Mental Health Treatment, Culture, & Social Justice
one of the reasons why this Clinic was created was a recognition in California that we needed transformative ways of doing Mental Health Services our job was to convince the community and the uh the policy makers that cultural competency when put into action is transformative I think psychiatrists have a critical role a very critical role a critical potential to um to improve the circumstances of poverty um Health disparities and um unequal access Society still for the most part believes that doctors are impartial except to further the best interest of their patients and that is a really important trust that Society gives to us and so when and and I’ve I’ve been to community meetings where policies were you know decided where my testimony to the needs of our underserved communities held a lot of weight because people felt and I’m honored uh that they felt this um because that’s what I try to do but they felt that I was being impartial and and that I just had the best interest of others in mind whereas if if I am not a doctor and I’ve seen this happen to my colleagues who um whom I work with who aren’t um psychiatrists there’s a suspicion that you know what’s in it for this person you know do they want their business to flourish we doctors still maintain trust for the most part and we we we need to earn that trust by truly investing in the best interest of of people I think the bottom line is that we as Physicians we as psychiatrists have unearned Privileges and every day we have to check ourselves and see if that day we’ve earned that trust and that’s uh I I think that um that’s at the core of uh of a physician’s ability to work in the community the history of transcultural Wellness Center uh actually dates back um to the 197s when the original Founders uh Luke Kim um being one of those he’s a um Asian-American psychiatrist sort of saw a need for social um supports in the Asian-American Community here um they developed a program called asian-pacific Community Counseling which um for many decades was uh was just focused on Social Services support and interpretation Services I became involved in the uh mid 20000s um when there was an opportunity to apply for funding to create the transcultural wellness center the transcultural wellness center is a collaboration between uh UC Davis so myself and another psychiatrist uh Dr Allen K collaborated with the nonprofit um asian-pacific Community Counseling so it’s really um I am I’m the founding medical director of transcultural Wellness Center but um it really has been a collaboration between many people in key institutions here as well as um the uh Asian-American communities here there was there were significant motivation to um to develop a Asian-American Mental Health Service um when the county officials um looked at uh the penetration rate of mental health treatment into the Asian-American Community especially the Southeast Asian Community they found very very limited penetration and this is consistent of course with what we were seeing nationally as well um and so given those statistics as well as mobilization of the local uh community members here the Asian-American community members uh we became a very strong voice in um in the process to develop in Innovative uh uh Community Mental Health Services and that was how the transcultural wellness center was essentially born so Sacramento in 2002 uh Time Magazine uh named uh Sacramento the most diverse major city in the United States so that’s a um that was a uh reach national attention what they found however was that the uh the diversity was very integrated so if you looked at a uh a given zip code there was a lot of integr unlike in other cities where we saw like greater pockets of um of ethnic diversity um people tried to address Asian-American mental health in the various clinics but what would happen is that there would be one one case manager that had an Asian language but then they would be um uh they would be transferred to another clinic and then the the population uh from one Clinic would dwindle down so there wasn’t a uh a a uniform concentrated effort and the problem with that then is that uh you can’t really give asian-americans a sense of community when they come to clinic and so the Asian so this Clinic the transcultural wellness center um we focus on eight major uh language groups um within the Asian and Pacific Islander Community we have 11 um languages represented inous and and um and so when we have um Community get togethers we have the um the critical mass to really embody culture whereas if there was just like one counselor one psychiatrist here one case manager there you can’t really develop culture in the same way uh we we’re a training site for social workers medical students and Psychiatry residents child fellows um uh primary care physicians and so what we can do is we can build that infrastructure build that Workforce and um whereas if you don’t have that critical mass it’s very hard to do that one of the reasons why this Clinic was created was a recognition in California that we needed transformative ways of doing Mental Health Services and so uh so the state passed a proposition called uh proposition 63 which was geared specifically to fund trans programs that have a potentially transformative impact on the way we think about Mental Health Services and so uh so our job at um at uh UC Davis and and our collaborators was to convince the community and the uh the policy makers that cultural competency when put into action is transformative and so this Clinic is has really been a proof of concept for the cultural principles that we teach in our cultural Psychiatry uh classes I think there’s been significant impact um that the transcultural wellness center has had on the level of patients every Clinic uh every Community Clinic in this uh uh area gets a report card from uh the division of mental