Welcome to the American Psychiatric Association's Mental Health Equity Fireside Chat. My name is Dr. Regina James, and I'm the chief for the Division of Health Equity and Diversity and deputy medical director here at the APA. Thank you for joining us to discuss a very timely issue, building coalitions and supporting the mental health of Asian Americans and Pacific Islanders during the COVID-19 pandemic with the rise of xenophobia. Now before I continue, let me first thank the following, the APA Board of Trustees, councils, assembly, caucuses, and the administration for their continuous work on advancing mental health equity. So to set the stage for the webinar, I'd like to share some key points that I think can serve as a springboard for discussion. So with the onset of the COVID-19 pandemic, we have seen numerous forms of devastation on communities of color. So for example, with the Latino community, the African American community, and the indigenous population, they have experienced an overwhelming exposure to the virus, subsequent illness, hospitalizations, and ultimately deaths. Unfortunately, the damage does not stop there. We've also seen a rise in many forms of racial discrimination and racially motivated violent acts, particularly against the Asian American community. With the blame of COVID-19 pandemic being placed on China, there was an increase in racially motivated violent acts, particularly against Asian Americans. So for example, being coughed on purposely, verbally abused, physically abused, and even deaths by homicide. For example, the incident that happened in Georgia. So it goes without saying that these racist, xenophobic, and violent acts can have a significant negative impact on one's mental health and well-being. And as the director of the Center for Disease Control and Prevention declared in April of this year, racism is a serious public health threat that directly affects our well-being. So knowing that race-based traumatic stress can be devastating to one's mental health and physical health, we assembled today a panel of experts that will discuss the following. For example, how can we improve coalitions and advocacy to address this anti-Asian xenophobia? And can they share some strategies or best practices for psychiatrists to help address mental health and the trauma that's being exacerbated and experienced by Asian American and Pacific Islanders? So although this is a panel discussion of experts, we also want to hear from you. So please be sure to put your questions in the chat box. Now I have the pleasure of introducing my esteemed colleague, Dr. Gabriel Escontrías. Dr. Escontrías is the Director of Health Equity in the Division of Diversity and Health Equity here at the APA, and he will serve as our moderator. Dr. Escontrías. Thank you, Dr. James, for the opening remarks. I truly appreciate your leadership and commitment to diversity and health equity. It is my honor to introduce our amazing panel of experts today. Joining us, Dr. Wang, a psychiatrist, author, and president of our APA Asian American Psychiatrists Caucus. Dr. Quang Vang, a psychiatrist with a focus on geriatric communities and recently completed her term as an APA Foundation Board of Director. Dr. Jung, a professor at San Francisco State University's Asian American Studies Department and co-founder of Stop AAPI Hate. Also the Office of U.S. Congresswoman Meng apologizes that she was not able to attend this afternoon as previously scheduled, but Congress never rests. They have rescheduled time with us for Friday, June 18th for noon, Eastern Time. More details to come. And now, let us begin the fireside chat with our esteemed panelists, Drs. Wang, Quang Vang, and Jung. Through your unique lens as researchers and practicing psychiatrists, what have you found to be the most concerning COVID-19 pandemic misinformation affecting our Asian American and Pacific Islander communities? And anyone that would like to go first. Well, I'll start by just saying I hope I got the lighting here right. I tried to make it look fireside here. Love springtime evening fires. So I think one of the key pieces of misinformation is just that Asians are spreading the virus. For example, there was that family, the Burmese American family attacked in Texas. And this was one of the very early anti-Asian hate incidents. And after that was when the FBI issued a warning about the rise in anti-Asian hate, a two-year-old boy had his face slashed. And afterwards, the assailant said he was trying to keep the family from spreading the virus. So there's a lot of misinformation out there. I think that but I think a lot of people are reacting to the to the rhetoric that this is the China virus. This is the Wuhan virus. And I just want to say that this reminds me of the start of the AIDS epidemic. And yes, I was a medical student at that time. And I remember when it started in Los Angeles and it was called the gay illness. And I remember even Time magazine having articles about something about gay lifestyle was conducive to this virus. And it was somewhere between 20 and 30 years later for them to trace the virus, not to the Los Angeles gay community, but the origins were actually on the other side of the globe in Cameroon, Africa, actually. And so it just takes a long time to figure out where a virus, you know, a new life form originates. And so I just wanted to say that we have a WHO sent a team over to Wuhan even and what they found was absolute actually that what they found was no origin in Wuhan. And the origin is still inconclusive. And if AIDS is to be a lesson in history, it may be several decades before we even know the origin of the virus. But in the meantime, I think a lot of Asian Americans are being scapegoated, blamed for this awful virus that has caused such a change in our lifestyles. Yeah, I'd like to echo Dr. Wang's statement. You know, the term Chinese virus has been really deadly and devastating and it's actually surprised me. You know, people ask. We've received over 6,600 incidents of hate and people have asked, why so much surge of racism? And I really attribute it to the language that was used by the political administration last year. Again, the term Chinese virus, it racialized a biological virus and made it Chinese and stigmatized the people, Chinese people, were the disease carriers. And then anybody who looked Chinese would become the disease carriers. And so, you know, that's really led to the scapegoating and the directing of a lot of fear, a lot of anger and a lot of grieving. You know, there's been over a half million deaths. A lot of that grieving gets then directed towards Asians. And so it is a real strong case study of misinformation and how words really make a difference. It's really normalized hate in America. I don't know how much it impacted vaccination, but I know subsequently, you know, Asian Americans are in a state of siege. They have real heightened fear and anxiety at the moment. And that early start of misinformation has led the Asian American community to be more hesitant to get vaccinated because they're afraid to go into public. So racism has led to lower rates of vaccination, I believe, among the Asian American community. Wow. And something that I would like to add, you know, I think, you know, this is an APA, American Psychiatric Association panel. I am sure many of the participants attending today are psychiatrists or mental health professionals. And in the circles that I've been in with my mental health colleagues, the very sensitive question has come up of, you know, some of the perpetrators of the attacks are mentally, they have mental illness. They have severe mental illness, meaning a psychotic disorder or schizophrenia. And how do we as mental health professionals make sense of that? It's a struggle. We don't have an easy answer for that. But what we have talked about is how those with severe mental illness or serious mental illness are more vulnerable to the rhetoric and are more vulnerable to the