Explainer: How do I talk to my Vietnamese parents about mental health?

There is no widely accepted term for “mental health” in the predominantly refugee Vietnamese American diaspora. Many mental health diagnoses don’t have translations either. (Though, the LA Times recently published a guide to some of these terms.) So when it comes to addressing mental health issues with their families, many children of immigrants and refugees have no idea where to start. 

A 2008 study from the UC Irvine Center for Health Care Policy found that Vietnamese Americans who came to the United States as refugees were twice as likely to experience mental health issues than whites, but were less likely to discuss these issues with a medical professional. 

Of the people surveyed, many of their issues stemmed from traumatic experiences related to fleeing the communist government in Vietnam after the 1975 Fall of Saigon and through the 1980s, when many refugees escaped by boat, endured unimaginable hardships at sea and spent extended time in “re-education” camps.

“There’s so much fight in the Vietnamese diaspora to survive,” Cynthia Huynh-Wu, a Licensed Clinical Social Worker for Diaspora Counseling in Seattle, told PIVOT. “We’ve been taught as a community to grind through things, that you don’t spend too much time looking back because if you do, that’s when you get stuck.”

Among the barriers to seeking mental health treatment are cultural stigma, a lack of Vietnamese mental health providers, rising costs, and difficulty communicating vulnerably with family members.

Cultural Stigma

A 2018 study from Cambridge University found that Vietnamese Americans were reluctant to discuss their mental health issues due to “shame, embarrassment, and being frowned upon” by their peers. Many feared attracting gossip that would also tarnish their family’s reputation.

“When people talk about mental health in the community, they’ll say things like, that person’s crazy, that person has problems in their brain,” Doan Phan, a Licensed Clinical Social Worker for Sunny Days Counseling in Houston, told PIVOT. “There is an expectation in the community that you keep things within your family.”

As a child of Vietnamese immigrants, Phan struggled to find resources to deal with her mental health problems growing up, including ADHD. A 2024 study found that Asian children are less likely to receive diagnoses of ADHD than other racial groups.

Some researchers cite the “model minority” stereotype — the narrative that Asian American children are well-behaved and high-achieving — as a reason that ADHD symptoms are often dismissed. In Phan’s case, her parents pushed her to work twice as hard in school instead of seeking professional help.

It doesn’t help, Huynh-Wu pointed out, that many Vietnamese elders are already generally skeptical about the Western medical model. She’s seen many children having to fight their parents just to get them to see a primary care doctor.

She also believes more parents might be open to talk therapy, also called psychotherapy or counseling, if their children were able to describe it in a way that “reduces some of the medicalization.” But the only Vietnamese word she knows to describe counseling is “bác sĩ tâm lý” — a phrase tied to “doctor.”

“And if they do go to a doctor, it has to be a Vietnamese person,” Phan noted.

A Lack of Vietnamese Mental Health Providers

A 2020 study from the Stanford Medical School found that Vietnamese Americans have the lowest English proficiency among all Asian Americans. For Vietnamese in Orange County, home to the largest Vietnamese population in the world outside the motherland, 90% of seniors have limited English proficiency and 40% of households are linguistically isolated, meaning everyone over the age of 14 has limited English proficiency.

But the search for a Vietnamese-speaking mental health provider is extremely challenging when, as of 2016, Asian Americans in general compose only 5% of active psychologists. And it’s become even harder as the demand for Asian therapists has risen. 

Huynh-Wu said most of her colleagues are fully booked or have long waitlists, especially those who are Vietnamese. Phan said her practice has become busier since the start of the COVID-19 pandemic, and the subsequent rise in anti-Asian violence.

“There’s been an uptake of people coming into the mental health system for the first time,” Phan said. “But there’s not a lot of providers who speak Vietnamese.”

When people don’t speak the same language as their medical provider — or even come from the same background — they tend to get misdiagnosed or “pathologized in some way that isn’t accurate to their experience,” she said.

“I’ve had clients that, because of my background, when they express things in a certain way I know exactly what they’re trying to say,” she said. “But to another person they might think this person is suicidal when they’re not.”

Rising Costs

The same 2020 study from the Stanford Medical School found that 8.1% of Vietnamese Americans do not have medical insurance, the second highest of all Asian Americans. This habit may carry over from the health financing system in Vietnam, which relies predominantly on out-of-pocket spending.

But even for those who are covered, Huynh-Wu said she’s noticed more and more therapists aren’t working with insurance companies anymore, as it’s become harder for patients to get approved for reimbursements. Some insurance companies require a diagnosis, and others restrict the client to a certain number of appointments.

As a free alternative, she recommends tapping into local nonprofits and community outreach programs such as the Vietnamese Health Board in Seattle, which hosts events such as mental wellness workshops, group walks and Vietnamese-translated yoga. Huynh-Wu regularly uses their translated feelings charts in her therapy sessions, a comprehensive list of emotions in both English and Vietnamese.

Phan also recommends the Asian Mental Health Collective’s Lotus Therapy Fund, a program that connects those in need with Asian therapists and provides them with eight free sessions. 

Orange County’s Nhan Hoa Comprehensive Health Care Clinic is another resource for affordable Vietnamese-language health services, including therapy.

Difficulty Communicating Vulnerably

When Phan worked for the Asian Family Support Service of Austin, many of the Vietnamese community members she encountered didn’t understand the purpose of counseling, coming to her instead to seek advice on how to fix their children’s behavior.

“We would have a deeper conversation about family dynamics and they would disappear,” she said. “They’re not willing to dive into the emotional experience of it because it’s too painful or difficult to regulate.”

For those who struggle opening their parents up to these types of conversations, one resource Huynh-Wu recommends is Parents are Human, a card game that comes in multiple languages, including Vietnamese. Each card has a question for the players to answer ranging in their level of intimacy, written in English on one side and the other chosen language on the other.

“This helps the parents maintain the sense of authority in which they are more comfortable, that I am in the position to teach you,” Huynh-Wu said. “Meanwhile, you’re asking them something quite vulnerable, and maybe they start reflecting on their internal world, which is the first step toward talking about mental health.”

Avoiding accusing language can also help to bring someone’s guard down, Phan said, especially in a culture that respects the elderly and hierarchy of power.

“I would suggest being really vulnerable,” she said. “Saying something like, when you said that it hurt my feelings and made me really sad. Maybe next time, it would make me feel good if you did this.”

Phan has seen many children become resentful because they feel their parents are unwilling to change. She tries to help reframe their mindset. “For a lot of people, this is just what they know,” she said. “It’s what they’ve learned from their parents.”

Sometimes, parents can’t change. And in cases where having these discussions may bring about more harm than good, Phan recommends that a person work out their own feelings about the situation with a mental health provider they trust, who can help them figure out the safest way to deal with the situation.

“It might mean accepting that your parents may never be that kind of parent for you,” she said. “It’s not reasonable in every situation to try and reconcile relationships.”

For those experiencing new challenges in their family dynamic, a gentle way to approach the subject is to help a person acknowledge they’re struggling by pointing out concrete things about how their behavior has changed.

“It can be things like, I notice you’re not going to karaoke with the aunties anymore, that you’re not doing this thing that you used to do,” Huynh-Wu said. “Naming you notice these things just to get them to the stage of acknowledging that maybe change might be necessary.”