“It’s Taboo to Talk About It”: Korean American Clergy Members’ Views of Mental Health
Abstract
Korean Americans are more likely to seek guidance from church leaders than to use traditional mental health services. Through semistructured key informant interviews with 16 Christian clergy members serving later-generation Korean Americans, the authors explored clergy members’ perceptions of the mental health needs of their congregants. Insights from the study suggested that communication and collaboration between mental health professionals and church leaders may be helpful in addressing the Korean American community’s emotional and mental health needs.
HIGHLIGHTS
•
Christian clergy members play an important role in addressing the mental health needs of later-generation Korean Americans.
•
Information gained from this qualitative study (N=16) suggested that establishing channels of communication and developing partnerships between clergy members and mental health professionals may help address disparities in Korean Americans’ access to and use of mental health care.
Among racial groups, Asian Americans have the lowest percentage of mental health service use, including prescription medication, outpatient services, and inpatient services (1). Stigma and shame attached to mental illness, low perceived need for services, structural barriers, and lack of belief that services would ameliorate mental health problems contribute to the gap between the need for and the use of mental health services (1, 2).
Research with African American and Hispanic participants suggests that partnerships between mental health professionals and faith-based organizations may increase service use among people in traditionally underresourced communities (3). Korean Americans, the fifth largest Asian American subgroup (4), may particularly benefit from such collaboration, because the Christian church has been pivotal in meeting not only the spiritual but also the social and cultural needs of its community since Koreans began immigrating to the United States (5). In fact, studies have shown that Korean Americans often seek counsel from church leaders rather than from traditional mental health professionals when they have mental health concerns (5, 6).
Most research examining the role of clergy members in identifying the mental health needs of Korean Americans has focused on first-generation immigrants (those who were born in Korea and immigrated to the United States as adults). Because Korean immigration to the United States has steadily declined and first-generation immigrants are aging, the Korean American population is increasingly composed of individuals from subsequent generations (4). Few studies report findings about these later generations: the 1.5 generation (those born in Korea who came of age in the United States), second generation (those born in the United States to immigrants), and beyond.
Empirical Investigation
Through a qualitative study, we update the current literature by exploring the perspectives of clergy members who serve later generations of Korean Americans. Our goal was to gain a better understanding of their congregants’ perceived mental health needs, potential barriers to mental health treatment, and ways mental health providers can better collaborate with church leaders to serve this community.
We conducted 16 semistructured key informant interviews with male Christian clergy members in a western region of the United States via snowball sampling. Participants had to be current or former clergy members serving predominantly English-speaking congregations of later-generation Korean Americans. Participant characteristics are summarized in Table 1. The University of California, Los Angeles, Institutional Review Board determined that this study met criteria for an exemption from review.
| Characteristic | N | % or % range |
|---|---|---|
| Age in years | ||
| 20–29 | 4 | 25 |
| 30–39 | 7 | 44 |
| 40–49 | 3 | 19 |
| 50–59 | 2 | 13 |
| Birthplace | ||
| United States | 9 | 56 |
| Korea | 6 | 38 |
| Other | 1 | 6 |
| Primary language | ||
| English | 15 | 94 |
| Other | 1 | 6 |
| Highest level of education | ||
| Bachelor’s degree | 3 | 19 |
| Master’s degree | 12 | 75 |
| Doctorate | 1 | 6 |
| Church denomination | ||
| Presbyterian | 10 | 62 |
| Nondenominational | 3 | 19 |
| Other | 3 | 19 |
| N of congregants in the church | ||
| <100 | 5 | 31 |
| 100–299 | 5 | 31 |
| 300–499 | 4 | 25 |
| ≥500 | 2 | 13 |
| Age of congregants in years | ||
| <18 | 0–40 | |
| 18–29 | 5–80 | |
| 30–39 | 5–60 | |
| 40–49 | 0–35 | |
| 50–59 | 0–30 | |
| ≥60 | 0–40 |
a
The mean age at immigration to the United States for foreign-born clergy members was 8.7 years (range 3 months–15 years). Time in pastoral ministry among all clergy members averaged 13.8 years (range 6–31 years).
