Disaggregating the South Asian Category: Language-Concordant Psychotherapist Availability and Affordability in the...

Mental health workforce research treats South Asian Americans as a single group, yet they speak many mutually unintelligible languages, and language concordance shapes whether people with limited English proficiency (LEP) reach and stay in care. We measured the availability, geographic concentration, and affordability of psychotherapists listing eight South Asian languages. We analyzed 347,464 Psychology Today directory profiles (2025), identified providers listing Hindi, Urdu, Punjabi, Gujarati, Bengali, Tamil, Telugu, or Nepali, and linked counts to American Community Survey (2019-2023) speaker and LEP populations. We computed listed providers per 100,000 speakers and per 100,000 LEP speakers, supply-need alignment, geographic concentration, and payment acceptance and session price. Of all therapists, 2,310 (0.66%) listed a South Asian language; 59.4% of them listed two or more. Listed availability per 100,000 LEP speakers ranged from 1,160 for Hindi to 22.8 for Nepali, and per 100,000 speakers from 213.7 (Urdu) to 7.6 (Nepali); provider shares were unevenly aligned with LEP shares (index of dissimilarity, 0.41). Of Nepali LEP speakers, 43.0% lived in a state with no provider listing Nepali, against 0.9% for Hindi, and the languages with the fewest listed providers had the largest LEP shares and most recent arrivals. Providers listing a South Asian language were more often out-of-network (adjusted odds ratio, 1.58; 95% CI, 1.31-1.92) and charged $3.90 more per session (95% CI, 1.16-6.64). Language differences in listed provider availability within the South Asian population are large and invisible in aggregated data, pointing to the need for disaggregated data systems, language-specific workforce development, and affordability policy.