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Southeast Asians who fled Cambodia, Laos, and Vietnam more than 45 years ago due to conflicts in the region have higher rates of mental health challenges compared to the general population. Yet decades after resettling in the United States, access to mental health services needed to help people heal from the traumas of fleeing war-torn countries remains sparse.

Civil rights nonprofit Southeast Asia Resource Action Center (SEARAC) published a report in March based on nearly 250 survey responses from Southeast Asian Americans in California, which is home to the largest concentration of these communities. The study found that mental health services need to be appropriate and accessible to Southeast Asian Americans and should consider all areas of culture, language, intergenerational factors, healing, and intersectionality. Additionally, access to this type of care is crucial for healing in the community and ending cycles of trauma. Overall, the study found that effective community solutions addressing barriers to care already exist, but are limited in their effectiveness by a lack of financial investment, support, and integration in the mental healthcare industry.

Lee Lo, co-director of the Sacramento Asian Pacific Islander regional network, said during the March 25 virtual launch of the report, SEARAC was aware that mental health was a critical concern for community members.

“We needed to find out where exactly are the biggest challenges,” Lo said. “How are we able to address these things? How have we already been successful at different local levels? This [report] really allowed us the opportunity to make that deep dive and develop a policy platform moving forward in terms of increasing mental health services for our communities.”

Mandy Diec, California director at SEARAC, said existing research shows that Southeast Asian Americans experience higher rates of mental health challenges—including depression, post-traumatic stress disorder, and anxiety disorders—due to experiences of war, genocide, and displacement. The rate of PTSD among Cambodian Americans surpasses that of U.S. veterans.

Southeast Asian refugees fled Vietnam, Cambodia, and Laos in the 1970s and 1980s at the conclusion of the Vietnam War and the fall of the Khmer Rouge Regime. An estimated 2 million people died under the Khmer Regime following the end of the U.S. Secret War in Laos. Part of that conflict involved a nine-year bombing campaign where the U.S. dropped 2 million bombs and artillery in Laos.

But those conflicts aren’t the only source of trauma for Southeast Asian Americans. The toxic effects of America’s own history of social and political oppression created additional complications for communities in need of stability, support, and security. Many refugees were resettled in impoverished neighborhoods rife with gang violence, racial tension, and poor schools. 

“Our communities experienced violence even before the war in Southeast Asia and continued to experience violence even after resettling in the United States, navigating violent systems of white supremacy, of patriarchy, xenophobia, and homophobia,” Lo said.

More than half of survey respondents said their mental health issues were tied to their experience with personal trauma and intergenerational trauma (when trauma is transferred between different generations). This impacts many children of refugee families, in part because the culture of silence it creates inhibits healing, Diec said. Children internalize the silence of their families and develop their own mental health challenges, even if they don’t understand the reason or cause for the behavior of their parents, grandparents, and community, she added.

Rita Phetmixay is a psychotherapist with the nonprofit Laotian American National Alliance and the host of Healing Out Lao’d, a podcast she created to acknowledge the pain and trauma in the Laotian diaspora and to show that healing is possible. 

“I can’t leave my community behind,” she said. “It was so important for me to acknowledge that I can do this. It can happen.”

Phetmixay experienced abuse growing up in a household with refugee parents who fled Laos. She didn’t have anyone to talk to about the abuse. She became hyper vigilant and angry, but didn’t realize until she was in grad school that those were symptoms tied to mental health conditions, including PTSD, and when she first started therapy. Phetmixay is currently in therapy and said she encourages listeners of her podcast to consider it as a form of self-care and a way to build confidence. It’s something her listeners have shared they’ve thought about after listening to Healing Out Lao’d, she added.

Having someone within a community talking openly about their mental health can have a normalizing effect by framing those conversations within a recognizable and culturally-appropriate context, Diec said. In Southern California, the Cambodian Advocacy Collaborative, a coalition of five organizations, is working to increase access to culturally sensitive mental health services through a wellness program that incorporates community-based practices.

Susana Sngiem, the executive director of United Cambodian Community, one of the organizations in the collaborative, said the program has four key elements: case management, mental health education workshops, outreach and education, and social support activities that are based on strengths and existing practices within the Cambodian community, such as Buddhist water blessings and gardening.

“What we saw within the Khmer community is that the way that we heal together is through our social support networks,” Sngiem said. “So we wanted to create these family systems and build those social support networks.”

Preliminary data from the collaborative’s pilot program, which is funded by the Reducing Disparities Project of the California Department of Public Health’s Office of Health Equity, showed that more than half of participants have reported a reduction in stress and the effects of trauma.

“These are the things that we’re able to report back to our state that [show] we know what we’re doing. [They] need to invest in this,” she said.

Diec said survey respondents indicated that providers who understood the community’s history, cultural values, roles, and expectations were some of the elements they felt were missing from mental health care. More than three-fourths of respondents said the lack of culturally appropriate services discouraged them from seeking further care. Only a small percentage of individuals reported that they successfully received culturally appropriate care. Virtually all of those individuals said those services helped improve their mental health conditions, while about half said the experience gave them a positive outlook on mental health.

“We see here that culturally and linguistically appropriate care is a huge indicator of whether folks will seek out mental health support or try to access it again,” Diec said.

Based on findings from the survey, the report offered several policy recommendations, including developing a pipeline to increase Southeast Asian American mental health providers, funding culturally and linguistically appropriate outreach, increasing language access in part by providing translated materials and enforcing the use of trained interpreters specializing in mental health, and funding the development and implementation of culturally appropriate evidence-based practices.

While the report illuminated many areas where Southeast Asian American communities can focus their efforts in improving access to and the appeal of mental health, but Lo said many Asian communities have historically been reluctant to openly address mental health. She noted how communities’ willingness to talk about mental health was still fairly recent, and that developing successful solutions and policies depends on an honest and accurate assessment of what their problems look like and where they need the most support. Lo added that putting the community’s regular experiences of violence and loss into words through the report was a heartbreaking and revealing process that she found valuable to her own healing.

“I hope [it’s] something that can help others heal, and then also help us improve mental health services for our communities,” she said. “It’s been too long and our communities have continued to just suffer and we can’t continue to allow that any further.”

Agnes Constante

Agnes Constante