Asian American and Pacific Islander Mental Health – Episode 21

In honor of AAPI Heritage Month, NAMI CEO Daniel H. Gillison Jr. speaks with NAMI National Board Member and Cambodian American Connie Mom-Chhing about Asian American and Pacific Islander mental health, the trauma of the COVID-19 pandemic lockdowns and rising hate crimes against the AAPI community.

“It was like a perfect storm from our perspective that hit our communities because of the combined effects of the increase in racial discrimination, the social isolation and with already existing underutilization of mental health care among the AAPI community,” she says.

You can find additional episodes of this NAMI podcast and others at nami.org/podcast.

Transcript

[0:00] [background music]

Connie Mom‑Chhing: [0:01] The lockdowns lead to that feeling of isolation, anxiety, depression. We've also witnessed things on television, the hate crimes against AAPI communities.

[0:12] It was like a perfect storm from my perspective that hit our communities because of the combined effects of increase in racial discrimination, the social isolation, and along with already existing under‑utilization of mental health care among the AAPI community.

Daniel H. Gillison Jr.: [0:29] Welcome to "Hope Starts With Us," a podcast by NAMI, the National Alliance on Mental Illness. I'm your host, Daniel H. Gillison Jr., the NAMI CEO. We started this podcast because we believe that hope starts with us. Hope starts with us talking about mental health. Hope starts with us making information accessible. Hope starts with us providing resources and practical advice.

[0:53] Hope starts with us sharing our stories. Hope starts with us breaking the stigma. If you or a loved one is struggling with a mental health condition and have been looking for hope, we made this podcast for you. Hope starts with all of us. Hope is a collective. We hope that each episode with each conversation brings you into that collective to know you are not alone.

[1:20] In honor of Asian American and Pacific Islander Heritage Month, today, I'm joined by NAMI National Board Member, Connie Mom‑Chhing to talk about AAPI mental health. In addition to being a board member for NAMI National, Connie is also a senior director of regional systems integration at the Community Health Plan of Washington and Vancouver and a member of the NAMI Southwest Washington affiliate.

[1:47] She previously worked as the chief behavioral health officer at Columbia United Providers and has been recognized by the Washington State Governor's Office with the Governor's Recognition Award for statewide services to mental transformation. Connie, thank you so much for being with us today.

[2:08] It's important to start out by recognizing that the AAPI community is incredibly diverse, encompassing a wide range of countries, ethnicities, nationalities, and identities. The experiences of Native Hawaiians may be quite different from those of Indian South Asian descent, Cambodian refugee survivors, second‑generation Korean families, and so on.

[2:31] In many ways, this is why the concept of cultural humility is so important in mental health and why it's so important to refrain from making assumptions about people's backgrounds and perspectives.

[2:42] Connie, as someone who has extensive experience working at the intersection of culture and mental health and has lived experience in this space, can you talk to our audience a little bit about some of the unique experiences, strengths, and challenges, people who are Asian American and Pacific Islander often face when it comes to mental health?

Connie: [3:03] Thank you so much, Dan, for including me in this program. First of all, I wanted to say thank you so much to NAMI as an organization and NAMI leadership as well as staff for recognizing and celebrating the Cambodian heritage along with the Asian Americans and Pacific Islanders as well.

[3:24] I also wanted to express my appreciation to NAMI for allowing me to be a part of the Hope Starts With Us and really appreciate the opportunity to share my Cambodian cultural heritage and the impact of mental health and social events such as the pandemic, the anti‑aging violence, and all the global events, the war that we're witnessing right now.

[3:52] How that impact with the mental health of my own Cambodian community as well as the Asian American communities. I do want to acknowledge, as you had mentioned, that the AAPI represent a very diverse and fast‑growing population of 23 million Americans that included roughly 50 ethnic groups, with groups in more than 40 countries.

[4:17] I was born in Cambodia, which is a part of the Southeast Asia. Countries that included other countries such as Vietnam, Laos, Thailand, Singapore, and many others. Each country, as you had mentioned, has its own unique culture, history, and religion, so definitely, we are very diverse.

[4:41] I came to America at the age of 12. I and my family are survivors of the Cambodian Killing Fields that took place between 1975 to 1979. The experience that I and my family along with other Cambodian families have gone through during that time has significant impact on our mental health.