messages that they hear from the very top, from, you know, our former president. So like Dr. Jung, I also see a direct correlation between the anti-Asian rhetoric and the violent attacks. And I think that, in a way, these people, these individuals are acting sort of on behalf of society and what's in the ether. And a lot of my non-Asian patients, I have to say, are so confused. They really don't understand why there is all this violence against Asians. And I think helping them to understand how the rhetoric does lead to a direct effect on Asian people is important. You know, what Dr. Kwon Dong said about the concerns about perpetrators and their backgrounds. I think another piece of misinformation for the broader issue is that there are a lot of hate crimes being perpetrated against Asian Americans. I think there are actually two trends. There's the racism fomented last year by the political rhetoric and throughout the pandemic. And then there's the crime that Asian Americans have always experienced, especially those of us who live in low-income urban areas. And what's happened is, the misinformation is that those two trends are conflated. So every crime against an Asian American is considered a hate crime. And I think the problem with that is that it masks the issue that, first of all, only 5% of what's happening actually are hate crimes. There's a lot of hate incidents. Racism is occurring at the workplace. Racism is occurring in public transit at schools. And you're not going to get arrested for these incidents of being abused verbally or being bullied at a school. So I think the issue is much broader than just a hate crime. And as you take it more broadly, then you develop more comprehensive approaches towards it, rather than just hate crime enforcement. And the second problem about the focus on hate crimes is it does sort of criminalize communities. It could criminalize the mentally ill, it could criminalize communities of color. So I think this over-focus on hate crimes can be misleading. Dr. Chung, I just wanted to thank you for everything you've done in co-founding Stop AAPI Hate. And you're an academic, you're an Asian American Studies professor at San Francisco State, where Asian American Studies was founded, if I'm not mistaken. And it's just an honor to have you on an APA panel, and that as an academic, you are engaged in this larger national issue outside of the, you know, ivory tower, you know, just research paper realm, and you've had such an impact. Thank you. Dr. Wang, you bring up a great point where I wanted to segue to. You mentioned Stop AAPI Hate, which is, Dr. Chung is one of the co-founders. I think for a lot of us, as we've been reading more of the research out there, peer-reviewed articles, or even news articles going on, a lot of the data being highlighted does come from Stop AAPI Hate. Dr. Chung, for those of us that aren't very familiar with this organization, with this coalition, could you tell us a little bit more, I think, just from the initial conversation we just started? We know the reason for why it started, but would you expand a little bit more on how it came to be and the importance of Stop AAPI Hate? Yeah, well, thanks for the question. For background, you know, we, as an Asian American Studies scholar, I knew from Asian American history that whenever a disease came from Asia, Asians would get blamed and face violence and face racist policies. And so we really wanted to document what was happening in order to hold government accountable. We feel it's government's responsibility to safeguard the public health and safety and the mental health of its community. And so we began to track racism, self-reported incidents. Our partners are community-based groups with over 100 years of experience in the community. So we created a website with six different languages initially, and now we're going to be up to 15 different languages, including Pacific Islander languages. And so because we're rooted in the community, we've received a lot of reports, hundreds of reports, a lot more than law enforcement receives. And so we were able to track the data, again, not just crimes, but the range of incidents that Asian Americans were experiencing. So we've used that data since then to show that racism is widespread, it's been institutionalized, it's systemic, and it's nationwide, sadly. And the sad thing, too, is that people are targeting the most vulnerable populations of the Asian American community, our elderly, youth, and then women are attacked twice as much as men. So given this type of data, we're coming out with a women's report this week with the National Asian Pacific American Women's Forum. We're going to come up with an elderly report soon as well. I just wanted to highlight that I read some of your data, Dr. Joan, and you talk, some of the reports have to do with things like shunning. There was a report of an Asian American person in the post office, and everybody else was helped before the Asian American person. And then, you know, there was just help refused to the Asian American person, you know, things like that, just shunning that. I think it's hard to classify as a crime, as you're saying, but it's very damaging. It's very damaging mental health wise. It really is. Actually, we're coming up with the mental health report at the end of the month. And again, the anger directed towards Asian Americans is palpable. And that's why we weren't surprised to see elderly killed this year. That's why I wasn't surprised by the online shootings, because, you know, there is a lot of scapegoating, a lot of racism still in our nation. And the question I had. Oh, Dr. Ponder, I just wanted to just go along with what you were saying, that it's oftentimes the people who are least able to think critically, such as our mentally ill, mentally compromised population, who are just following the leader. And I think what we're seeing is what we as psychiatrists call parallel processes, which is basically follow the leader, you know, what leadership does, the population does. And I'm just remembering the first fireside chat that I attended was Jimmy Carter in his sweater during the energy crisis of the 70s. And he was trying to model wearing a sweater to keep warm because of the energy crisis and wanting to save energy. And similarly, when we see leaders, you know, direct such hostility towards our Asian American population, other people follow this example. Thank you. The topic of hate crime versus hate incident is so interesting to me, because one way when people ask me, how do we stop or reduce these hate incidents, these violent attacks, let's just call them, from happening? Well, one of the responses is, and it's not the only solution by any means, but, you know, a legal approach, an approach where these are seen as crimes. And it is very difficult to, as I was listening to the Daily Podcast a few weeks ago, it is more difficult to classify these incidents, violent incidents as hate crimes for the Asian population compared to that of, you know, hate crimes towards Black people or Jewish people, because there's so many more clear symbols for those other populations. And so, and I'll just give this quick example. One of my patients was elderly and was attacked. And, you know, there's a lot to unpack there in terms of how he reacted. He did not want anyone to know. He did not want his family to report it. You know, he wanted to keep it quiet. And for many reasons, very many cultural reasons. But importantly, when the family did report it, the police investigated and basically said it wasn't a hate crime. And I think because, and then he cited the young man said it was because of a dispute over something else. So it's just so without, and Congresswoman Meng, I think part of her policy, would have included information about how to better classify these incidents as hate crimes so that there can be a legal recourse. But it's very tricky, this whole topic of how to make change. Thank you to the three of you. and