Pandemic exacerbated mental health issues
Over the years, friends and family have been reaching out to Dr. Mala Nayak, a Bay Area psychiatrist, with mental health concerns for themselves and their loved ones. She would reach out to her network of psychiatrists and help them find treatment. With the onset of the pandemic, this need exploded. Almost every week someone was reaching out for help, many of whom were South Asians. There was no roadmap to navigate this deluge; doctors simply did not have the time to accept new patients. Seeing this growing need motivated Dr. Nayak to create a nonprofit mental health navigator called REVA.
Growing mental health crisis
The pandemic brought out simmering mental health issues to the forefront. The disruption in our daily routines — work-from-home, schools-from-home, increased caregiver responsibilities, and economic uncertainty — took its toll. Losing access to therapy sessions or having them on Zoom disrupted the mental health services that patients needed.
A 2023 study on the state of mental health in America reveals that in 2020, 21% of adults experienced at least one mental illness while 55% of adults with mental illness received no treatment.
The South Asian Public Health Association (SAPHA) reports that 1 in 5 South Asians in the U.S. reported experiencing a mood or anxiety disorder in their lifetime.
Asians were 60 percent less likely to have received mental health treatment as compared to non-Hispanic whites – according to a US Department of Health and Human Services study in 2018.
Finding the right patient-provider fit
Since finishing her residency in psychiatry at Stanford, Dr. Nayak has been working for over 25 years at Momentum For Health, a community-based organization that provides wraparound services to people with severe mental health issues in Santa Clara County.
With REVA, Dr. Nayak wants to provide curated connections for patients with mental health professionals. “My goal with this venture is to really connect with everyone who reaches out to me for mental health services and to give them the names of three people that are well matched to their needs…so that it increases the likelihood of success in treatment and fosters long-lasting, sustainable change,” said Dr. Nayak.
“There are so many things that go into a good fit. What is the age of the provider? I feel like when a person my age reaches out, they want somebody a little bit older, who’s had more life experience. When somebody my children’s age, in their 20s, reaches out, they want a younger person. They don’t want somebody who makes them think of their mom or their aunt… With REVA, my mission is to really pay attention to those things when giving people names of providers I think will be a good fit for them,” she said.
Recognizing signs of mental health illness
Look for changes in thought patterns, emotions and behaviors, says Dr. Nayak, and seek help sooner rather than later.
Some changes in thought patterns can be somebody becoming more negative, despondent, or maybe disorganized in their thinking process.
“You want to pay attention to their emotions and then their behaviors. Are they isolated? Are they withdrawn? Are there changes in their sleep patterns? Are there changes in their eating patterns? Any of those things are sort of where you want to raise your antennae,” says Dr. Nayak.
But Dr. Nayak warns that a single symptom doesn’t make for a diagnosis. You really have to see a conglomeration of symptoms to make the diagnosis. The symptoms should translate to a change in functioning and the pattern should be pervasive and persistent.
How to broach the topic and offer support
“Don’t minimize yourself,” advises Dr. Nayak, because a lot of people are vigilant for their families and ignore it in themselves. Be kind to yourself in the same way that you are kind to your family or your loved ones.
When you recognize signs of mental health issues in a friend or family, keep it to observations only, says Dr. Nayak. For instance, if you see somebody that used to play the piano but no longer enjoys it, say, “I noticed that”, and keep your observations limited. No subjective statements. Don’t ascribe any motivations to the person’s change in behavior and don’t pass any judgment about their behavior – just put it out there as an observation.
Be aware that the other person may not be ready to talk about it because they may not have acknowledged to themselves that there is a problem. And that’s okay, says Dr. Nayak. This gentle conversation lets them know that someone has noticed and cares about them.
For South Asians, acknowledging mental health issues can be even harder as many are apprehensive about how families may react. “So this lets them know that you know, you are able to listen to what it is that they have to say. They may not yet be ready to open up to you. You put it out there that I have noticed that a change has happened. Sometimes they will open up later, or they may open up in little bits whenever they are ready,” says Dr. Nayak.
Therapist, psychologist, and psychiatrist
It doesn’t matter whom a patient approaches first, says Dr Nayak.
“I would like to try to take the stress out of the whole thing by saying that all of us work collaboratively. And so if you went to see a therapist, and you needed medications, the therapist would point you to a psychiatrist,” she says.
The primary care physician can sometimes be the gatekeeper, either because of insurance reasons or because that is whom you go to first.
Psychiatric treatment is the treatment of biological, psychological, social, and cultural factors that prevent an individual from reaching their full potential.
A psychiatrist has a medical background like Dr. Nayak. After medical school, she did an internship in internal medicine, leading to a residency in psychiatry. Psychiatric training involves the diagnosis and treatment of mental health issues, and psychiatrists are trained to see issues from biological, psychological, social, and now cultural perspectives.