[5:04] Yet, my own Cambodian American communities, along with the other AAPI communities do experience disparities the most when it comes to accessing mental health treatment and support. Part of it because of the stigma attached to individual living with mental health conditions.

[5:23] A person living with a mental health condition in my community is still regarded as dangerous, crazy, incompetent, shameful, embarrassment, and weak because the person is not capable of taking care of oneself or the family. Having a mental health condition is shameful because it takes away a person's abilities to care for their families.

[5:50] One of the major struggle right now is that there is still a significant lack of understanding among families and friends that mental health is an illness in that it touches many people regardless of their race, ethnicity, cultural, or social economic background. That's one area.

[6:10] The other struggle that my community facing is really the pressure of living up to that model minority that stands in the way of seeking treatment from my perspective.

[6:20] We have been characterized as intelligent, capable of taking charge of our lives, and therefore, having to admit to having a mental health condition, which is considered as weak or shameful, would be letting down the entire family or community. Those are some of the challenges that my family and my community and many of the AAPI community are facing right now.

Daniel: [6:45] Connie, thank you so much. To the Cambodian community, we would just like to say on behalf of NAMI and to the entire AAPI community, your resilience is such an example for so many. We do recognize the stigma and the expectations. There's such high expectations within the families that it really does create the lack of a safe space to talk about one's mental health. Thank you for sharing that.

[7:22] I have a question for you that's really focused on the last few years. We've seen a rise in hate crimes, phobia, and violence towards the Asian American and Pacific Islander community with one report showing that Asian Americans who experienced racism were more stressed by anti‑Asian hate than the pandemic itself, and that pandemic was so incredibly filled with uncertainty and doubt and fear.

[7:49] The other metric is that one in five Asian Americans who experienced racism, displayed signs of trauma, psychological emotional harm caused by racism. Connie, can you talk more to us about how you've seen COVID‑19 and hate crimes over the last few years affect the AAPI mental health?

Connie: [8:10] Definitely, Dan, during the last several year has been really difficult for our communities across the nations. The lockdowns led to that feeling of isolation, anxiety, depression. The distress that are usual feeling, out of school, isolated from their friends and families. Definitely, that has been a major impact in term of the mental health of our community.

[0:07] We've also witnessed things on television the hate crimes against AAPI communities. We were feeling and still, feel traumatized by what we're seeing across the country.

[9:04] It was like a perfect storm from my perspective that hit our communities because of the combined effects of the increase in racial discrimination, the social isolation, and along with already existing under‑utilization of mental healthcare among the AAPI community.

[9:21] We're also facing and still facing unique challenges when it comes to accessing mental health, especially during the COVID pandemic because of language barriers and anti‑aging violence, so everyone staying home. We were fearful of going out.

[9:42] When the mental health system, I remember, shifted to providing care using telehealth, we have community members that do not know how to navigate services virtually or have access to computer, or Internet, or culturally appropriate services. There is no Pacific Asian American providers within the communities to be able to seek help from, at least in my own community here.

[10:18] From what I have seen speaking from my own community is the rate of suicide and suicide attempts among our youths have gone up. The witness of violence against the AAPI and the Black community created a secondary trauma. It's like a PTSD and depression for us. Yes, COVID‑19 has a profound impact on my communities.

Daniel: [10:47] We call this vicarious trauma because it's trauma through what we've seen. Maybe we didn't directly experience it, but we're now carrying that trauma because we've seen it and someone we know or someone that we've watched has experienced it. It's very compelling, and it is paralyzing. It's really interesting to look at what's the way out.

[11:12] With that said, man, thank you so much for that description because it really gave us a visual of what it is like, from the standpoint of technology and telehealth for some, but not for all. There's this assumption that telehealth and technology can benefit all communities and that's not necessarily the case, so thank you.

[11:35] With that said, Connie, I want to ask you, what advice do you have for others in the AAPI community looking for help with mental health. I have a set of questions, but I'll start with that one, and then I'll go to the other two.

Connie: [11:49] First, for those that made a decision to seek help, I would like to say congratulations on your decision because they are not alone. As I've mentioned, mental illness touches everybody regardless of our own race, ethnicity, our educational background, or our class.

