When an estimated 5,000 Hmong arrive in the Twin Cities from a Thai refugee camp this summer, CHE’s Yat-sang (Terry) Lum will follow their resettlement with an especially concerned and discerning eye. Lum, an assistant professor of social work, heads up a multi-layered study of the mental health needs of two generations of Southeast Asian residents in Minnesota, both the traumatized and bewildered Vietnam War refugees who arrived in the late 1970s and their uneasily bicultural children.
How well these new Minnesotans are faring—and how well Minnesota is responding to the challenges and opportunities of its growing diversity—are of more than passing relevance to policymakers, businesspeople, and others concerned with the state’s vitality, Lum notes. Once largely a stronghold for Germans and Scandinavians, Minnesota today is home to one of the country’s 10 largest Southeast Asian communities (among other growing minority groups), with a conservatively estimated 100,000 people identifying themselves as Vietnamese, Cambodian, and Laotian. And Minnesota is thought to have the country’s largest number—about 60,000, experts say, surpassing official Census counts—of the Hmong, a highly traditional ethnic minority group from the mountains of Laos.
That Southeast Asians are transforming the face of schools, businesses, and neighborhoods across the state is clear, Lum observes, as Nguyens, Vangs, and Thaos mingle in greater and greater numbers among the Johnsons, Petersons, and Smiths long at home in Minnesota. Yet Lum says that even as Hmong, Cambodians, and Vietnamese fill out Minnesota classrooms, chalk up entrepreneurial success stories, and assume a place in civic life, they’re bedeviled by a host of psychosocial issues rooted in their cultural and family histories of loss, strife, and dislocation.
Unresolved mental health issues among Southeast Asian Minnesotans can have profound consequences for families and communities alike, Lum says. But many do remain unresolved, owing both to murky understanding of these issues and to a paucity of culturally appropriate resources that could make a difference. Lum’s study is intended to change that.
Pioneering work
Lum is a third of the way through his three-year project, which involves detailed interviews of social service professionals, individual clients, and Southeast Asian elders and other leaders. Lum (Ph.D., Washington University) is uniquely well-suited to the project. A Hong Kong native who joined the CHE faculty in 1999, he brings to the project considerable expertise in policy analysis and program evaluation—expertise he has brought to bear in past research focused on the social and mental health needs of older people, minority families, and immigrant families.
Previous social science research has documented significant health care disparities—differences in access and outcomes —between white Minnesotans and minority and immigrant populations, including Southeast Asians. Lum’s project goes considerably further, as the first comprehensive effort to map mental health issues among Southeast Asians and to identify potential solutions.
The picture emerging from his work is of a community grappling with a wide range of mental health concerns, from depression and posttraumatic stress to youth behavioral problems, family violence, and even suicide. The root causes are many: the trauma of war, loss and grief, difficult (and sometimes lengthy) detentions in refugee camps, culture shock, loss of social status, linguistic isolation, spiritual estrangement, and intergenerational conflict, among others.
The causes vary by generation and life experience, Lum emphasizes. They also reflect differences of cultural history: although often lumped together, the Hmong, Cambodians, and Vietnamese are three distinctly different ethnic groups. The Hmong, Minnesota’s largest Southeast Asian group, may be at particular risk of mental health problems. A very traditional, clan-based culture of farmers with no written language, the Hmong have experienced profound culture shock as they’ve been thrust suddenly into the fast-paced, highly wired world of contemporary American society—a transition some have described as leaping two centuries from their original way of life.
The Hmong also suffered intensely during and after the Vietnam War. Hmong of all ages actively aided U.S. forces in Laos, with some 35,000 killed in combat—a high percentage of the overall Hmong population. Lum says it’s likely that nearly every Hmong household in Minnesota lost a relative or friend in the war. The Hmong endured further hardship after the war ended, with over 100,000 fleeing to refugee camps under threat of persecution by the new communist governments.
Generational differences loom large in Lum’s study. Among older immigrants and refugees, traumatic war and refugee experiences, loss of social status, and breakdown of traditional family order are perhaps the biggest contributors to mental health problems, Lum says. Men who once worked as professionals in Vietnam or Laos now work on factory assembly lines; former military officers work as custodians. Some can’t get work at all because they speak little English.