Dr. Quang Dang, you bring up the next question that we're going to transition into, and this question is for Dr. Wang. As Dr. Quang Dang mentioned, there is a stigma associated with mental health in many Asian cultures. How can members of the American Psychiatric Association encourage discussions about mental health care among Asian American and Pacific Islander communities? In addition to that, to those who are more recent immigrants? Well, that's a really tough question because the stigma is definitely there, and there have been studies that have shown that Asian Americans are less likely to report a family history of mental illness, and not that it's not there, it's just that they don't report it. And one example of how one person reflects upon the entire family is that in China, if somebody did something wrong or there became a stain on the family, that would follow the family for nine generations horizontally and vertically. And another example of stigma is that suicide is not taboo in a lot of Asian cultures and is considered a noble way of, if you've done something to embarrass your family, to remove yourself. And I think that in Japanese, there's something like 20 different words for suicide. These are just examples of how there is stigma about mental illness. So what are we to do? I think in our own practices, when we evaluate patients or talk to patients, we can ask about, was there anybody ever in a psychiatric hospital? Or was there anybody in your family that was a little off? In terms of the wider community, I really like what Dr. Ravi Chandra is doing in San Francisco. He holds these webinars, he blogs for Psychology Today, and he does these non-traditional media outreaches. I remember many years ago when Vivek Murthy was just a resident, I got this email about joining Doctors for America, and I liked his email so much I actually joined it. And that is an organization that teaches physicians to do outreach, like how to write for your local newspaper, how to do blogs, how to try to get on local news shows, things like that. And they've been very successful. So I think psychiatrists can write op-eds, reach out to your local news outlets, hold rallies, there are lots of things we can do. Thank you. Yes, Dr. Quang Dang. In addition to all these creative ways that we can reach out to the public at large, I think that these violent incidents is actually an opportunity for the younger generation of Asian Americans to have these difficult conversations, but can be very eye-opening conversations with their family members who are older. And to start this conversation of how do you feel with everything going on right now, using it as a jumping off point to have a larger discussion about the discrimination or racism that they've experienced over decades, possibly, and have never had the opportunity to talk about. So I'll make a plug for somebody I follow on Instagram, Asians for Mental Health. And it's Jenny Wang, W-A-N-G, PhD. And she has a whole set of five-page slides, very, very simple on how to talk to your elders about the anti-Asian American violence. And it goes through question by question, like how to even broach the topic, and then how to explore a little bit more about their personal history of discrimination and their feelings. And then the very end is basically, if I recall correctly, kind of a game plan. Like what can we do to make you feel and actually be safer when you go outside? And so having something so concrete that, and it's in multiple languages. So I highly encourage all of us to take a look and have those conversations at home with our families and our friends. Yeah. You know, Jenny Wang's Asian American Mental Health Collective, Ravi's work is really helpful. And I just, I'm going to just sort of highlight another project we're doing. I think it's really difficult to have those conversations in the Asian American community about mental health. I know my students are talking about it a lot, but the question is, how do we broach the topic with our elders and the older generation? So what we're going to do is we're going to actually, you know, and our elders have dealt with mental health issues. They've become resilient. They have all this cultural wealth on how to deal with mental health. They just don't have terms for it, or they may not have Western psychiatric terms, or even ideas about racial trauma. So what we're going to do is we're going to actually interview a lot of elders, especially religious elders, to talk about how they've experienced trauma, how they've dealt with it, and how they've become resilient. And I think that wisdom will then, I think other elders will listen to fellow elders. You know, I don't think Asian elders will necessarily listen to younger people, but they'll listen to their peers. And I think it's great for the younger generation to recognize that our elders have already developed that resilience, have already been healed. And we just look to them for ways to integrate these Western concepts of psychiatry with their, you know, religious traditions from the East. So look for that in the next couple of months as we do those videos over the summer. And Gabriel, since you asked that question, do you have any ideas? Do I personally have any questions? It came to your mind to ask that question. Well, these are some of the questions that we also just crafted as a team. But I think part of, I think as we really think about it, and just based on the information I was reading, I think it always goes back to how can we be more culturally and linguistically relevant and considerate and respectful. And that's really what I found because I know I was discussing with my colleague, as I was reading more and more of the articles, I realized that there's just such a vast comparison, meaning similarities with the Latino communities. Because as I thought about everyone coming from Mexico, coming from South America, Central America, all I could think about, especially as I start looking at the immigration patterns, I start looking also at how many of our families, especially our elders are still monolingual speakers and their native tongue. The data, especially the statistics, the percentages were very similar between Latinos and also the Asian communities. And I know for myself personally, one of the things I always focus with within my own community is how can you become your best healthcare advocate for yourself? How do we make sure we empower anyone, not just our elders, but anyone seeking medical attention to make sure A, they're listening to their bodies because they know themselves best sometimes. And two, how do you build that confidence, not necessarily that medical knowledge all the time, but how do you build that confidence to have those difficult conversations with your primary care doctors or anyone giving you any type of care where it really impacts you personally? So just a few things off the top of my head. I'd like to add, we were talking about elders, but I think for the younger generation, you know, people, Asian Americans in their 30s, 40s, 50s, they are dealing with a lot of anxiety and that's the thing about a hate, you know, these hate crimes is that they have this unique power to victimize or terrorize an entire population of people. Exactly. Right. Yeah. You don't have to be the direct recipient of the assault, but you feel that on some level, that trauma and that anxiety. And I have been doing support groups and healing circles for companies and what they have, what I have found and together is that the non-Asian American and Pacific Islander communities, the allies have a tremendous role to play in the support groups. The, I think a confluence of factors, one of them being that the Asian American culture does not lend itself to speaking out. So, you know, seeing their non-AAPI colleagues bring up, initiate conversations and talk about how upsetting these events have been for them. Then that really provides a great forum and cultivates a