While biological factors can be treated with medications, the psychological and social may be addressed with therapy, and psychiatrists have a background in both.
A psychologist has a degree in clinical psychology. They are experts in evidence-based therapies. They also do structured assessments like ADHD or autism spectrum disorder.
A therapist is anyone that does therapy – it could be a licensed marriage and family therapist, a licensed clinical social worker, a psychiatrist, or a psychologist.
Who is right for you?
“I would say that a good mental health professional is someone you feel comfortable with. That is the number one thing. And that person should be an active listener, which means that they are listening with openness and empathy,” said Dr. Nayak.
Should a South Asian see a South Asian provider?
There are no absolutes and it’s all relative, says Dr. Nayak.
There are some cases where you really can make a case that a South Asian provider would be appropriate if, for example, language competency is a factor. On the other hand, your need may be for a particular kind of therapy or a particular niche where cultural compatibility is not as important as the medical expertise of the provider.
“Sometimes the culture may be something else, in the sense that you are South Asian, but maybe you also belong to the LGBTQ community. And so for you to find somebody in the LGBT community supersedes your need to find a South Asian person,” says Dr. Nayak.
The most important thing to consider is if the provider you are going to is culturally competent, says Dr. Nayak. “Someone who is open to understanding your background and your culture. Are they willing to look at how you understand your illness and your symptoms in your cultural situation? How does your culture play out in your psychosocial world? Someone who is also willing to address this difference in cultures and how that is playing out in our relationships in a country where people are of a different culture.”
Why is mental health a “log kya kahenge” issue?
There is a stigma related to mental health in every community. Dr. Nayak surmises that it exists because of two reasons, “lack of understanding, and our own prejudices and biases.”
Lack of understanding in a lot of cultures, including South Asian, means that mental health issues are viewed as some kind of moral weakness or a character flaw.
“There is a feeling that you should just be able to snap out of it, you know, pull up your socks, and get on with the program. Especially in a sort of collectivist culture like ours, people start feeling bad, because they’re not able to pull their socks up, not able to snap out of it. The feeling of guilt and shame extends to the family and the community as well. And then that results in just people wanting to hide it,” she said.
Also, says Dr. Nayak, South Asian cultures lack the vocabulary to communicate mental health symptoms. “We have never talked about our feelings and our emotions, we have never allowed those to see the light of day because there really was no language for it.”
What does depression mean in neurobiology?
Depression is a complex interplay of external and internal factors. Your genes, family history, and your neurobiology and neurochemistry, all play a role.
“In terms of neurobiology, you think of the brain as a collection of nerve cells or neurons. Impulses or messages have to pass from one nerve cell to the other. And some neurochemicals help with the transmission of these impulses. When somebody has depression, there is a dysregulation or imbalance in a group of neurochemicals or neurotransmitters called monoamines, particularly serotonin and norepinephrine. The treatments are built to address these problems,” explained Dr. Nayak.
Mental health medications have been stigmatized
Dr. Nayak recommends that a patient seek out a provider they do not know personally. Confidentiality is the cornerstone of this profession, she says.
In psychiatric treatment, a patient is first evaluated, for biological, psychological, and socio-cultural factors. “After I’ve ruled out other medical causes, I may decide that for this person, medications are an option,” says Dr. Nayak. “I would like to emphasize that medications, like other things, have been stigmatized in mental health. A lot of people are concerned about mind-altering drugs, they are afraid that they will get addicted to these medications. There is a dysregulation in your nerve pathways and the medication is working on fixing that. So with most medications, you’re not going to get addicted. There is a biological problem, which is being addressed here.”
Some patients might have a psychiatrist managing their medication and somebody else for therapy. She cautions that in therapy, is it very important to be completely honest with the care provider. “I would say about all psychiatric treatment is that what you get out of it is what you put into it, and there is work because if you are depressed, you’ve carved up a lifestyle of isolation and withdrawal, then the medication can help you feel better, but it’s not going to help you make you call your friends. That effort has to come from you.”
Investing in mental health
Our mental health is our greatest wealth and the onus is on us to invest in it.
“I do want to emphasize getting sleep, eating healthy, exercising, and spending some time in the day on some meditative activity, whatever is right for you. Also, spend a little bit of time in the day on something enjoyable to you – like playing with your dog, or reading a book. Have some me time – make time to validate yourself …you need that self-care as well. And the last is socialization. And I truly mean, in-person connectivity, not on social media,” says Dr. Nayak.
Mental health should be on par with physical health, she says. “We should all work together. The responsibility is everyone’s in creating an environment in which we are as comfortable talking about our challenges as we are about our successes.”