALL undergraduates.
Malia Coghlan majored in psychology at Fordham College of Lincoln Center with a minor in bioethics (Class of 2025).
References
Chen, J. A., Chung, W. J., Young, S. K., Tuttle, R., Collins, M. B., Darghouth, S., & Mak, W. W. (2021). COVID-19 and telepsychiatry: Early outpatient experiences and implications for the future. General Hospital Psychiatry, 66, 89-95. https://doi.org/10.1016/j.genhosppsych.2020.10.002
Farmer, P. (2004). An anthropology of structural violence. Current Anthropology, 45(3), 305-325. https://doi.org/10.1086/382250
Javier, J. R., Rangel, D. E., & Boles, R. E. (2022). Addressing mental health disparities among Asian American youth: A call to action. American Journal of Public Health, 112(2), 188-190. https://doi.org/10.2105/AJPH.2021.306578
Leong, F. T., Kim, H. H., Gupta, A., & Zachar, P. (2011). Attitudes toward professional counseling among Asian-American college students: A longitudinal study of social and cognitive factors. Journal of Counseling Psychology, 58(1), 21-30. https://doi.org/10.1037/a0022902
Matsumoto, A., Iwamoto, D. K., & Lee, J. (2020). Culturally adapted peer support models for Asian Americans with mental health concerns. Asian American Journal of Psychology, 11(3), 153-164. https://doi.org/10.1037/aap0000192
Ng, K. M., & Park, C. (2019). Stigma and help-seeking attitudes among Asian American students. The Counseling Psychologist, 47(3), 393-422. https://doi.org/10.1177/0011000018822947
Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390-395. https://doi.org/10.1037/0022-006X.51.3.390
Sentell, T., Shumway, M., & Snowden, L. (2013). Access to mental health treatment by English language proficiency and race/ethnicity. Journal of General Internal Medicine, 28(3), 379-386. https://doi.org/10.1007/s11606-012-2229-z
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