meaningful conversation where the AAPI people don't feel as isolated without their peers initiating the conversation. The tendency is to just stay quiet and not talk about it. So I have a huge, you know, encouragement or recommendation for everyone. AAPI and non-AAPI to talk about this issue because it will help the AAPI community immensely. Thank you. And Dr. Quang Dang, a question, because I know you already mentioned one of the horrific hate crimes incidents that are either aired on the news or on social media, or a lot of them that we just never hear about for some of the items, for some of the reasons that you already mentioned. As a psychiatrist focused on geriatric age populations, are there mental health or physical symptoms that you have observed in the past year in your clinical practice? Absolutely. So there was the trauma of COVID-19 and then people got vaccinated and then there was the trauma of these violent incidents. So older Asian Americans are especially susceptible to feeling vulnerable with COVID-19 and then later, you know, with these incidents targeted towards them. I've seen a lot of anxiety and depression, paranoia, and almost obsessive compulsive level of caution with not going outside and just isolating at home. And Dr. Quang, I attended your APA talk a couple of weekends ago and someone on your panel very touchingly talked about how when he went to give COVID vaccinations to see at their home, he couldn't help but cry because he saw so many Asian American older people who had just lost so much weight and, you know, just being neglected. Meals on wheels would come by, but it was not Asian foods. They just simply didn't eat. I mean, the combination of that plus depression and anxiety is just a horrible, perfect storm. So, you know, I see all of this in the older adult population and the tendency to not reach out for help is quite strong. So I have an anecdote. An ER doctor, a friend of mine, very good friend from college who lives in LA, he tells me when, he likes to say that when he sees an elderly Vietnamese woman coming in and saying that her pain is level five, that she needs to be seen immediately. All the labs and all the tests probably having a stroke or heart attack. And, you know, and this friend of mine is a white Caucasian man and that's just his observation of seeing the extent to which older Asian Americans can minimize their pain. So, you know, they're not big talkers in general, but then with very deeply personal issues such as feeling scared or anxious, that's going to be even harder for them to talk about. So, yeah, I think that the elderly are an especially vulnerable population and we need to all do more to reach out and make sure they're seen and helped. Can I ask a follow-up question related to that? So we found that Stop AAPI Hate, our respondents are showing signs of racial trauma, elevated symptoms of anxiety and depression, hypervigilance and avoidance like you were just talking about. Can you both explain to us, at least for me, is racial trauma different from other types of trauma? Are there better ways to respond to it that our community needs to hear? So what makes racial trauma different from any other type of mental health trauma? Or is it similar? Dr. Wang, do you want to take that or? Well, just my initial thoughts that when there is a crime committed against somebody simply because they are Asian-American, like for example, when Win Ho Lee was imprisoned in New Mexico because he was Asian-American, I bought my own computer instead of getting one from the university. I was vigilant driving down the street in New Mexico. And if somebody is attacked just because they're Asian-American, then all Asian-Americans feel at risk. Also, another difference is that you are at risk not because of anything you've done, but because of who you are. So you can't, it's hard to change your behavior except for staying in. And Dr. Fain, I thank you so much for bringing up that issue. And I wonder if that's an issue that we haven't brought up enough is the elderly Asian-Americans just staying at home because of COVID and because of the hate incidences. And my heart just dropped when you said that because my own father, he got so deconditioned during COVID. And I think he wasn't asking for help. He wasn't going out to do Tai Chi in the park or going out for the Chinese lunch specials. And he lost so much weight that he's been in the hospital since December. And I'm not sure that he's ever gonna leave. Yeah, and so, yeah, yeah. So, I mean, that's very, but because you brought that up, I wonder if that's happening to other people too. Yeah, and Dr. Jung, I think you asked, so is treatment different? I think I saw that question pop up. Yeah, so PTSD from trauma that people experience due to life altering events or sexual assault, being victims of war. The PTSD symptoms I think are unique when there's a certain event that has happened. But with the racial trauma in terms of a whole community internalizing what they're seeing in the news, feeling paranoid and scared, I do think that the treatment is more about connecting with others and also feeling safer, ways in which they can actually feel physically safer. So, whereas trauma in the other sense, the event has happened directly to them. So there's all sorts of different therapies and treatments for that. The racial trauma that's happening to our society or the AAPI community, I think it is different. And it's more about connecting, building bridges, having conversations, feeling like they're not isolated. And actually, I'll just slide this in. One Korean American patient of mine in her late thirties, a recent immigrant, felt so isolated and she had no idea. She, for some reason, she wasn't on Facebook or Instagram. And when I showed her these different sites, she felt much more supported. So just the idea that there's this larger AAPI community that is strong and fighting. And I introduced to her your website, Dr. Jung, so that empowered her, that made her feel less isolated and more safe. Whereas before she just felt like, wow, we're being attacked. And if I go outside, I will be attacked. And there's nothing being done on our behalf. So that's, I just wanted to make sure your question was addressed. Yeah, that's really helpful. So it is like a collective experience, a collective trauma, more than an individual type of experience. And so then we need to respond really in a collective manner, right? Well put, well put, well put. Thank you, thank you. And I feel like Dr. Quang Dang always knows where I'm heading to next. Because the next question is for Dr. Jung. Based on the data from the Pew Research Center in 2020, where they surveyed 9,654 US adults over the past 12 months, 31% of Asian American people have reported being subjected to slurs or racist jokes. 