All interviews were conducted in English by one author (S.H.) and lasted 45–90 minutes. (The semistructured interview guide is included as an online supplement to this column.) The same author’s open coding of the transcripts identified four broad themes: the role of the church in addressing the emotional and mental health concerns of its congregants, the primary perceived emotional and mental health needs of later-generation Korean Americans, barriers to addressing those needs, and steps that church leaders and mental health professionals can take to better serve this community.
After the initial codebook was developed, a different author (H.S.L.) independently coded two of the transcripts. Both authors (S.H. and H.S.L.) then discussed the codes, reconciled discrepancies, and revised the codebook. One author (S.H.) used the finalized codebook to code all transcripts. To ensure consistency, one-third of the remaining transcripts were randomly selected, independently coded by one author (H.S.L.), and checked for reliability. The interobserver reliability for these codes, calculated by using Cohen’s kappa, ranged from 0.66 to 1.00, with an average of 0.97 across all twice-coded transcripts.
All participants expressed their belief that congregants should receive care from clergy members or mental health professionals for their emotional and mental health needs. Most participants believed they should play an important role in providing mental health guidance and counsel for their congregants. However, they recognized their own limitations and felt that collaboration with professional mental health providers is key to meeting congregants’ mental health needs. One participant, an outlier, felt that the church’s primary role should be spiritual and that the clergy is not fully equipped—by calling, staffing, or training—to directly provide mental health services.
Nearly all participants identified relationship struggles and conflicts (e.g., between couples, family members, and friends) as top concerns and sources of distress for congregants. Almost half (N=7) of the participants noted that a strained parental relationship was a significant issue not just for youths but also for adult congregants with their own parents. More than one-third (N=6) of participants commented on their church members’ continued struggles, even as adults, stemming from a perceived love deficit, especially from their immigrant fathers.
Many of the first-generation Korean fathers were absent from their [children’s] lives. For good reasons, because I think their love language for their children was coming [to this country], sacrificing a lot, working hard, and trying to provide for them as a family. . . . But I think the drawback was that a lot of times, the children felt like they didn’t have a relationship. Add to that the culture gap, the generational gap. Parents in the first generation didn’t know how to speak and really communicate with their children who grew up in . . . America. (participant 8)
Addiction (e.g., to alcohol, drugs, gambling, or pornography) was the second most frequently cited issue, followed by concerns about academics, careers, and the future. Participants also noted that congregants struggled with issues of cultural identity, domestic violence and abuse (in congregants’ childhood or the present), depression, suicide, and a desire for community.
Participants most frequently identified the traditional Korean shame culture, in concert with the stigma surrounding mental health issues, as the largest barrier keeping congregants from discussing emotional or mental health concerns. They also indicated that congregants’ use of treatment was hampered by low mental health literacy, a lack of recognition of the need for help, and fear of seeking help.
Because we come from an honor-shame culture, it’s hard for parents to admit that there are issues. It’s hard for [children] to admit that there are issues in the home. Because what you’re essentially doing is . . . making you and your family vulnerable to scrutiny. And that . . . is something we have a very big issue with, culturally—with being exposed. So we do a lot of things in secret and darkness. And when [a mental health problem] gets revealed later, it’s usually the worst of the worst because we never got help for it. (participant 12)
All participants indicated that they felt inadequately equipped to address the emotional and mental health needs of their congregants. Almost half (N=7) identified as a serious barrier their lack of knowledge about available resources and the means to utilize them. This lack of knowledge was especially common among participants from smaller churches, young participants who were new to the ministry, and those serving later generations within a primarily immigrant congregation.
All participants expressed a desire for more educational opportunities for themselves, their staff, and other church leaders to learn about the mental health field. They also wished to know about available resources, specifically local practicing psychiatrists. Many prioritized raising awareness about mental health and breaking down stigma with their congregants. All but one participant reported having either preached about or discussed in other settings emotional and mental health concerns. Three-quarters of participants (N=12) had experience referring a congregant for professional help (although not always successfully), and most reported a positive experience with the process. One-quarter (N=4) of participants wanted to hire or were actively in the process of hiring Christian mental health professionals as consultants who could also provide mental health care for congregants.
More than one-third (N=6) of participants mentioned that some of their colleagues may lack trust in the mental health field. Participants expressed concern about how mental health providers view the Christian faith and how that perception may affect what is conveyed to patients about the role of faith and the church in their lives. Many also spoke of their hesitancy to refer a congregant to someone they did not know or trust, and they expressed a desire for mental health professionals to build relationships with local churches and their leaders. Different participants hoped that mental health professionals would share congregants’ Christian faith or Korean heritage or that such professionals would be knowledgeable about the church or the unique struggles of Korean Americans.