[12:11] Seeking help can feel lonely, but I feel that NAMI at the national and local levels are here to help people and their families in terms of learning about community resources. I definitely encourage everyone to check out the resources that NAMI at the national and at the local level has to offer. Their website is wonderful. I feel there's so many resources that people can learn more about.

[12:39] I also wanted to encourage everyone to seek help from trained professionals, as well as other support systems, such as close friends, families, and spiritual leaders. It's important to end the silence by speaking about it and share your recovery story.

[12:59] Last, it seemed fitting to share this statement from my mother who had instilled in me when I was at a very young age. She often said, "Do not lose hope. Without hope, there is no future." That's really the message that I wanted to share with those that have made the decision or hope that you've made the decision to seek help.

Daniel: [13:26] Thank you, Connie. As Connie just said, do not lose hope. Her mom's message is so critically important. You've got to hold on to hope because if you don't, we want you to be hopeful and not hopeless. We need you to hold on to hope. Connie, as you think about the practitioners, advocates, and allies looking to support the AAPI mental health community, what advice would you have for them?

Connie: [13:55] Understanding that traditions, religious, culture, and families are all important factors that influence our health belief system. There are very types of religious beliefs within the AAPI communities.

[14:13] For my own Cambodian American community, some of our community members believe that illness is caused by the lack of harmony of emotion or by evil spirit, or result of bad luck, or past bad behavior. We tend to delay seeking professional treatment or not seek professional treatment at all because it may not be thought of as a will illness.

[14:41] It's important as professional to recognize that that's the mentality that some of my community are having still, so it's important to recognize that. Then when we do seek help, recognize that we tend to reach out to faith‑based leaders, such as Buddhist monk, for spiritual consultation or other rituals such as holy water blessing.

[15:08] We also tend to try traditional healing methods as well. Traditional herbs, meditation, offering food to our ancestor for exchange for good health, peace, and harmony. Recognizing that culture shape, how we express, and how we recognize our mental health condition.

[15:29] Another thing for professional to recognize is that we keep issue inside the family because of the pressure of saving face for the family in the community. It's important to recognize that as well. In terms of the family structure, we are part of extended families. We have two or three generations living in the same household.

[15:57] Major decision‑making rest with the father in consultation with the grandparent. When it come to decision to seek treatment or not seek treatment, that decision can be influenced by the family. That's really what I wanted to share with them, that they need to understand our culture.

Daniel: [16:19] The cultural humility is so critically important, and then it's almost you have to walk in someone else's shoes before you assess or assume certain things, certain behaviors. What you're sharing is so wonderful. I wanted to ask before we get to the last part is that you came to the United States at the age of 12, as you said, from the Cambodian Killing Fields.

[16:51] We probably here can't really think through the power of what you just shared. Where am I going with that is as follows. I wanted to ask about your navigation here from the standpoint of your mental health. Is there anything you'd like to share with our audience in reference to your mental health as you've navigated over these years here, and you navigating for yourself and navigating others?

Connie: [17:23] Having gone through the war where I was separated from my family at the age of nine or so and were able to reunite before the end of the war. Then, walking from Cambodia three days, three nights through the jungle to reach a refugee camp, so adjusting to life in refugee camp, and then, a year or so afterward, settle in Brooklyn, New York.

[17:52] The language that I have to learn, the culture that I have to learn, it was very traumatic from what I have gone through, and I can't imagine anyone in my family or my community that have experienced similar experience what I've gone through. Of course, we all experience mental illness, mental health condition at one point in our life. The fortunate part in my family is that we talk about it.

[18:24] My mother always encouraged us to talk about it. Part of healing is talking about it and sharing our story. We reflect on how we get to where we are today, and part of that reflection serve us a process of healing for us. When we talk about it, we recognize that, "Oh, I did not realize that this has impact you, and how can we support each other as a family member."

[18:52] Then when we share that story with our community, we realize that you're not alone as other people feeling the same thing or having the same experience, having anxiety, PTSD, so how do we then help each other out? For us, the process and the ongoing of talking about our story help us heal. I'm still talking about it every day, definitely.

[19:20] Like we said, the pandemic is a great example. It is a PTSD for me having witnessed what's happening the last several year. We talk about it, so how do we help each other, how do we overcome the fear of the need to go out and get groceries, food, and things like that? It's important to talk about it.