26% have fear that someone might threaten or physically attack them. And 58% believe that anti-Asian racism has increased since the beginning of the pandemic. As we learn more about Stop AAPI Hate, what resources are made available that our community members can utilize? Thanks, actually those numbers have increased in their more recent survey. So I think 80% of Asian Americans fear that violence against Asians is rising. And 45% have experienced direct violence. And 10% have experienced direct racism in the past year. So the numbers are even higher than that previous survey. So in response, and now that Stop AAPI Hate has more capacity, we're providing a lot more mental health resources about what to do if you do experience harassment. What to talk to, how to talk to your kid about bullying. We're working with a lot of different organizations to provide those services. And then what we hope to do is put those materials out in language and actually having corporations like Disney or like TikTok put them out. So we'll have professional actors, hopefully, producing little skits about how to talk to your youth about that. We're providing legal resources. That's the second most requested thing is, can I take action on what's happened to me? And so we'll provide more legal resources. And again, more family resources, how to talk to your, your young people about their fears about being bullied, or why they're being treated differently. We're working a lot with local governments, again, besides the resources for targeted people, we want to provide a lot of policy advocacy. So we've been working on the federal level on the state level, and locally, a lot expand civil rights protections and ethnic studies. California, we just got a larger API equity budget as a model for the rest of the country. Thank you for doing that. Dr. Jiang, just to follow up with that, as you mentioned policy and advocacy, advocacy. And earlier, Dr. Wang, also highlighted the fact how we're able to bring together APA members, who are psychiatrists and also a scholar, such as yourself here to really have a well rounded panel. So can you tell us a little bit more about how possibly APA members who are looking to advocate for AAPI mental health equity, or for, for instance, we also mentioned the bills that Congresswoman Meng is one of the sponsors of, and there's a series of mental health equity bills, but specific to the AAPI community, how can APA members, if they chose to advocate through you, how could they partner? How can they be part of this? That's a great question. Actually, I think I'd like to ask the same question, what can stop AAPI help to do to promote mental health equity, right? It's going to be one of the main long term consequences of the racism against Asian Americans beyond the violence, and, you know, grieving over those who passed away, I think the mental health impact is probably the most serious issue that we're having to deal with. And so I think what we want to promote in terms of policy is making sure that there's culturally responsive victim services, right? So they've had a lot of trauma, the victims themselves, and those victim response services need to be in language, and to be accessible. We need victim witness assistance. So a lot of times people can't even report or share what's happening because they can't speak the language. So the witnesses also need support. We really need, again, this whole idea of racial trauma, I think even a lot of clinicians aren't prepared to work with their clients or their patients on the issue. So I think we want to train more clinicians, more therapists, more mental health professionals on this notion of racial trauma, and how can we address it. I know our students are really calling for it at the K through 12 level. We have a youth campaign, and they themselves have asked, we need these mental health resources in the school, again, in language with Asian American mental health professionals so that we can have role models. And so I think this issue is at crisis proportions, and the real vulnerable populations of our community are really needing it like the elderly and like our young people. Thank you, Dr. Jiang. Yes, Dr. Quang Dang. I'll make a quick plug for the APA Foundations Program. It used to be called Typical or Troubled. Now it's called Notice, Talk, Act. And it's a program that's directed for training schools, teachers, all staff, coaches, etc., to be able to pick up on the signs of mental health issues in their schools. And so I can see that as being a way in which there's a culturally competent model for that, for picking it up for racial trauma seen in teenage Asian Americans, that that could be helpful. Thank you, Dr. Quang Dang. And then this question is for Dr. Wang. How can we support South Asian American colleagues and friends who are seeing family and friends in South Asia so terribly affected by the pandemic right now and feel powerless to intervene in this crisis? I saw that as a possible question I might get, Gabriel. So I just wanted to say that my family is, I have family in Taiwan, actually. And there, at the height of the pandemic here, they were zip lining, they were in cafes without masks, they were, because they had beat the virus. On the other hand, I also have family in Brazil. My name is Dora Linda, because I was born in Brazil, and things are just devastated there. I don't want to speak for South Asians, but I just really, you know, give my sympathies as to what's going on there. That's, that's, that's really amazing. And I think it speaks to the close knit culture there, how communal things are there, how much sharing there is. Yeah. So in general, just with anyone in any situation where they may feel powerless, what advice or, I don't want to say tips, but truly what advice could you give potentially to individuals in general that feel powerless, or they feel that something is out of their control, because clearly a pandemic is out of the control, the majority of people? Are there any advice or any advice you would give individuals that are that maybe are feeling that or maybe it's leading to depression or spilling to some kind of unhealthy state of mind? And that can be to either Dr. Quang Dang or Dr. Wang. What a question. What a question. Abigail, my goodness. Thank you so much for these really interesting questions. What to do when, when, when one feels hopeless and helpless, helpless, I think is what you said, actually powerless. That is a question that comes up all the time in our work. And whether it's related to COVID, or these incidents of violence, or, you know, other issues, that is a main question that we that we talk with and discuss with with our patients. And, you know, there's so many ways to answer this. The way that I'll choose to answer this, this question is actually quite practical. It's almost like doing CBT for yourself, cognitive behavioral therapy. But it can be very helpful to have a situation. What is out of your control? And what is within your control? What can you do? And to separate it out? Yes, you mentioned Gabrielle, the pandemic out of our control, but the actual day to day activities that we can do, you know, and what are the ramifications of the COVID pandemic? Or what are the ramifications of the attacks? Well, you know, we know that we're in a pandemic. We know that we're in a pandemic. So what are the ramifications of the attacks? Well, I feel isolated, I feel scared, I, etc. And what can you do, you go down the list, and you figure out what can you actually do for each one of those and empower yourselves with things that you can do. Very often, we kind of in a state of emotional distress, we clump everything together. The whole situation is, I feel powerless. But when we start to write out, or list out what we have control over, it can be incredibly empowering. And it gives an action plan, actually, that you've created for yourself. So that I mean, that is a very concrete answer. It's a wonderful answer in the sense of is something that individuals because in addition to APA members, we also have community members here. So definitely something that individuals can apply to their everyday life. And really, as you're trying to reach a healthier state of mind, and just a mental health wellness. But before we get to the real hard questions, which are those from our participants, because if you thought my questions were tough, there's all the questions have been very active. So we appreciate everyone putting questions. Along those lines, I actually have a question for you, Gabriel. So if I can ask about that, and it's a what can what is okay for the APA to do? For example, the Caucus of Asian American Psychiatrists for the APA, we're a large group of Asian American psychiatrists. And I don't think there's another group like us. We're national, we speak many languages, we have many different specialties. Is it possible for, for this caucus of the APA to partner with Stop AAPI Hate? Like perhaps if on Russell's Stop AAPI Hate website, there's a little button or something, or there's a there's a weekly webinar or a weekly webinar like this that's interactive, a zoom webinar, like, so it could