(Image Description: Dr. Noel B. Ramirez’s parents representing Mango Tree at previous Filipino Seniors Health and Information Fair in the beginning of August.)

Navigating Culture, Care, and Mental Health as Asian Americans

Written by: Dr. Noel B. Ramirez, DBH, MPH, MSW, LCSW, BCD

Earlier this year, my father was put on insulin. For many of us with type 2 diabetes, this marks a significant moment in our care journey. It can signal disease progression, elicit fears about needles, and stir anxieties about managing a chronic condition that seems to become more demanding with time. This transition for my father was followed by a brief hospitalization due to complications from medications and inadequate follow-up from some of the healthcare providers responsible for his care. This distressing experience highlighted the importance of vigilant, informed advocacy within our family.

This was also a moment when my role within my family changed. I became a more active participant in my father’s care, stepping into a familiar and daunting position. As a former care manager for individuals living with HIV and other chronic conditions, I was no stranger to the responsibilities of caregiving. However, this experience with my father felt different—more personal, more challenging, and, at times, more frightening.

For many of us in the AANHPI  community, cultural expectations, especially regarding family care, weigh on us. Our cultures have a deep sense of indebtedness, a commitment to our elders expressed through action and service. But what happens when the transition from child to caregiver brings unresolved issues to the surface? How do we navigate the emotional complexities of this role, especially when dealing with a stubborn parent, a language barrier, or the limitations of our knowledge?

The Importance of Mental Health Tools in Every Phase

Reflecting on this journey, I’ve come to appreciate the need for different mental health tools at each transition phase—beginnings, middles, and ends. Each stage requires us to adapt, find new coping strategies, and lean on different forms of support.

Beginnings: Acknowledging Change and Uncertainty

When my father was first put on insulin, the initial reaction was one of fear and uncertainty. This was a new chapter in his health journey, and a host of questions and concerns came with it. I found solace in the concept of the four Cs, borrowed from the recovery community: I couldn’t Change, Control, Cure, or Cause any of this drama. Embracing this helped me manage my energies, focus on what I could influence, and honor my father’s dignity throughout the process.

Middles: Leveraging the Crisis for Positive Change

As the reality of his condition set in, we entered the middle phase, where the day-to-day management of his diabetes became a central focus. I learned that crises can be powerful catalysts for change. Despite years of delivering wellness messages to my family, it wasn’t until my father’s hospitalization that some of my concerns and advice were indeed heard. We began tracking glucose readings through a Google Sheet. Despite the challenges of teaching older Asian parents new technology, we established a routine of wellness activities that my father adhered to.

This phase also highlighted the importance of building a care team. Recognizing my limitations as a non-medical provider, I sought out additional support. Through some quick Google searches, I discovered that my parents were entitled to a chronic care manager through their insurance plans. I also advocated for including a dietitian to provide proper education on nutrition—a critical component of diabetes management that, despite my knowledge, I felt unqualified to address fully.

Ends: Acceptance and Active Engagement

In the final phase, I had to confront the reality that I couldn’t do everything independently. I engaged my chosen family to talk about my father’s transition, my hopes, and my fears. This process of acceptance was crucial. I had to accept that my relationship with my father, like many others, had its unresolved issues. But I also committed to ensuring that he received the medical care he deserved, refusing to allow him to be neglected by the system.

The Cultural Context: Asian American Elders and Healthcare Disparities

The experiences I’ve shared are not unique to my family. Many Asian American families face similar challenges, particularly when it comes to caring for older adults who are limited English proficient (LEP). According to research, Asian American elders, especially those who are LEP, are more likely to receive substandard care (Haley et al., 2022). They often struggle to navigate the healthcare system, face language barriers, and experience cultural misunderstandings with providers. This can lead to poorer health outcomes and increased stress for the elderly and their family members (Ramirez et al., 2023).

As we navigate these transitions, we must recognize the importance of mental health—both for ourselves and our loved ones. We must acknowledge that each phase of the journey requires different tools and strategies and that seeking help, whether through professional support or our communities, is not a sign of weakness but of strength.

Moving Forward Together

Transitions are a natural part of life, but they can be particularly challenging when they involve the care of our loved ones, especially in the diaspora. As Asian Americans, we must navigate these changes with a blend of cultural understanding, mental health awareness, and practical strategies to move the varying barriers that exist. By acknowledging the beginnings, middles, and ends of our caregiving journeys and equipping ourselves with the right mental health tools at each stage, we can ensure that we provide the best care possible while also taking care of ourselves.

Later this year (October 2024), one of our Senior Clinicians, Joann Francis, LCSW, will facilitate a seminar on family transitions. Additionally, Bisma Nasar, LSW, will host two AANHPI parent listening circles to provide a space for our community members who are parents and raising families (defined broadly). We are also here to provide psychotherapy to you and your family members. We want to remind you that you are not alone.