As the daughter of Lebanese immigrants growing up in Minnesota, Rayyan Mikati was used to being one of few people of color in her high school classes.
But when she arrived at Northeastern University four years ago, she felt even more isolated by her culture and religion. Mikati developed an eating disorder, and she struggled to find people who could understand where she was coming from.
Her therapist was sympathetic but she couldn’t fully relate to cultural issues like how to handle Ramadan, a month of fasting. Mikati found a great student support group, but she felt unable to speak as openly as she could around other Muslims.
The obstacles are familiar to racial and ethnic minorities on campuses nationwide and affect how they get assistance. New national research by a Boston University professor shows minorities are less likely than white students to seek mental health services or have their problems properly diagnosed and treated.
Arab and Arab-American students have the highest prevalence of mental health issues and the lowest levels of knowledge about mental health, the study found. Asian students are least likely to believe they have a need for mental health treatment.
And at a time of renewed national attention to mental health issues and suicide among young people, the needs of students of color are of particular concern to college officials, whose student bodies have become increasingly diverse.
“We all know that there is need,” said Madeleine Estabrook, the vice president for student affairs who oversees Northeastern’s efforts around mental health. “I think we’re trying to come at it from as many angles as we think of.”
BU professor Sarah Lipson, whose research included a survey of 43,000 college students across the country from 2012 to 2015, measured not only their mental health status by race and ethnicity but also the rate at which they sought help.
Students of all races experience mental health issues at roughly the same rate, but students of color are less likely to seek help, the research shows.
Among those with clinically significant symptoms of a mental health condition, 46 percent of white students received mental health treatment in the past year, compared with 26 percent of African-American students, 23 percent of Asian students, and 33 percent of Latino students, according to the study.
Lipson found that many students of color deny they need help or opt to deal with the issues themselves.
Many worry about being a burden to their families, judged by other students, or misunderstood by counselors who don’t understand cultural issues.
“You’re held up as an example of what everyone else in your community is like,” Mikati said. “Basically you don’t want to pollute an idea of what your community is to people who are not a part of it.”
At Northeastern, Mikati’s therapist at one point suggested she take time off school to seek more intensive treatment for her eating disorder, but she declined because she didn’t want to fall behind in school or become more of a financial burden to her parents.
“I think that’s a really common idea of ‘I’m not going to accept more help from you because you’ve already gotten me to this point,’ ” she said.
Lipson, whose findings will be published in the Journal of Adolescent Health, said she hopes her work will spur not only more research but action by colleges to address the specific mental health needs of students of color and the barriers they face in seeking it.
“We have a more diverse student body in colleges across the country than we ever did before, which is something to celebrate, but that also comes with enormous responsibilities,” Lipson said.
Students with untreated mental health issues are more likely to drop out, research has shown. Students of color already face lower graduation rates, and if schools are serious about helping them succeed, they should do more to address their mental health needs, Lipson said.
Experts in the field of college mental health say schools have begun to take steps to reach more students of color.
McLean Hospital, a psychiatric institution, for the past 10 years has run a program focused on college students. The program director, Stephanie Pinder-Amaker, said nearly 80 percent of the requests she receives for consultation from colleges have to do with reaching students of color and other marginalized populations.
That wasn’t always the case, she said.
Pinder-Amaker said she tells schools to talk directly to students of color to find out what types of services would be helpful to them and what barriers might stop them from seeking help.
“It’s up to us to figure out what are the barriers,” she said. “Sometimes the barriers are real, sometimes they’re perceived barriers, but it doesn’t matter.”
Northeastern University has a diverse student body, with a large number of international students. The university is trying to reach more students of color through the cultural centers on campus and by experimenting with video therapy that students can use on their smartphones or computers. It has a much lower copayment ($10) and shorter wait times.
Northeastern is also working to hire more therapists. The school has about 20,000 students and 12 therapists, though it hopes to hire three more over the summer, according to Estabrook. Two therapists are people of color, and one speaks Chinese.
Still, many students find the most support from fellow classmates.
At Boston University, Anjali Balakrishna said she is part of a student group that helped her open up about her mental health and change the way she thinks and talks about it.
Balakrishna struggled to describe her problems to family members, including her grandmother in India. “She just laughed and said it’s all in your head,” she said.
Things have changed, however. Balakrishna is working to improve her mental health through the student organization, therapy, and a service dog. And her grandmother has become more open about the subject. Balakrishna hopes other students and their families will, too.
“If my grandmother who is in her 80s can start to kind of shift her views and be more open and understanding to these kinds of things, that’s definitely a positive sign to what could happen,” she said.
For one student, the right answer for his mental health challenges was escaping the stressful environment at school in Boston and returning home to California.
Rusty Cosino, who attended Boston College until he transferred to San Francisco this year, said even though he has dealt with mental health issues his whole life, it is still a taboo topic among some of his relatives. If you are struggling, they say, it is because you are not trying hard enough, he said.
Cosino, who is Filipino and was raised by his grandmother, said his mental health trouble began in high school. He was at the top in his class and making his family proud, but then his academic performance slipped, and with it his self worth. He almost didn’t graduate from high school on time.
“I thought I wasn’t worth anything anymore,” he said.
At college, it was hard to be so far from home, and he sometimes felt his high school had not prepared him for the rigors of BC. His grades slipped again, he said.
During his struggle, Cosino was able to get an appointment with a school therapist who was helpful, but he also saw a psychiatrist who put him on what seemed like a random succession of medications that did not work.
Cosino took one leave of absence his freshman year and another after a breakdown last December. He now lives at home, has a job he likes, and plans to finish school in California.
The debt he accumulated at BC had also begun to weigh on him.
“It’s not that I’m finally cured or anything, but I’ve come to terms with how I am and what my conditions are,” he said.