If you are in room 308, here for the anti-API plus racism discussion and dialogue, you are in the right place. So congratulations on making it. And thank you for joining us, you are the real troopers on the last day here of the APA conference. So again, thank you to everyone here coming out to hear us talk. This is gonna be a discussion and dialogue on coalition building and kind of healing our communities and workforce. We really invite participation from the audience here. I by no means, and neither of the discussants here, we don't claim to be experts in any of these talks, but we would love to engage everyone to have a nice robust conversation as you are inclined to. So again, thank you everyone for coming out. I'm gonna move to the next slide. My name is Adam Chan, I am the chief resident at the University of Tennessee Health Science Center in Memphis, Tennessee. Had one more month to go and I get to start Child Fellowship again back in my hometown in Memphis, Tennessee. So I'm really excited for that. No financial disclosures for myself. Hi everyone, am I too loud? I'm Bob Chung, a psychiatrist and psychotherapist in Chicago and a second generation Chinese American. By second generation, I mean the second generation in the US, my parents were born in China and immigrated here, so they were first generation Chinese Americans. I wasn't sure exactly what counted as a relevant financial relationship, but we're going to mention affinity groups and I get paid to lead affinity groups. So if any of you were to prescribe an affinity group to an Asian American patient and they joined one of mine, I would benefit financially. Okay, and I'm Theresa Lee, I'm a psychiatrist and a psychotherapist who specializes in group psychotherapy. I am physically based in Berkeley, but my practice, my private practice covers New York and California. In my practice, I also lead groups and I lead one with Bob and that is the Asian therapist process group, so if that counts as a financial disclosure in the way that he referenced, then I'm part of that. Thank you, Theresa and Bob. And my disclosures as well, I consider myself a 2.5 generation Cantonese American. On my mother's side, I'm fifth generation, but I'm a second generation on my father's side who immigrated from Hong Kong. So I think we have some time, maybe we can go around in the audience and anyone that would like to share a little bit about themselves, just so we know who's in the audience and we can draw upon each other's strengths and get to know each other a little bit better today. Okay. Since everyone else is shy, let's go. So I'm Ravi Chandra, 1.8 generation Indian American. Grew up in the South and the Midwest and East Coast before being in California, I'm in San Francisco now. Psychiatrist and writer in private practice and no relevant financial disclosures. Ravi, that was really interesting, all of it, but what's the 1.8? So I came when I was about two years old, so. Makes sense. Yes, please. That way, this session also, I should remind everyone, is being recorded for APA Live on Demand. So this will also be recorded for everyone's virtual sake as well. Thank you. Good afternoon, my name's Eric Rothwell Yuan with a hyphenated last name. I was born in New York, my dad was born in China and my mom was born in Egypt. And I'm now in San Diego. Excellent, thank you, Eric. Thank you. I'm Mark Reagans, I'm a psychiatrist doing street medicine in Los Angeles. And I came to this session because I know so little about it despite the fact that I live in Torrance, which is a good 35, 40% Asian. Excellent, welcome, Mark. Hi, my name is Alicia Cho. I am Korean American, my parents were born and raised in Korea, but I was born and raised in New Jersey. I've been all over the nation, did my adult psychiatry training in Colorado and now I'm in Portland, Oregon for Child and Adolescent Psychiatry Fellowship. And I'm interested in learning more about catering to the Asian American community. Excellent, welcome. Curtis Adams, I'm from Baltimore, Maryland. My father immigrated from South Georgia to get an education because he couldn't as a black man back when. And, but I just, I grew up with a sort of, as I was saying, cartoonish sort of notion of Asian. So it's either my classmates in private school who were bright and hardworking, and then our, the folks that took care of our car, my parents called the Koreans, and they were just reliable and good. And so that, you know, I just had this little narrow view. And so racism is something that I hadn't been thinking much about, and so I gotta learn some more. Thank you for joining us in our session. Hi, I'm Lucy Wong, I'm here from Seattle, actually the University of Washington. My parents came over from Taiwan for school when I was born in the States, and I'm a geriatric psychiatrist. I practice up there, at the VA there. So good to meet everyone. Very nice to meet ya. Hey everyone, my name is Estrella. I'm also from Memphis. I'm first generation, I guess. Born and raised in China, but came here for college, so very excited to learn about this topic, and nice to meet y'all. Excellent, for those that are joining us, we're just introducing ourselves, just that way we can, again, you don't have to share unless you would like to, but we're just kind of gauging where everyone's coming from in this room. Hi everyone. Sorry, I'm a little winded. My name is Nico Morisot, I'm actually a psychotherapist, so I'm in California, a licensed marriage family therapist, and I work predominantly with low income, underserved populations, folks who are experiencing homelessness, folks using substances. I worked at