Asian American immigrants can struggle to find therapists who understand their culture, speak their language, or come from similar communities, making it hard to get the mental health support they need. — TNS
In her first months as a community health worker in California, United States, Kim Jee Hyo helped violent crime survivors access supportive services and resources.
When a client with post-traumatic stress disorder (PTSD) sought a therapist, she linked him to one that fit his needs.
She helped clients afraid to leave their homes obtain food delivery vouchers.
As one client described her, Kim was a “connector”.
Then, she learned to go further.
Through a training programme, she gained the know-how and confidence to provide emotional support.
She learned evidence-based mental health counselling skills, such as asking open-ended questions.
She also discovered that some things she was already doing, such as listening attentively and restating what she hears, are core to communicating empathy – a vital component of a successful relationship between a client and their mental health provider.
“It was very refreshing to see that it’s named and to realise those are skills,” she said.
Asian Health Services, where Kim works, is a part of a fledgling movement in the US trying to address a dire shortage of therapists by training community health workers and other non- licensed professionals who have trusted relationships with their communities to add mental health counselling to their roles.
This approach, already implemented abroad and proven to help address some common mental health conditions, is called lay counselling.
Filling the therapist gap
The Oakland-based community health centre serves mostly low-income Asian immigrants who speak limited English.
As a community health worker, Kim now also practises lay counselling under a licensed therapist’s supervision.
She does not have a license, but as a Korean immigrant and strong-arm robbery survivor, she shares lived experiences with many of the people she serves, enabling her to build trust.
Research suggests that Asian Americans see mental health providers at lower rates than people of other races, and up to half of some subgroups report difficulty accessing mental healthcare.
Figures like these may be only the tip of the iceberg, as Asian Americans can be reluctant even to seek help.
Cultural stigma against mental illness and feeling like one’s problems pale in comparison to the trauma faced by earlier generations are among the reasons, said US think tank AAPI Data senior research analyst Connie Tan.
Asian Health Services introduced lay counselling during the Covid-19 pandemic.
Violence against Asian Americans was spiking, and therapists fluent in any of the 14 languages spoken by the communities the health centre cares for were in short supply.
Six percent of people in the US identify as Asian, Native Hawaiian or Pacific Islander, but these groups account for only 3% of psychologists.
Concerned that people were falling through the cracks, the health centre launched a grant- funded initiative in 2021 to support victims of violence.
In addition to lay counselling and therapy by licensed providers – available in several languages – the programme, known as the Community Healing Unit, provides services such as helping clients access crime victim funds.
The programme has sent 43 community health workers, case managers and other employees to a lay counselling training programme, said the health center’s special initiatives director Ben Wang.
Trainees learn through formal instruction, observing teachers providing counselling, and practising counselling with one another, along with feedback from instructors.
After undergoing training in lay counselling, Kim gained skills to provide her clients with emotional support.
Recognising existing skills
Nguyen Thu, a domestic violence survivor, was struggling with anxiety and self-blame.
“My inside talk eats me up,” she explained.
Worried that sharing with family members would burden them, she was unsure where else to turn for support after meeting with a therapist she didn’t click with.
Through the programme, Nguyen was assigned to Kim, who connected her to a compatible therapist.
Nguyen also leaned on Kim for emotional support.
When she confided feeling guilty and inadequate as a single mother, Kim responded without judgement and affirmed Nguyen’s dedication.
“She validates my feeling,” said Nguyen, a Vietnamese immigrant.
“She would say, ‘I understand that it’s hard. You’re doing the best.’”
Asian Americans can struggle to find therapists who understand their culture, speak their language, or come from similar communities.
Licensed therapists typically must complete an advanced degree, pass professional exams, and work at least two years under supervision.
Requirements vary by each American state and by type of license.
It has long been held that the process ensures high-quality care.
Lay counselling proponents contend this path is costly and time-consuming, limiting the field’s diversity and exacerbating the therapist shortage.
They also point to favourable research.
Lay counselling has been implemented in several countries, where mounting evidence has shown that it can improve symptoms of depression, anxiety and a few other mental health conditions.
“The idea that someone without a license could not [communicate empathy] skilfully is ridiculous,” said psychologist and Lay Counselor Academy co-founder Elizabeth Morrison.
The academy has trained 420 people, including Kim, to add lay counselling to their roles since launching two years ago.
Trainees hail from a variety of jobs, including faith leaders and first responders.
The 65-hour primarily-virtual course teaches topics such as supporting people who have experienced trauma; counselling methods such as cognitive behavioural therapy and motivational interviewing; first-line strategies for treating depression and anxiety; and setting boundaries.
The course does not teach how to diagnose mental health conditions.
Instead, trainees learn to affirm strengths, acknowledge feelings, avoid giving advice, and otherwise listen empathically.
Asian Health Services staff members who provide lay counselling receive ongoing support and guidance after the training from a programme manager and a licensed therapist, Wang said.
American Psychological Association senior director Raquel Halfond said that she believes it’s important for lay counsellors to receive training and to practise under the supervision of a licensed mental health professional, but the group has no formal model or standards for the use of lay counsellors.
The course not only upskills, but also recognises what many trainees already do, or have learned, that may not be acknowledged as counselling.
“It’s like this invisible, unpaid work, and people chalk it up as someone being nice,” Morrison said.
The issue of funding
Lay counselling is still nascent, and it often takes years for a new field to become established – and for insurers to get on board.
Morrison and research fellow Laura Bond of Harvard Medical School’s Mental Health For All Lab – another lay counselling training initiative – said they are not aware of any organisations that can bill US public or private insurers for lay counselling.
In an email, spokesperson Leah Myers for the California Department of Health Care Services, which oversees the US state’s public health insurance programme Medi-Cal, acknowledged that there is no billing code for lay counselling or certification for lay counsellors.
She said Medi-Cal reimburses certain non-licensed providers for services that “may include what would be considered ‘lay counselling’-like activities”, but would need more details to make a determination.
The Community Healing Unit’s largest grant, from the state of California to support victims of hate crimes, ends in 2026.
The programme has served over 300 people and is developing a survey to gather feedback, Wang said.
Nguyen knew Kim wasn’t a licensed therapist, but didn’t care, she said; she appreciated that Kim, a fellow Asian woman, made her feel safe to process her feelings.
Kim was also easily accessible through biweekly check-ins, and responded promptly if Nguyen called at other times.
Now, Nguyen said, telling herself “you’re doing good” comes more easily. – By Sarah Kwon/KFF Health News/Tribune News Service
KFF Health News is a US national newsroom that produces in-depth journalism about health issues and is one of the core operating programmes of KFF – an independent source for health policy research, polling and journalism in the US.