be a group discussion, and different APA caucus members can can can lead it, take turns. So that's just a question for you. I, what to what extent can can the APA be helpful? You know, you've organized all of us and can we now go out there as a group and and try to be helpful as a group as APA group? I like where this is going, because it's also our following question, but it's really where we focus more about coalition. And that's really what a lot of the work I think, you'll think you'll see, and you'll see some of the actions coming out of not just APA, but also through the Division of Diversity and Health Equity. It's really we're looking at how can we build coalition and how can we make sure that we're creating tools, not just internally, to our members that are that will be helpful to APA members. But are there opportunities for us to also can expand that coalition with other members such as Dr. Jung, and obviously with Stop AAPI Hate, or if there's also some of the work that we're doing right now, and doing congressional briefings and educating also our elected officials. So I say that because I think there's always room and opportunity for coalition building and for us to partner and for a look at ways that we can continue. Ultimately, what our all of our goal is, is mental health equity. And I think there's always room for what that looks like and what's necessary. So I hope that helps. I have a great need from Stop AAPI Hate. You know, we do want to make recommendations for coming out with a mental health report. So it would be great to have APA's own policy recommendations that we can add and include as concrete, you know, here's what's happening. We know nationwide, here's what APA recommends to be done. So we'll follow up with that. Yeah, and there's always as some of our members know, we are very grateful and appreciative to our APA members, because a lot of them are the ones that come together and create toolkits, they create fact sheets, they really help guide the conversation and the research as to where we are with mental health with all of our diverse communities. So as Dr. Jung is saying with the report coming up, a lot of the conversation we're having today is things that the AAPI community may have experienced, but now it's experiencing at a much higher level because of how it's escalated. If it's through what some of you have definitely pointed to the past president, if it's to misinformation as to where COVID-19 originated from. So there's so much information that is always evolving. But we definitely can work together also on different resources that we create, so that we get the right information and the most up to date information to our members in our community. So the following question before we go to q&a from the audience is, as we navigate not only this pandemic, but the increase increased health disparities among our communities, what do you believe is the role or benefit of coalition building? And what does that look like to each of you? And I will defer to Dr. Jung, if you feel as comfortable going first. I think for us, it's not even coalitions, it's solidarity work, right? And we really need to recognize that in terms of racism, injustice faced by one group is injustice faced by everybody. And that for us to deal with anti Asian racism, we're just a small minority group in the US, and we really have to build coalitions and have our allies work with us to pass legislation if we need to, to change the narrative. It really is, you know, the racism and violence is a national issue. It's not an Asian American issue, right? And so it's actually other people's problem with us. And so they're the ones have to deal with their anti Asian hate, they're the ones have to deal with racism. So I think it's important for us to build coalitions and actually promote racial empathy and solidarity, especially among our young people. So for us, the coalition of solidary work is basically the solution to dealing with racism, right? It's just an integral part of what we're doing in trying to stop HIV. So that's a broad answer. But no, I appreciate it. Thank you, Dr. Jung. Let's see, I will go to Dr. Quang Dang. Right. So for me, because of the backdrop, and that's probably not the right way to frame it. But with the all the events of, of violence against, you know, our black community, I can't help but think of coalition building in terms of building bridges, and with, you know, between the Asian American and the black community. And I am trying to learn as much as I can, actually, from thinkers, black thinkers, black writers, who have been tackling this topic for so long, and learning from them. And what I'm realizing, as I'm on this journey, is that, and I shared this with the panelists, before this meeting started, I've had probably, you know, 50 to 100 hours of conversations, just in the last few months, with my colleagues, with my patients, with family, and it's a lot of hard work, a lot of reading, a lot of learning, unlearning. I'm listening to a podcast by Tressie McMillan Cotton and Roxanne Gay. And I'm just trying to learn as much as I can, from communities, like the black community who have suffered so much racism, and seeing what lessons our community, the AAPI community can learn. At least that's where I am at right now with this, this idea of coalition building. And thank you, Dr. Quang Dang. And Dr. Wang. Hi, thank you for convening us here today. We're doing a little coalition building right now, the APA and Stop AAPI Hate in San Francisco State. And then, you know, I think I think the best way is organically, let's just all get together. I'm thinking of San Francisco State, and there's the Asian American Studies program, there's the Latinos, Chicano Studies program there, African American Studies, I mean, everybody's just there. And, and in over time, like, for example, I, my cousins all speak Spanish. We're from Brazil. I'm, I married somebody who was Greek Orthodox, at some point in my past. But, you know, we just have, you know, I think, just just getting together and by Zoom, we're doing it also. And, yeah, and just within the APA, there are many operations, opportunities with the different groups we have to get the different groups together, actually. And, and, yeah. Thank you. And now to do it. Absolutely. And now a few questions from the audience members. I will, this can be for Dr. Jung. I live, this is a person, not myself. I live in the Detroit area. And this week in the news, they discussed the 1982 murder of Vincent Chin. I was a resident when this murder occurred and recall the tensions then. Do you feel that we have made any progress in the US addressing AAPI hate? Yeah, that's a difficult question. For those of you who don't know, Vincent Chin in the 1980s, was having a bachelor party the night before his wedding, and he was killed by laid off autoworkers. They mistook him for being Japanese and blamed Japan for their economic situation. And so it really galvanized the justice for Vincent Chin movement. It galvanized Pan Asian unity because Chinese, Japanese were being targeted. And so back then, America was in an economic decline and for blaming Japanese for their down. Last year, during COVID-19, there were three conditions that led to the racism beyond the economic downturn from the recession, we had the pandemic, and we had US China Cold War. Right. So those three conditions actually exacerbated the racism even more. So I think in terms of the situation, the conditions were more right last year for racism against Asian Americans. And then, sadly, I think the administration really exacerbated the issue and actually, you know, normalized hate. So I think compared to the 1980s, it's actually gotten worse in some ways. It's clearly more violent, it's clearly more widespread than the 1980s. The good thing, though, that I want to point out is that from the justice for Vincent Chin case, we're still learning from activists back then, we're still learning from our elders. And