the Harm Reduction Center and at the Mental Health Association. I worked with a lot of Asian populations too. I'm a second generation, I'm a second generation Asian woman, and I'm a second generation Asian woman. I'm a second generation Filipino American, a daughter of immigrants, so really interested, obviously, in this topic and how to best support the folks that I serve as I work in tandem with a lot of psychiatrists and MDs and other clinical social workers in my field. Yeah, glad to be here. Excellent, excellent. We're happy to have your perspective as well from an interdisciplinary side. Hello, my name is Isabel Tran. I'm a second generation Vietnamese and Chinese American. I'm a rising third year medical student considering psychiatry. I am originally from Orange County, California. I was visiting a close friend who's graduating nursing school this week in San Francisco when I heard this conference was here as well, so I decided to check it out. I'm currently studying for step one, so I'm kinda early in the career process, but I am considering psychiatry, which is why I'm here, and then I saw this session, so I thought I'd stop by. Excellent, well, I don't envy you right now. So. You have the loudest voice, apparently, in all of your different lives, so you are destined for psychiatry. All right, well, I think we're gonna move on to this next slide here. We have four. Just interrupt, we are, we would like, it would give the group a smaller field if the people in the back would move up, but no pressure, just encouragement. Thank you. In service of dialogue and discussion, it could be more fun, lively, and intimate. And I promise we don't bite. That's a good thing. That's why we sit up here, to restrain ourselves. Sorry, Adam. Thank you, Bob. We have four objectives here for the audience today that we would hopefully like to cover and go into more detail. First, we will talk about and appreciate the COVID-19 pandemic, specifically in its historicization and the API plus history here in the US. Number two, learn evidence-based clinical strategies to engage API plus patients in culturally humble care. Number three, to learn how the behavioral health system can accommodate and promulgate anti-racist policies. Excellent. And finally, fourth, and this is where we need a lot from the audience here, the dialogue about strategies to support frontline API plus mental health workers to bring your experiences to the table and so we can have a good, robust discussion. All right. So what's the importance of a name? We'd first like to start off our presentation acknowledging the Ramaytush Ohlone people who are the original peoples in the San Francisco Peninsula. There are some resources linked down here from ramaytush.org, US Department of Arts and Culture, Honor Native Land Project. And then finally, the nativeland.california, which has a list of kind of information for indigenous territories across the land. So we'd like to do a land acknowledgement for today's presentation. And now I will turn it over to Teresa. Thank you. So Adam, you set us up nicely for knowing the importance of a name. And in coming up with this talk, we needed a title. And we know we wanted to focus on the Asian American population. And I think it was a title that we also felt that we could learn from. So here we've written AAPI, or AAPI as I say it. That stands for Asian American Pacific Islander. And the little red cross sign is intentional. It's a plus. You know, I'll say that the first time I thought of this, I took inspiration from the LGBTQIAA plus community. I think what they did there with all those letters was to over time include more and more people. But the plus at some point stood for the fact that there are people who are coming to this who don't know their labels, who have yet to come into it, who are still exploring and discovering. And then there are limitations of what we know as labels as well. So I think of the plus as an attempt to be more inclusive. And hence, we borrow from that. There are additional monikers that precede AAPI plus. I think we're probably the first to use it. But other ones you've heard of is Asian American, Asian Pacific Islander, South Asian American, APISA, and that's the name of our APISA therapist process group. The term Asian American first came into existence that I'm aware of in 1968 through UC Berkeley, in parallel to the African American movement, where I think that term came with empowerment and agency. So we've highlighted the word Asian and African to show that there is a desire for specificity in this label and that there's a relationship between the two. Next, we'll move on to the levels of impact and kind of discuss this more in further detail. As you can see on the screen, there are three different federal legislation acts that were put in motion of recent sort. But I also, before we even talk about these, I'd like to also just talk about kind of the wave of the anti-Asian hate. This is certainly not new in historicalization. From the Chinese Exclusion Act of 1886, where it was the first time the US had barred an ethnic identity from being able to immigrate to this country. The 1913 California Alien Law Act was passed, as well, where it made it illegal for aliens to own land. 1940s with FDR passing Executive Order 9066, which created the Japanese internment camps, and so that all existed in the 60s. And so the United States' history is riddled with a lot of federal policies, and as we discuss more about this term about anti-racism, the active process of disenfranchising people. And so we wanna bring highlight to some of those things here today. And