Korean American Church Leaders as Mental Health Gatekeepers in the USA: A Needs Assessment of Readiness, Barriers, and Referrals.

Asian Americans underutilize mental health services, with particularly low rates among Korean American (KA) immigrants. Churches serve as central sources of support in this community, positioning clergy as critical mental health gatekeepers. Yet little is known about the factors shaping KA church leaders' readiness, perceptions, and referral behaviors. This study analyzed survey data from 93 KA church leaders across the USA to explore factors associated with readiness (comfort addressing mental health), perceptions of issues and barriers, and the action of recommending professional counseling. Using multiple regressions, we found that prior mental health training was the only significant predictor of leader readiness, with trained leaders nearly three times more likely to report higher comfort levels (OR = 2.97, p < 0.05). Perceptions of church needs varied by ministry context and personal experience: Leaders with mental health training were over six times more likely to recognize depression and suicide as key concerns (OR = 6.71, p < 0.01) and more than twice as likely to identify marriage conflict (OR = 3.11, p < 0.05). In contrast, leaders who had personally received counseling were significantly less likely to report depression and suicide as a congregational issue (OR = 0.23, p < 0.05). In the integrative model, referral behavior was shaped primarily by ministry context and stigma awareness. Leaders in Korean-speaking ministries were significantly less likely to recommend counseling (OR = 0.02, p < 0.05), while those who identified stigma as a major issue were substantially more likely to make referrals (OR = 9.50, p < 0.05). These findings highlight the central role of training, bicultural ministry contexts, and stigma recognition in shaping church leaders' engagement with mental health. The study underscores the need for culturally adapted training programs and closer collaboration between mental health professionals and immigrant churches to address persistent disparities in KA communities.