we're learning from those who fought Islamophobia right after 9-11. So Stop API Hate is actually led by a South Asian woman, a co-founder of South Asian. And the National Table is also led by a South Asian. They're not directly impacted by COVID-19 discrimination, which primarily targets East Asians, yet they're working with us in solidarity. You know, we talked about just now about coalition. So I think the times and the conditions are worse now, especially with the pandemic, the violence and the deaths have been much more grievous. But we also have much more unity now at this moment, we have more outspoken younger generations, we have more leadership in office, we have more leaders in APA, we have more leaders in the newsroom. And so I think the Asian American community has come together and has actually stood up a lot better than we did in the 1980s. So it's a both and. The racism is probably worse right now, but actually the Asian American community's ability to stand up, to fight back, to build allies with others, I think is stronger now and will continue. Thank you, Dr. John. And the following question I'll direct to Dr. Kwan-Deng, just because I know she recently in the last week did a presentation on this. How do I speak to leadership, organization managers and up about some of the responses to AAPI violence feels performative? So the context is they tend to send emails acknowledging attacks, but lack actual check-ins with staff or ways to support. So what can our employers do? Oh my goodness, should I just send you my slide deck on this? Yes, that is a very, very, very common problem of only sending out an email by the CEO, a one time thing, and it never being talked about again. And there was a Harvard Business Review article on this topic as well, where basically Asian American and Pacific Islander employees, they notice when who's talking, how often, and not only is an email being sent out, but what is done longer term. So the first step is to acknowledge that's the bare minimum. Step two is to be available on an ongoing basis as a leader and to have empower your managers to also, if you're talking, if you're the CEO, to empower all the leaders below you to be available to all employees. And I want to emphasize, we don't know who has, it's not obvious who has ties to the AAPI community. You know, people could be married or could be half Asian. So anyway, it's a very important kind of message for all employees that leaders are available to talk about this issue. Number three is to have numerous avenues for discussion. So, not to just have support groups with, you know, because sometimes people are not ready to participate in a support group. To have Slack channels or forums, where there can be asynchronous, you know, discussions about this topic. And people can access those forums on their own time. And again, having this be an ongoing issue, because there's just so much to unpack. And for the Healing Circle that I did recently, for many of the Asian American employees, it is such a new thing for them. It may not be new for our, you know, older adults, but for them, this is all new. So there's a lot of raw emotions. So to have a psychologically safe space at work. Now, of course, this is complicated. You're in a work environment. So I do think that there can actually be harm done, inadvertently, if these Healing Circles are not facilitated with the skill and the experience of somebody who's done it before. There's this whole idea of asking people of color to show up authentically and to share. It can actually be a hard thing. Right. So anyway, so to have these different settings, and then finally to commit. So if you don't already have a DEI committee, form one and empower that DEI committee to then commit to longer term plans, you know, donating to nonprofits, improving hiring practices. So there's more diverse leadership, etc., etc. So that's a quick bullet point version of my presentation from last week. Thanks, Gabrielle. It's a terrific encore. So people should look it up because I know you have a lot more to contribute to that conversation and expand on it through your previous presentation. So we appreciate you giving us just a snippet of it, but all extremely helpful information. The following question is for Dr. Wang. Is mental health better for younger Asians versus older generation because they are more willing to face the issue? Well, I think there are definitely generational differences. So, for example, my father's generation, my father was college educated in China. He went to college in the 30s, 40s. But there was no word for depression in the Chinese language at that time. And indeed, even in English, the word depression as an emotion was coined by John Cade in the 1920s or 30s. And, you know, older European Americans also are just kind of, you know, this whole thing of a post Freudian vocabulary and vocabulary of feelings that is newer. And so, you know, our younger people may have more of this vocabulary to to talk about their feelings or to have this kind of emotional acquired emotional intelligence. But on the other hand, I think the older generations have more support there. It was you know, there were lots of organizations, families were more intact and more, you know, people live more along extended families. So, you know, we're at I think we're all more kind of more individualistic, more isolated now. Younger people may be more in touch through electronic means. So that's something that, you know, the impact of that. But I think it's all new. We don't know yet. In some ways, they're more connected. In some ways, maybe less connected. Oh, talk about connections. And, yeah. My daughter just came home. She's babysitting, you know, a bunch of kids. If you don't mind, I'll just let them in because everybody's smiling. I chime in here. And of course, I think as a sociologist, I really see generational shift. And the major shift for this generation is they're dealing with global warming. And I think that's a real existential crisis that impacted their mental health. And then they, you know, they've come of age during the pandemic. So that's already another strike against them. And then what Dr. Wang just talked about in terms of screen time and being so aware of what's happening. And I think they're aware of the world's problems. So not even just in their local community, but they're realizing what's happening in Israel and Palestine. They know what's happening in Syria. And so having all that information and being powerless in some ways to deal with the global events that they have no control over. I think that's led to more difficulty for this younger generation. Even though they have a better vocabulary, even though they're really aware of their mental health status. I think they are, maybe World War II was a sort of existential crisis too for previous generations. But this generation is confronted by issues that I think are much more difficult than what I had to grow up with. And then they have the career issues like what's the economy, you know, a lot of their parents. Or they've gone through the economic recession of 2008. So that's been really hard. Thank you both. And then this question, I will open it to everyone. But if Dr. Jung would like to go first. What kind of policy changes in funding structure and or strategies are needed to increase and make sustainable non-clinical treatment mental health services to incubate confidence, stigma reduction, and treatment? And I'll also put it in the chat room just because it's a very long question. Yeah, that's sort of our broad policy ask is that more funding and even more government funding and foundation funding go to Asian American community based organizations, right? So that's sort of non-stigmatizing, non-clinical, providing training our social service sector a little bit better to do some of the mental health delivery. So I think that's going to be our approach. We want to provide the capacity of local organizations to