then 9-11 with the rise of Islamophobia. So there has been a long, and this is not just 100 years ago, it's as recent as 10 years ago, and even now. And so we wanna bring to light that this current wave, especially for East Asian facing populations here in the US, we're kind of riding that wave right now with the COVID-19 pandemic. So just putting that in context. If you'd like a further kind of timeline on some of these different events that transpired, Stop AAPI has a fantastic timeline. It's so modular, I didn't put it in this presentation, but please go online to Stop AAPI, and they have an excellent timeline where you can track a lot of these different changes over their course. I'm actually gonna start from the bottom of this and talk about Stop Mental Health Stigma in our Communities Act. Has anyone heard of this? First proposed in 2017 by a show of hands. If you've heard of it, please raise your hand. I hadn't heard about this either until I was doing further research. So you are not alone. This was first proposed by Judy Chu, Representative Judy Chu from California back in 2017 and reintroduced again in 2021. It's still an active bill on the 117th, 118th Congress, and so it's still being proposed, but it was one bill that was specifically targeted to introduce legislation where SAMHSA would be instructed to provide translational, interventional resources in different languages for the AAPI plus community. So that was one motion for the Stop the Stigma in our Communities Campaign. However, it's still active and has not passed yet. Second on this is the Compacts of Free Association. Again, by show of hands, who has heard of the Compacts of Free Association? Highlighting some of this, this was a financial aid assistance agreement from the US government to several of the Pacific Island countries, the Federation States of Micronesia, the Republic of Marshall Islands, Palau. These were agreements from 1983 to 2006, was the first wave of financial assistance in exchange for us being able to operate military bases strategically in the Pacific front. But you'll also see, as we talk a little bit about the health insurance policies, that over time there's been uninsured rates of this going on. There was a 1996 policy called the Personal Responsibility and Work Opportunity Act that disenfranchised Pacific Islanders and many of non-resident immigrants where they could no longer access healthcare in our country. And so this made it problematic, and it wasn't until 2020 that Congress rectified it and actually passed laws where they can have these rights again. So you'll see that when we talk a little bit more about the health insurance. And finally, who has heard of the COVID-19 Hate Crimes Act? This is probably more recent. Yeah, I'm seeing some show of hands. This was passed by Senator, I guess it was a joint bill by Senators Hirono from Hawaii and Grace Meng from New York, and it was signed by Joe Biden. I guess that's a small little picture, but that's them signing it on the address. And this made it easier to report hate crimes in states and gave more powers to local and state authorities to kind of have a database on a lot of the hate crimes in this area. Thank you. Adam, I just wanna say, and I'm looking at the dates here, 2018, 20, the pandemic was 2020, and that's when we were stuck or should be stuck in our homes. And I feel like I personally didn't know about any of these acts until I was in some ways bombarded with the media exposure of COVID, racism, and then what follows through as this legislation. But this 2018, 2017 acts, I wasn't aware of until I did this presentation with Adam. So Adam's not alone, and none of you are alone if you didn't raise your hands. Thanks, Teresa. And this also highlights the impact and kind of representation of our coalition building in our communities where a lot of these data points are not necessarily from psychiatry or even medicine that you'll hear about today. A lot of it is from community grassroots organizations in response with anger, even to a lot of things that are happening in our country and our communities. So I just wanted to highlight part of today's presentation, not just only in the title, but also the data points that we get. A lot of these come from a lot of different organizations. Moving us along, next is the psychiatry workforce. This is a very interesting topic, and we couldn't really talk about this presentation unless we actually discussed the terminology. You know, once again, what is in a name? Who here has heard of the term anti-racism? I think a lot of people in the audience have. We define this here today as a system structured around conscious efforts and deliberate actions which are intended to provide equal opportunities for all people. So we really like to highlight deliberate actions and conscious efforts. The American Psychiatric Association, in a position statement, recognized that this was an active process. This is not their definition, but the active process of identifying and eliminating racism by changing systems, organizational structures, policies and practices and attitudes so that power is redistributed and shared equitably. So I know that's a long definition as well. But I'd like to invite the audience in our discussions also to kind of reflect on this term. I think I first heard of this term or when we were doing research from the National Action Committee for Women back in 1994, but most notably it's been attributed to Dr. Kendi over at BU and his Center for Anti-Racism. So I would love to hear kind of more discussion about this terminology. I'm curious what comes up for y'all when you