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Cambodian American mental health data show need for culturally sensitive programs, community leaders say

58 percent of participants in a Cambodian American community wellness program reported reductions in effects of past trauma, while depression-related symptoms declined for 69 percent.
Participants in a wellness program observe Kan Ben, one of the most important spiritual activities among Cambodian Buddhists, at a temple in Long Beach, Calif., in 2019.
Participants in a wellness program observe Kan Ben, one of the most important spiritual activities among Cambodian Buddhists, at a temple in Long Beach, Calif., in 2019.Virak Ung

A community wellness program is demonstrating the benefits of culturally sensitive mental health care for Cambodian Americans, a group that has struggled to benefit from mainstream services.

Thanks to in-language workshops about mental health and culturally specific social activities, the majority of participants reported reductions in symptoms of depression and past trauma, highlighting the need for such programs in marginalized communities.

The results are significant given the lack of culturally sensitive mental health care programs for Cambodians, said community leaders with the Cambodian Advocacy Collaborative, an association of five organizations in Southern California that conducted the program.

"The reduction of symptoms of past trauma was really important for us," said Susana Sngiem, executive director of United Cambodian Community of Long Beach, part of the collective. "The strategies that we provide really help our genocide survivors be able to cope with the trauma that they experience."

Cambodians began migrating to the United States en masse in the 1970s and 1980s after the fall of the Khmer Rouge regime, under which more than 2 million people died. A 2015 study in the journal Psychiatric Services found that 97 percent of its participants — all of whom had lived in Cambodia at some point during the regime — met criteria for post-traumatic stress disorder. The rate surpasses those of the U.S. population as a whole (about 3.5 percent) and of U.S. veterans (12 percent to 30 percent).

The program has four prongs: outreach and engagement to reduce the stigma of mental health issues in the Cambodian community; workshops to educate community members about topics like mental and physical wellness, signs of mental illness and how to cope with stress; case management to provide referrals needed for health and social services; and social support activities, such as Cambodian New Year celebrations, temple visits, water blessings for healing and positive energy, and potlucks.

Yat Touch at a community gardening activity at the Cambodian Association of America in Long Beach, Calif.Virak Ung

Preliminary data show that 57.7 percent of participants reported reductions in the effects of past trauma on their current well-being, while 69.3 percent of those with depression-related symptoms at the beginning of the program reported reductions in symptoms.

The findings are based on surveys collected from 179 participants.

In other findings, more than half of participants reported a reduction in the perceived stigma of mental illness, feeling less alone and being able to better distinguish cultural myth from facts related to contributors to and symptoms and treatment of mental illness.

Three former participants spoke highly of the program, which is funded by the Reducing Disparities Project of the California Department of Public Health's Office of Health Equity, and said they hope it will be offered long term so more in the Cambodian community can benefit.

Seang Vung, 65, said her biggest takeaway has been an understanding of what stress is.

"Mental health in the Cambodian community is very stigmatized," she said through an interpreter, Sochetra Hong, a counselor and administrative assistant at the Cambodian Association of America in Long Beach, the lead organization of the collective. "It helped me a lot with understanding stress, how to manage stress and how I can cope with my stress without having to use medication."

Sok Sovanary, 47, said through Hong that she learned how to cope with stress by connecting with others — something she previously didn't do. She said she made new friends through the program.

Vung, Sovanary and another former participant, Rin Sem, 56, all said they enjoyed the program's social activities, especially the water blessing. They said they would recommend the program to their families and friends, because it expanded their understanding of mental health and equipped them with coping mechanisms for stress and depression.

Sem, Sovanary and Vung took part in the program, which included in-person gatherings, before the COVID-19 outbreak. The collective has since shifted its programming online, which has been challenging, Sngiem said.

A water blessing as a social activity in a wellness program in Long Beach, Calif.Virak Ung

United Cambodian Community of Long Beach has adapted by holding educational workshops over Zoom. It has also tried to move some social activities online, but some people have been unable to participate because of difficulty navigating technology, said Lavyn Tham, program manager of the organization's health equity program. Case managers are also calling participants up to three times a week partly as a substitute for suspended in-person social activities.

While organizations in the collective say they've seen the effectiveness of their community-based practices, they've struggled to get financial backing, because most funding bodies prioritize evidence-based research. The state health department's Office of Health Equity is addressing that by supporting and evaluating community-based practices through the California Reducing Disparities Project. Founded in 2009, the project works for mental health equity for African Americans, Latinos, Native Americans, Asian and Pacific Islanders and LGBTQ+ people in California.

The Cambodian Advocacy Collaborative is one of 35 groups across the state pursuing community-based mental health practices over five years under a grant from the agency.

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Corey Egel, a spokesman for the state health department, said in an email that the disparities project has shown that community-informed approaches and solutions increase resources and support for underserved communities.

The program's lead evaluator, Pari Sabado, director of community engagement and evaluation at the Center for Health Equity Research at California State University, Long Beach, said the program also provides the opportunity to empirically test community-defined practices. She said that while evidence-based practices — such as support groups — may work for one community, they may not necessarily be effective in another.

"In the Cambodian community, mainstream services don't work," she said. "We can't expect a Cambodian elder to sit in a support group."

The collective and other organizations funded under the disparities project said that at the conclusion of the program, they will represent a model the state can follow to replicate strategies, approaches and knowledge, Egel said.

Sngiem, of United Cambodian Community of Long Beach, said she hopes the practices can be implemented in other Cambodian communities throughout the country.

"Our hope is that with the data we're collecting that we can show evidence that these social activities are really important to the mental health work in the Cambodian community," she said.

CORRECTION (Sept. 16, 2020, 2 p.m. ET): An earlier version of this article misstated the name of the group conducting the mental health program. It is the Cambodian Advocacy Collaborative, not the Cambodian American Collective. It also misstated the number of groups in the collaborative. There are five, not six.