Strategies for Reaching the Korean American Population
Through our interviews with Christian clergy members serving later-generation Korean Americans, we learned that the church plays an important role in this community, and we gained insight from clergy members’ perspectives about their congregants’ mental health needs and how to address them. Research in other minoritized communities has demonstrated how church-based health promotion initiatives can be effectively used (7, 8), and we believe that churches with Korean American congregants can play a similarly important role in serving their community. Lessons learned for future engagement with this community include recognizing the impact of historical tensions between religion and the mental health field, embracing opportunities to relieve these tensions and establish lines of communication and partnerships between faith leaders and mental health professionals, and building on the strengths of the community.
The Continuing Effect of a Troubled History
Sigmund Freud famously characterized religion as a mass delusion and a “defense against childish helplessness”; such negative attitudes toward religion were commonplace within psychiatry and other mental health disciplines for much of the 20th century (9). The clergy members we interviewed appeared to be cautious when engaging with mental health professionals, reflecting the continuing effects of the historical tensions between the clergy and mental health professionals. By learning about our field’s history, we as mental health professionals can better understand and acknowledge the source of church leaders’ concerns. Further, we can begin to reflect on our own beliefs and attitudes about the role of faith and religion in our patients’ lives.
Opportunities for Healing and Growth
Despite the “long history of suspicion and, at times, antagonism between psychiatry and religion” (9), the clergy members in our study indicated that they would welcome discussion and relationship-building with mental health professionals. They wish to know and trust those to whom they would refer their congregants. To begin the process of healing the rift between mental health professionals and clergy members, mental health professionals can initiate dialogues and work to build relationships with religious leaders, thereby creating a foundation for trust and collaboration.
Building on the Strengths of the Community
The participants in our study identified stigma as a significant barrier to seeking mental health treatment, suggesting that later-generation Korean Americans, like their immigrant parents, are still largely bound by the shame culture of their heritage. The participants also noted that later generations face unique challenges in navigating the cultural and generational differences between their immigrant parents and themselves. Our findings are consistent with the findings of research involving 1.5- and second-generation Asian Americans, who identify cultural conflicts within the family as a source of stress affecting their mental health and the stigma around seeking mental health care as a significant deterrent to seeking help (10). Thus, more proactive community engagement—through trusted church leaders—may be the key to reaching this population. The participants in our study were actively seeking to collaborate with mental health professionals so they could raise awareness of mental health and break down stigma about accessing mental health services. They also desired education and training for themselves and other church leaders. These direct and indirect means can be effective strategies that build on the existing strengths of the community.
High education levels of clergy members (and of those in the Korean American community at large) help provide a foundation on which mental health education can be added. Korean culture is collectivistic—strong social ties allow trusted individuals to crucially affect people’s lives. Moreover, people already gather at their church, making it easy for this single entity to reach a large number of people.
Discussion and Conclusions
These findings and recommendations should be considered in light of several limitations. This was a qualitative study with a small convenience sample of clergy members in a western U.S. region; thus, the findings may not be representative of all clergy members serving later-generation Korean Americans. It was also beyond the scope of this study to learn about what congregants perceived the church’s role to be in their emotional support and mental health; however, congregants’ perspectives would be important to explore in future studies, because this information would enable a comparison of the identified versus self-perceived needs, barriers, and experiences of this population.
These findings add to the understanding of the role clergy members may play in supporting the mental health of their congregants and decreasing barriers to treatment for later-generation Korean Americans. Discussion and relationship-building between church leaders and mental health professionals, as well as training and education for clergy members, can help clergy members and mental health professionals work together to better address the emotional and mental health needs of the Korean American community.
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Information & Authors
Information
Published In
History
Received: 2 June 2022
Revision received: 26 November 2022
Accepted: 2 February 2023
Published online: 12 April 2023
Published in print: October 01, 2023
Keywords
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Competing Interests
The authors report no financial relationships with commercial interests.
Funding Information
Dr. Lee was supported by Health Resources and Services Administration grant UA3MC11055.These views represent the opinions of the authors and not necessarily those of the University of California, Los Angeles.
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