hear the word anti-racism. Is it something that's close to you or far from you? Is it something that's in your practice or more if you're in a hospital setting, more in the structure of that hospital? Well, I'm not in an institution, but I really appreciate the terminology and actively facing it as opposed to just denying that you're a racist, a non-racist. Anti-racism is much more active, so I appreciate that. Yeah, we also spent some time talking about this definition and building this talk and we were like, is it a system, is it a belief, what is it? And I think it's gonna continue to evolve what it means and how we approach it. But yes, key is the activism or the activeness of it. One of the ways that I think about it is that the systems that we operate in, whether it's a hospital. Would you mind coming up to a mic? Sorry. Thank you, Eric. So what I was saying was the systems that we operate in, whether in the hospital, in life, in school, at work, many, if not all of them are racist, kind of their origin and design. And so anti-racism means that you need to be active and intentional in how we operate that and how we construct new systems. From my experience doing community organizing and I use psychiatry, a lot of folks feel like, well, racism is tied up with being a bad person. And if they don't feel they're a bad person, then they're like, well, I can't be racist. For me, the importance in this term is the idea that you need to actively participate in identifying the systems that are causing harm to people. Excellent points. Absolutely, when it comes to individual involvement, to be engaged with this and not outside of the system. There's what, a term or a saying for those that stay silent. Helps the oppressor. I'm curious also with this term and just with the audience here today, a lot of it also not only seems counterintuitive that we use an anti-term, like a not term to mean something maybe that a lot of people think of pro-diversity. What are your thoughts on this as kind of that feeling where this is like pro-diversity but you're also saying anti-racism? Yeah, I guess I don't see an incompatibility with those because we're talking about changing culture, changing hierarchical white male Christian centered cosmos with a more diverse and pluralistic and egalitarian framework. So I think being anti-racist and being pro-diversity are the same bailiwick. I don't actually agree. I grew up when the words were affirmative action and assimilation, which you could argue is making your more diverser things. And this has been, it had to be a shift for me. This is different than that. That this to me isn't saying the people who are the minorities or oppressed races have to change to be able to be included. It puts the onus on me or the establishment to say, how can I be against the forces that have pushed it down? That it's a different obligation than it felt 30 or 40 years ago when I was growing up. I agree, this term is more pointing. Right, and it points in a different, the valence goes in a different direction toward the same end. Both of you gentlemen, what you're saying reminds me of just how these terms are under a big tent and they kind of need to be considered together. And that's what for anti-racism is just one slice of the pie. We have to be activists, but we also have to have love and compassion too. So I think that has to be part of the conversation as well because the dominant culture denies love, compassion, and common humanity to those falling outside of that hierarchy. My feeling is our overall culture these days, there's so much pointedness in it. And the Republicans are anti-Democrat and the Democrats are anti-Republican. Everybody's so anti-something. And I kind of like the idea of being pro-something rather than anti. So I, I don't know. You can be pro, pro in your approach. Pro in your approach. I love this dialogue so far. And I, just to add on to Ravi's point that it has to be approached with love and compassion for others from a humanistic approach. I really do see this anti-racist movement, not necessarily moving that conversation towards the center but more towards the periphery, those that have been marginalized out into the peripheries. And that doesn't take away anything. The center can still be in the center, but maybe we make the center bigger to encompass those on the periphery. Yeah, how about pro-love and pro-compassion? You know, that's, I'd be okay with that. Well, I love hearing about thoughts on this term. Again, this will be an evolving term during our careers. I look forward to, you know, how this term will shift more over time. So time will tell. I don't know if any of you saw this in the exhibit hall, but I got a kick out of not actual size. Valbenazine is not a treatment for racism and I have no financial relationship with Neurocrin Biosciences. I don't know if anybody's working on an anti-racism pill. If so, it would need to be a big one, maybe that actual size. Tough pill to swallow. As we talk about the physician workforce and specifically psychiatric physicians, I wanted to highlight the AAMC, their criteria of what an underrepresented minority in medicine is. Because I, you know, being a trainee here in Memphis, Tennessee, it was, I didn't really understand it where we don't have a lot of people that look like me in those communities. And so I felt, you know, a little bit marginalized in that sense. But when we look at our psychiatric workforce, this was the diversity by race and ethnicity and sex within the US psychiatry physician workforce. And when they took this data, I think this was 2014 data, we look at how this