Elder Hmong and Depression

Written by Alice Daniel

When Yong Yang Xiong arrived in Fresno 14 years ago at the age of 53, he really wanted to find a job. But he couldn’t speak English and employers told him he was too old. On top of that, he was suffering from chronic physical pain.

“As a petite man, I was given very heavy loads to carry for days and nights,” he said, referring to the six long years he had spent helping the CIA fight its secret war in Laos.

When the war ended, he fled on foot to a refugee camp in Thailand where he spent the next 26 years. He and his family didn’t resettle in the United States until the early 2000s.

Since then, Yong has had a difficult time. For one, he’s still in a lot of pain. “This is a reason why physically I’m not well now,” he said. “I have a really bad back. It’s been bothering me a lot.”

Then there’s the language barrier, the isolation and the financial concerns. All of this stresses him out. Sometimes he’ll even take an anxiety medication. “When I feel like I’m very depressed, I take the medication so it kind of like eases my mind, kind of like I’m slowly not thinking about all the stress and pain that I have, so it helps from time to time,” he said.

But what helps him the most, he said, is attending a program at the Fresno Center for New Americans called Living Well or Kaj Siab. For the past decade, the center has offered culturally sensitive mental health services for hundreds of Southeast Asian refugees with depression under the Mental Health Services Act, or Proposition 63.

The Fresno Center
The Living Well Program gets elders involved in many ways including monthly craft-making activities. (Photo credit: Alice Daniel)

Ghia Xiong, a psychologist with the center, said depression is widespread in the older Hmong population and in other Southeast Asian communities in Fresno, including Lao, Cambodian and Vietnamese.

Life is so different here, Ghia said, and all the worries about money, jobs and transportation often lead to feelings of hopelessness and helplessness.

He said things were simpler back home. “…Just as long as you have a field to farm, and a jungle where you can go hunt and get food, and a river where you can get fish for your family,” Ghia said.

Ghia said it takes a very long time for most clients to open up even a little bit, to just scratch the surface of their sorrow.

“So now they’re carrying all this and they’re coming to therapy and we say, ‘Let’s talk about things that are really troubling to you,’ and they’re saying, ‘Do I trust you, are you sure you’re going to keep it confidential?’ I don’t know what confidentiality means. I mean that doesn’t exist in our culture,” he said.

It’s why group therapy is the best option at first, he said, because it gives them some basic tools to talk about themselves with the support of their peers. “Many do not understand yet or are not ready for individual therapy,” he said. “They may not have the necessary resources or skills to really begin exploring depression.”

Yong Yang Xiong said he benefits from group therapy. “When I come here they [the counselors]help me out. I’m not just by myself but in a group and everybody shares, and that helps ease up the depression,” he said.

Elders can also attend group activities and outings designed to provide peer support for people with depression. Dia Yang, a cultural broker at the center, oversees a crafts project every month. On this day, she instructed the group to make little paper gift boxes to fill with chocolate and give to a friend or relative. “It’s something to uplift them and keep them in the present moment,” she said. “And it gives them a chance to just be with each other.”

One woman looked through a stack of stickers before choosing the right one, an owl, to decorate her box. It’s her way of reaching out to her grandson.

“She chose an owl because she only knows Hmong, and then her grandson only knows English, and then the only [word]they both know is ‘owl,’ ” an intern at the center said.

The center has helped many people like this woman, Ghia Xiong said. But he worries that there are many others who need assistance but don’t know that options exist. That’s why the center recently started an outreach program with a grant through the California Reducing Disparities Project. Melanie Vang is the Program Manager.

“Part of my role is to do recruitment,” she said, “through Hmong radio, Hmong TV, or through house visits or connecting through friends and families.”

When she learned that a woman who had been well known for her activism in the Hmong community was now depressed, she decided to visit her at her home. When she arrived, Pa Vang was sitting alone in her kitchen, listening to Hmong folk music. She told Melanie that the music eases her pain and her depression.

Pa worked for years as a Homecare Provider. But now she’s losing her eyesight, she has diabetes and she misses her husband, who died a few years ago. The days are long for her, she said.

Melanie asked Pa to come to the Fresno Center for New Americans to try out some of their services, and maybe even attend group therapy.

“I would like to attend some of these programs to help me,” Pa said. “However, I have dialysis three times a week. And now that I have a visual problem, I cannot drive.”

A lack of transportation is just one of the many obstacles to treating depression in the Hmong community, Melanie said. But in 2018, the center will need to prioritize this issue in the Living Well Program.

And there are other positive developments. Discussions about mental illness are becoming less taboo. Mary Vang, the winner of the 2017 Ms. Hmong Central Valley Pageant in Merced, used her platform this year to increase mental health awareness. She knows a lot about the subject: she’s also a licensed MFT for the Living Well program. Most recently, Mary planned a Hmong New Year event at the Fresno Center for New Americans.

“Hmong New Year is a tradition where people come together and celebrate the start of a new year,” she said. “Along with this celebration, there is a deep investment of hope. Hope to meet a lifelong partner, hope to exceed last year’s abundance, hope for good fortunes but most importantly, hope for good health. With depression, the most common symptom is hopelessness. New Year celebrations are more than a tradition; they are the instillation of hope. My goal was to give these individuals hope.”

With the help of her colleagues, she organized a lunch, guest performers and even a Miss and Mister Kaj Siab Pageant.

She said the event was successful and rewarding. “The clients were very happy and a few of them cried. They expressed to me that they feel extremely grateful and that they’ve never felt so special.”

Alice Daniel reported this story as part of a Journalists in Aging Fellowship supported by New America Media, the Gerontological Society of America and the Silver Century Foundation.