Daniel: [19:49] It's so very important. It's much needed, it's healthy, and it's critically important. I remember when we were talking some time ago, Connie, last year, and there were so many in the community that wouldn't leave their homes when the violence was occurring at such a high rate. They wouldn't even go out to go to the grocery store.

[20:09] Sometimes we don't think about the vicarious trauma that creates in terms of what does that stress and what does that trauma look like and what does that depression develop into? We appreciate your leadership and what you're doing. As we come almost to the wrap‑up, I wanted to ask.

[20:29] [background music]

Daniel: [20:29] As you know, the world can be a difficult place and sometimes it can be hard to hold on to what you talked about hope. That's why each week, we dedicate the last couple of minutes of our podcasts to a special section called Hold On to Hope. Connie, can you tell us what helps you hold on to hope?

Connie: [20:49] What helped me hold on to hope, it's really the families and friends that are supporting me along the way. I do dream. I dream big because, without dream, there is no hope. Without hope, there is no future. Dream that things will get better. At the same time, not just dreaming, but actually taking action, what can I do to make things better?

[21:20] That could be making a decision to seek help. What helped me in terms of holding on to hope is that there are people out there that are available to help me out so that I'm not alone, basically. There are people that have experienced what I have gone through and that I can learn from them. Those are the things that give me a sense of hope.

Daniel: [21:48] That is wonderful, and then, we all need to carry that message. Connie, you also have mentioned your mom a couple of times and it makes me reflect on this organization. It was started by moms. The advocacy of mothers who started this organization to this point of 44 years later is significant and it's not lost on this conversation.

[22:12] Is there anything you would like to share? As we talked about in the Cambodian community as well as other communities and you mentioned that there is such a large population of 23 million and over 50 groups.

[22:27] With all of that, we know that suicide and suicidal ideation is high. How do we help someone who may be listening and/or watching this know that their life matters and that we want them to be hopeful? What could you say to inspire them to hold on to hope?

Connie: [22:49] Dan, my family, my community in the last several year has been impacted by the suicide rate. My family is part of that statistic. What I wanted to say to them is that what they have gone through, what I have gone through, that our life will forever change.

[23:15] I hope that we utilize the experience to help other so that hopefully, they would not become part of the statistic that my family have been part of recently. I just wanted to say to my families and my friends and my community that it's so important to open up and talk about the challenges in the family, especially when it comes to suicide.

[23:50] That it's so important to talk about it because without talking about it, we cannot take the next step in terms of seeking help. We have to accept that mental health touches many people regardless of their background and that there are people out there that are available to help us out, and that we also have to accept and willing to seek help.

[24:18] I would probably suggest start out by talking about it. Talking about it, it is a very helpful process for healing. It's a wonderful opportunity to connect with others that experience similar experience and in helping each other out along the way.

Daniel: [24:38] Thank you, Connie. We're so sorry for your loss. Thank you for sharing with us. Before we wrap up, I want to say thank you for your leadership. We think about three components, leadership, tone, and execution, and you do all three of them at the highest level.

[24:56] You set the bar incredibly high with your leadership. The tone that you set in the mental health community and the Cambodian community and society is incredible. Then your execution, how you operationalize it, how you actually put the work in place is so incredible, and we so appreciate what you do. Thank you.

[25:19] [background music]

Daniel: [25:19] Your leadership on the NAMI National Board is stellar. You represent us in so many different areas in terms of our committees and our work groups, so we appreciate that and we want to make sure that we acknowledge that, so I wanted to say thank you. As we wrap up, I'll close with this here.

[25:37] This has been Hope Starts With Us, a podcast by NAMI, the National Alliance on Mental Illness. If you are looking for mental health resources, you are not alone. To connect with the NAMI helpline and find local resources, visit nami.org/help. Text helpline to 62640 or dial 800‑950‑NAMI or 6264.

[25:59] To find Asian American and Pacific Islander‑specific resources, visit nami.org/AAPI, or if you are experiencing an immediate suicide substance use, or mental health crisis, please call or text of 988 to speak with a trained support specialist or visit 988lifeline.org. I'm Dan Gillison. Thank you for listening and be well.

Transcription by CastingWords