workforce is actually divided up. And they actually exclude the definition of Chinese, Filipino, Japanese, Korean, Asian, Indian, Thai, Vietnamese, and Southeast Asian. So a lot of it that is left is AI, AN, Native Hawaiian, or Pacific Islander. And so I just wanna kind of show, I don't know if this is a laser pointer, but we can see that by and large, the demographics of the US census. Top button. The distribution is not representative of our US census. And if that is our goal to be more representative of the patients and populations that we serve, we are certainly not there. And we can kind of see the breakdown between applicants. We have medical students here today, two psychiatry residencies. Those are my steps right here in the residents and fellows section. Different graduates practicing physicians and faculty at academic institutions. As you can see, there's quite a big breakdown in 0.2%. It's not really represented really well. But I wanted to highlight this because largely female and underrepresented minorities within the workforce is significantly lower than US population, even though it's projected that by 2044, they're actually slated to become the majority of the position. So that's kind of where we are with the stance. There hasn't been any more data that's been published about this information about our workforce. Yes. I understand that slide. They intentionally didn't measure any of those Asian groups. And what's left is just Native Americans and Eskimos and Pacific Islanders with the little teeny 1% that somehow all those Asian groups weren't important enough even to be in the study or the picture of the census. Thank you for your question, an excellent question. To clarify, it's not that it's being excluded, but actually the Asian Americans make up a huge chunk. I'll show you in the next slide here. We actually make up a pretty good chunk, about 23% of the workforce when it comes to psychiatric workforce. So actually, I think that's why the AAMC doesn't consider Asian Americans, East Asians, South Asians as part of that, just because when they look at underrepresented, we're actually overrepresented compared to the US census population. I think the US right now hovers about, Asian Americans are at 6% of the general census. So right now we represent about 20 to 25% of the psychiatric workforce. Weird. So why are we talking about this then if we are actually overrepresented as psychiatrists? Just because we think of ourselves, sorry, I shouldn't say that we think of ourselves, but the AAMC or the APA thinks of us as a majority. I don't know who here is a part of the Asian American Psychiatrists Caucus. I am myself. We're the largest caucus in the APA. And so I'd like to also kind of highlight. Maybe second to women. Second to women, okay. Second largest. But we should also measure that just because we're a big group doesn't mean that there's not differences in our population. So we shouldn't be lumped together in a lot of instances here. The American Psychiatric Association acknowledges that there's serious continued underrepresentation of certain ethnic minorities amongst medical students in all levels of training and supports effort to increase diversity and prepare psychiatrists to better serve a diverse U.S. population. So that is the APA saying that they want to reach that target where we look more like the U.S. census in a way. And that was back only about six years ago, seven years ago here in 2017. And I think we are making strides. So this is not to say that where we are going is not the direction that a lot of the people in the caucus are hoping that we're moving. But in its historicization, the first Asian-American president, Dr. Ojeste, was only in 2012 after 139 years of the APA. And then our president-elect here, Dr. Vishanathan, he's also Asian-American. As I was saying earlier, our current workforce is about 20% API plus. But if we further break this down and why this is kind of misleading in a way, 6.7% are professors, 3.5% are chairpersons, and 0% are deans. So when we look at the academic data from U 2013 to WISE 2020, there has not been a single academic data from U 2013 to WISE 2020, there has not been a single Asian-American dean of an academic center. And I think that's really telling if we're looking at 6% of the US population but zero of them are deans, 3.5% are chairpersons, we're not getting promoted. We're not getting promoted across the board. And we're seeing a lot of API plus members in the psychiatric workforce exiting the academic centers. We're seeing them participate a little bit more on the periphery, maybe going into private practice or finding other employment opportunities. And that's not done, not intentionally, but by drew systems and structures that be. So the idea of how to get this promotion, it's not a radical idea. So that if we look at the arrow here, it's not a radical idea. We have three ideas on how we can actually address this. Mentorship, career development, and skills training. These have been evidence-based models and programs that are used across different institutions to promote stuff like this. I'm benefiting as a APA leadership fellow on this track where I've received a lot of mentorship from different mentors across this, just meeting different people. But even in our, when we're taking it back home in our institutions, how often do you see someone that looks like you that actually can mentor you in your specialty? That's hard, it really is. Career development, understanding the different skills. There are some places, there are some studies that even suggest the differences that East Asians are