health that looks at uh recidivism um adherence uh uh hospitalizations and our program has seen a reduction in rehospitalizations um by about 80% crisis visits by uh 70 to 80% they’ve been able to uh We’ve in increased the connection to primary care physicians by 80% we’ve uh decreased homelessness as well um so from a from a individual patient standpoint uh we see uh those impacts from a community standpoint Point uh We’ve uh been a uh a center for for the community to Rally around so we have uh for example Elders from the Vietnamese Community come here um have activities um teach uh younger generation so so there’s a passing on of culture that’s uh we play a role in as a psychiatrist who’s worked here I’ve seen some pretty amazing things we collaborate with um traditional Healers here and um and we’ll you know facilitate our patients if they if it’s relevant for them to connect with um with the healers in their community and so we’ve seen uh greater collaboration and dialogue with um with traditional healers uh as a result of that and so the when you think about mental health from the standpoint of community as well as from the standpoint of patient s I’ve uh I’ve been proud and humbled at the same time at the um at the results that we’ve seen uh so we have a pretty diverse uh uh patient population when we first started out it was uh it was a challenge to uh reach out um fortunately we had a lot of uh clinicians and um providers that were well connected with the community and so our reputation started to develop there we also worked at non-traditional ways of referral so for example in Vietnamese culture um the point of contact for um for Health Care is actually pharmacies so in the Old Country you wouldn’t go to your doctor if you had a a problem you would go to your pharmacist and then the pharmacists would prescribe medications and if it was uh challenging they would say it’s time to go see your doctor so we have a uh uh we developed a relationship with a local ethnic uh Pharmacy um and we started seeing referrals from them uh so uh uh from churches as well from spiritual and and Community leaders and then we uh word started spreading the community so we would uh have uh patients or clients um as they’re um referred to here clients would say Hey you know this Clinic helped me with such and such why don’t you try it out so we saw a little bit of this breaking of the um of the traditional stigma associated with mental health it’s still a big challenge but um but it’s more of a conversation now in our community so a lot of our services uh occur at the client’s home at the school in Temple we try to meet uh the clients where they feel most comfortable to meet us um so the majority of our uh psychotherapists and uh service coordinators will meet our clients at their home the psychiatrists will do the bulk of their work in the office but they will also do home visits as well and so you know I I had a a client for example that’s uh had really bad experiences with mental health and so uh was very afraid um to come to anything associated with the mental health uh label and so for years I would go monthly to her home um get to know her family and and got a lot of insights into her ability to function she was um very psychotic uh and in the office I would have uh thought that she was just very disorganized but at home uh she was you know when I conversed with her she was still quite disorganized but when her grandchild was playing with something that was Danger dous her attention just focused on the child she got the um the uh the toy that was uh dangerous and uh I would have not seen that um had she been in the office so the the power of uh of being in the client’s environment and seeing them shine in ways that uh you wouldn’t see in an office environment we do do um out reach so uh one of our uh members uh is rarely in her office because she spends her time with Korean elders and so um she is uh mainly offsite comes in every once in a while to check in but her work is out there uh we we have a um a Family Wellness Center um that’s part of uh the apcc organization um and we have uh Polynesian hoola dancing so community members come in um to participate in that we have ballroom dancing that our community members have um set up uh we have language classes and we have computer classes and we try to get uh people together from different Generations because of you know the generation uh Gap can be very significant in the Asian-American Community now one of the things that um we are um are starting to do is we we now have a permit to to um to have a kitchen open up to community members and so one of the things that’s um that we would like to do um currently we we have a farming group and so our our our our clients many of our clients come from strongly agricultural um societies and coming to Sacramento in the inner city it was a big source of stress distress and uh cultural disconnection not to be able to use their hands and to farm and to use the knowledge that they developed so we have a farming uh group they Farm they bring produce back to their family they um leave some here um our next step is then to uh engage um our community in cooking culturally healthy foods and and using food and preparation of food as a medium for uh cultural exchange between uh the different Generations um we have to remember that many many people from Asian American communities experience two senses of disconnection being disconnected to the mainstream Society being disconnected to their own ethnic group because of the mental health issues and so in this Clinic they’ve been able to reconstitute a sense of community and a sense of cultureal identity so they get a lot better however one of the challenges that we face is that um are when a person reaches a certain level where they are doing well they need to be transferred out the challenge that we have and we’re working um to explore