“Sometimes it’s easier for women to get jobs, even without English skills—cleaning hotel rooms, for example,” Lum says. “That also causes family stress, because it represents a shift in the traditional hierarchical order of Southeast Asian families. The same is true for families that come to rely on their kids, who tend to learn English, to become the mouth of the family. It’s another way elders, especially men, feel powerless in the new culture.”
The family tensions only intensify as children become by degrees more Americanized, Lum says. He notes that more attention is needed to the psychosocial needs of adult children—the so-called “sandwich generation” pulled between the traditional cultures of their parents and the highly Americanized life embraced by their own children.
“There’s a lot of interest in the community in the needs of immigrants settling in Minnesota, but in fact we’re seeing that the kids of immigrants have many unmet needs,” Lum says. “It’s tremendously stressful to navigate the expectations of two cultures. Also, they may not understand the needs of their own kids who are growing up much more immersed in mainstream American society—they don’t know what’s acceptable, what the expectations are, what the challenges are. It’s tough, and there aren’t many resources geared to helping them sort out all the mixed messages.”
Barriers
If the mental health needs of Southeast Asians are complex, so too are the reasons those needs often go unmet across Minnesota. Lum says the way in which mental health care is funded—as part of the health care system—is partly to blame. People who would benefit from mental health counseling find their options tightly constrained by insurance reimbursement policies, which “typically will pay for 8–10 counseling session per ‘episode,’ like a body check, usually at certain designated centers or clinics,” Lum says. He adds that there’s little or no reimbursement for key “accessibility services” (apart from interpreters), such as transportation or child care.
Another problem, Lum says, is the lack of qualified mental health counselors—whether Southeast Asians trained to provide mental health care or mainstream providers able to meet the needs of Southeast Asian clients. Lum says Southeast Asians are understandably spurning social work and other highinvestment, low-salary “helping professions” for more lucrative occupations.
“Many Southeast Asian families struggle to put bread on the table, and they sacrifice to send their kids to school to better the family’s lot in life,” Lum explains. “There’s great pressure on young people to finish their undergraduate degree and get a good job to support the whole family. It’s hard to tell parents, ‘I’m going to spend two more years getting a master’s in social work, and then work in a field that doesn’t pay very well.’”
Mainstream mental health professionals are ill-equipped to step into the breach, Lum says. “The issue is lack of cultural competence. Most social workers just don’t know much about the cultural beliefs and life experiences of people who are Cambodian or Vietnamese or Hmong.” Particularly critical, Lum says, is an understanding of the importance of families and clans in traditional Southeast Asian culture. American-style mental health care that focuses on an individual—or even on a nuclear family—is fundamentally mismatched to this cultural reality, Lum points out.
So, too, is mental health counseling that fails to take into account Southeast Asian spiritual beliefs. Ancient and strong, those beliefs—which include an emphasis on spirits and folk healing traditions—are often at odds with Westernized approaches to health care, both physical and mental.
The issue of cultural competence is even more complex when you factor in age, social status, and political dynamics, Lum observes. “Providers need to be sensitive to social and political tensions
within groups and between clans. And if you are a younger doctor or social worker or psychologist, you may find that a 50-something elder finds it difficult to accept your help. The sense of social order is such that respect is given only to people who are older. It’s a good example of how complicated cultural competence can be. Even being from the same culture is not enough.”
Possible solutions
After completing his project’s information-gathering phase next year, Lum will take what he’s learned directly back to the community. He will meet with Southeast Asian elders, other respected leaders, and mental health providers to seek their help with interpreting his mountains of interview data
and “to integrate them into a community perspective.”
Still, Lum is wasting no time thinking about possible solutions to “the massive mental health needs we’re documenting.” Undergraduate scholarships and graduate fellowships might make it possible for more Southeast Asians to pursue careers in mental health. Another strategy might be “subsidies
for people going into the mental health care profession specifically to work with refugee populations, much like those now provided by the federal government to people going into child welfare.”
Meanwhile, he suggests, the University and community might collaborate on two fronts: to train mainstream providers to offer culturally appropriate services, and to train people from the Southeast Asian community to provide certain badly needed mental health services under the supervision of qualified professionals (some providers already are doing this, Lum says).
“I don’t know if these are all meaningful solutions or not, but maybe they’re things the community will want to consider,” says Lum. “My role is to help build a bridge between University research and the community. The community will know best how to use what we learn.” |