provide wellness care more broadly understood. Thank you. Dr. Wang or Dr. Quang Dang, if you'd like to add anything. You don't have to because there is another question from the audience right after this one. Well, somebody from the Caucus of Asian American Psychiatrists, Will Wong, brought an idea to us and he wants to write recommendations for portrayals of Asian American characters in the media. And so guidelines for that. And so we're, you know, we're taking it on, and hopefully it'll become an APA document. But that's something our caucuses is doing. Yeah, because some somebody had the idea and he's going to put the energy into it. Thank you, Dr. Wang. And then last question and we do have five minutes left. As an Asian and being Muslim, I have to face a lot of racial behaviors. Since I migrated here in the US. Being an IMG physician, how can we earn the trust and win the heart of these larger groups of people. Well, first of all, I'm glad you're here. One in three practicing psychiatrists is a practice, an IMG physician. And so there's this that fact you're not you're not alone. Muslims are a important part of Asian culture, and especially Chinese culture. One of the most one of the important races of Chinese culture. I just wanted to say that. Thank you, Dr. Wang. Dr. I mean, I have so much immense respect for IMGs. My parents are both psychiatrists, my mother was an IMG. So I'm a bit biased, but I have immense respect for IMGs. I think we could probably do better as an organization as you know APA to to highlight and to include on, you know, the faces of Muslim and South Asian, you know, and different, you know, different ethnic minorities of different groups in our materials on our website. And that can have I think a large impact on on on prior or highlighting the value of all of our psychiatrists. Yeah, just for backdrop, we're getting a lot of incidents from healthcare professionals about the racism they're facing. And so, I don't think you're alone, you know, doctors and nurses and other healthcare professionals are facing a lot of racism in the hospitals and so that's another we're doing is just looking at racism at healthcare sites, and how prevalent it is. And, you know, it is a workplace issue even facing workplace discrimination from your own patients. You're not alone. Sorry to say. And by special request we're going to sneak in one more audience question and I'll direct it at Dr. Quang Dang. During all of this and even prior to the pandemic we started seeing a lot of things that individuals might consider systematic anti-Asian racism in college admission process. So the question is, how could this affect and has it affected the mental health of Asian American youth. I thank you so much for making time for this question. I think that this goes back to actually a very important concept of, of white supremacy, and, and, and how it creates a system where they're whites are supposed to be at the top, and everyone else, it takes up space, and it's supposed to be on the bottom. And so what that leads to that leads to minorities pitting against each other, vying for these spots that are supposed to mean that what the message is that underlying message is that these spots are supposed to go towards Caucasian or white students. And so when that balance becomes, quote unquote like too much, too many Asians, then, then it does bring out this, what I do think is, is, is a byproduct or a an expression of, of structural and systemic racism towards Asian Americans. I think this is a very controversial topic, I am more than happy to be further educated on this topic, but in my understanding and learning about white supremacy and the model minority myth. You know, grouping all Asian Americans together as though Hmong and Cambodian and Thai and Indonesian are all having the same success, or Vietnamese, as you know, Japanese, Chinese, Taiwanese so I think it, it is very, it is very harmful and we're not doing things and thinking about things I think in a granular enough way and. Yeah, so those are my, my thoughts. Thank you, Dr. Quang Dang. And last question, just as we begin to wrap this up because we're, it's now 6.15. As we get ready to end our afternoon after a very engaging and meaningful conversation. What is one pearl or takeaway that you would like our participants to come away with? And I will start with Dr. Quang Dang. All right. My takeaway is, I wrote it down. Okay, here it is. My takeaway is that we can all support each other. I've had over 15 years of experience working with patients and groups, and though what I'm, you know what I'm about to say may seem counterintuitive, I find it true over and over again, that for those of you who are not of AAPI descent, that we really need you now more than ever, and that you have a truly powerful role in supporting your AAPI friends and coworkers and peers and neighbors. So, please don't miss out on an opportunity to speak up, initiate the conversation and create space for them. Thank you. Thank you so much, Dr. Jung. I've been really struck about, I'm really concerned about the elderly in our community, and how isolated they're feeling, how fearful they're feeling, and how a lot of us are dealing with collective trauma. And so, I keep on telling you, we can go into fight or flight mode, right? And what we need to do is really go into flock mode, and really come together for strength, come together to have a collective response to this racism, come together for more voice, more equity, and more allyship. So, thank you for talking with us today. Of course. And Dr. Quang, the president of our APA, Asian American Caucus. Thank you so much for organizing this, Gabrielle. So, I think we touched upon one of the reasons all this is happening right now is the rhetoric leadership that I feel is misguided, and just also wanted to say that along the lines of what Dr. Quang Dang was saying about focusing on what you can do and what you can't do. Everybody who's here is a leader, just by the fact that you're here, you're an influencer, you're somebody that people, your patients, students, community members, they look up to you. And so, I think everybody here can set an example of leadership. And I think that what's happening right now against the Asian American community is misguided leadership, you know, ex-president calling us, calling it the China virus, the Wuhan virus. And we as leaders in the community can also be leaders and examples and to kind of, you know, mitigate that. Thank you, Dr. Quang. And then as we begin to wrap it up, I will say a few housekeeping items. There will be a post-event survey going out tomorrow morning via email. Kindly complete and provide us your feedback. The email will also include information on how to claim hours of participation and receive an official CME certificate. This webinar will also be live in the next couple, well, sorry, not live. The recorded version will be on our APA Learning Center. So, if any of your colleagues were not able to be here tonight, please encourage them to visit our API Learning Center, where it will be available. We look forward to your participation at future Fireside Chats, but also at our More Equity in Mental Health 5K. Go to our psychiatry.org backslash DDHE website for more information. And now on behalf of the American Psychiatric Association's Division of Diversity and Health Equity, I would like to express our sincere gratitude to our panelists, Dr. Wang, Dr. Quang Dang, and Dr. Jung. To Dr. James for the opening remarks, and to Douglas and Tanya, who I know you can't see, but they've been helping me behind the scenes. And of course, a big thank you to our attendees who joined the webinar. We hope you found this event informative. May you all have a nice evening, and thank you once again.

Mental Health Equity

Fireside Chat

Asian Americans

Pacific Islanders

COVID-19 pandemic

xenophobia

racial discrimination

hate crimes

racial trauma

Stop AAPI Hate

elderly Asian Americans

systemic racism