solutions for this there’s no where that they can go and still preserve that sense of cultural identity and connectedness and so um so we’ve we’ve started to reach a point where uh it’s the next phase I think of of how to think about our work in Sacramento which is we’re getting we’re we’re experiencing that people are recovering from mental uh uh health conditions part of that is their sense of being part of a community and then how do we then extend that so that the rest so that when they transition out that they still maintain that sense of community but one thing that I think um uh in regards to uh building community in structure so we’re a clinic we get funding one of the things that I’ve been thinking about is how do we how do we Infuse the community the API business Community with some of the funding that we have to do some of the work that um that we do thereby improving the community the Asian-American community infrastructures so an example of this is um we have funding to to uh subsidize housing for uh for our clients and many of our clients struggle with poverty so it’s a very important um uh resource um to to to give what if we were to you know develop a collaboration with a um with a uh an apartment complex or a a cluster of housing um whereupon they would be able to accept our clients then there’s a community that’s being built there that that um that owner starts to develop a sense of what it’s like to be part of Asian-American Community Services they start to develop their connections and then it builds and so that um we’re not just doing everything ourselves but really becoming part of a um connected to the vitality of the Asian-American Community here my 10year thoughts about um transcultural wellness centers uh I would like to see the center help to develop the community’s infrastructure that’s a big piece because as we’ve talked about when we look at Health it’s the social determinants of Health that actually have the most impact and so while I believe we are doing good work at um at the the center we really need to focus our energies on addressing um issues like access to nutrition uh access to Safe housing um I’ll give you one example uh one of our clients uh came to me and said I can’t sleep because uh uh it turned out he was in a neighborhood where there was a lot of violence and you know my a traditional psychiatrist hat would say oh you have post-traumatic stress disorder let me give you something to help you with the sleep and to help you with your hypervigilance however that from from the standpoint of uh the patient would have been dehumanizing because it would send the message of I know that you live in a dangerous place your body’s telling you to be where and I want you to ignore that it’s very dehumanizing what we were able to do was to relocate um so he and his service coordinator looked around for a safe neighborhood they were able to identify safe neighborhood we were able to put down a deposit for him to go there he’s been doing much better saving Society much more money because uh he would have been on chronic you know medications whereas the deposit was not that much but it was beyond his means so so so the idea of empowering the community both economically from an infrastructure standpoint I hope to see that we at the center uh have a have a meaningful impact on that so I I would like to convey a message to uh young Asian-American psychiatrist or those who are interested in working in um the field of cultural Psychiatry or Asian American uh Pacific island or mental health I would say that uh it is so needed we need you um the more people from Asian and Pacific island communities that become psychiatrists just by fact that we become psychiatrists helps to uh to uh uh diminish the stigma and stigma is such a profound barrier to uh to good treatment some Asian-American Pacific Islander psychiatrists don’t want to do this work or afraid to do this work because they don’t have the language uh capabilities and um the message I have for you is I struggle with uh speaking Vietnamese um my ment for wanted me to work in Asian-American mental health uh services and I was very ambivalent about that I thought that I would do no good I would say that there’s a role um because many of our patients actually struggle with cultural transition and conflict um a lot of my elders uh uh uh who are patients will struggle with trying to understand why the younger generation does what they do and can they actually connect And when they see a psychiatrist who struggles but tries to speak the language and I try to speak Mong I try to speak Cantonese and Vietnamese I um I think I fail hum humorously um but it’s that effort that gives hope and it’s the relationship that you build with your clients that’s uh model a way for the elders to re connect with the younger generation and for the younger generation to uh connect with the elders so there’s a role for for you know many people in the field and there’s a there’s a significant need so I hope you take that challenge [Music] [Music]
This video features Dr. Hendry Ton, a psychiatrist and founder of the Transcultural Wellness Center, affiliated with the University of California, Davis. Dr. Ton shares his vision of the ties between mental health treatment, enhancing community vitality, and addressing social justice issues. Dr. Ton describes the double alienation of Asian American mental health clients–the alienation from mainstream society and from their own ethnic communities due to stigma and illness. He then describes the community-orientation of the TWC, the ways it creates a sense of community, and how it aims to enhance community capacity to address social determinants of health (poverty, disparities in health and access to care). Dr. Ton delivers an inspiring message of the transformative potential of culturally competent care.
This video was filmed and edited by Enrico Castillo, MD
Copyright © 2014