least likely to be promoted than South Asians. If you looked at my previous slide here, the last two presidents are actually South Asian or identify as South Asian. So there is even discrepancies when we say we promoted the first Asian American. That's not including East Asians in this picture too. And there's even research that suggests that that doesn't exist for East Asians as well. So we can't always lump all these ideas that okay, we have a first Asian American means that everyone has that opportunity. Skills training. Not that there's competition between East Asians and South Asians. Correct. But we should also look at when we further divide or look at the differences, there are major differences that we should still be aware of on the periphery of these conversations. So it'd be very nice for me as a healthcare organization or as the APA to say, well, we have an Asian American president, but we don't really understand that that's not representative of all of our shared experiences, our identities, and what that representation actually means. So no, that doesn't mean that we're competing against each other, but we should also not just be lumped in together as Asian Americans. Thank you. Thank you, Bob. Thank you for letting me clarify on that. So what does a anti-racist workforce look like? And we invite discussion on this point too. Crushing the bamboo ceiling, having a diverse workplace for all levels. When we look at APBN certifications, there's rarely any competencies when it comes to advocacy or even on racism. So is there a need for us to maybe develop some sort of competencies related to this? If we can just stay there another minute, I'm thinking, you know, the arrow, the mentorship, the career development, the skills training, that's all cohesiveness and supporting each other. And that's more pro-love and pro-compassion than anti-racist. I mean, there's no anti in there. My name is Xiaoping Xia, I'm a psychiatrist from DC and my full-time job is for VA Medical Center, but also I volunteer in Asian community on weekends. So yeah, I met some people just like you said, the bamboo ceilings regarding how the Asian, seems like you all, all the Asian people, people consider you are very dedicated technically, skill-wise, very good, but you just don't have leadership. So I met someone who work, he's Asian, from Taiwan, and he is a veterinarian, like a doctor, and work for FDA as an officer. And he realized this, he starts to sponsor, to coach Asian kids how to speech, public speech, and invite people, coach, because Asian people just like, keep silent, just do your job, don't stick out your head, and like that. So he sees that, he gradually, gradually tries to do that, and also he likes to organize overall big talk, inviting people in different field, help to make a network. So I think, you know, people are doing it to try to move forward as I just want to share some information. Yeah, that echoes what Dr. Amy Alexander and her group talked about this morning, and Dr. Alexander talked about assertiveness, and being part of the career development, demonstrating assertiveness, and verbal, fluent, you know, just being talkative and so forth as being important in this culture. And also, I guess I was going to say, just in terms of being anti-racist, I think developing relationships across the board with African American, Native American, all the different Latinx, et cetera, is very important. It's something which I think a lot of the traditionally, you know, basically it's kind of the old boys network. White people just, you know, this morning I was at a talk where another white physician promoted another white physician very prominently, and I was like, why am I being subjected to that? So I think, you know, I think it's like all about just expanding our networks and supporting each other, too, because I think, you know, appreciating us, each other, giving each other attention, attending each other's talks, et cetera, I think that's all important as part of advancing who gets to sit at the table. And it's also anti-racist to do that. So I can't really speak to the workforce, but I go to medical school in Texas, and I happen to be the only one who looks like me in my entire class. I'm the only East Asian presenting woman in the class. There's three East Asian presenting men in the class, but I'm the only East Asian presenting woman. I say that because I'm also Southeast Asian as a Vietnamese American, but I'm the only one as well in the class above me. There's also one other East Asian presenting woman, too, in the entire class. She's also half Chinese, half Vietnamese for some reason. Maybe they can check off two boxes at once. I don't know. I'm just kidding. But I thought of that because if you were to look at the website, they have higher statistics than that because of South Asian women in the class, and they're all my friends, and I'm really grateful to them. They're my support network as well. But it kind of shows that with aggregation of Asian American data, it can kind of hide, for example, the isolation I might have felt during my first year. It was very difficult, and I think through that experience, I learned, because I think as an Asian American woman, I was taught to kind of blend in. I was raised in Orange County, and I went to UC Irvine for undergrad, which is 60% Asian American, so I had a very different experience when I moved over to Texas for medical school. And at first, I struggled to understand that feeling of attention and also that feeling of responsibility to speak about my culture and also in, I guess, conversations within class, even, to provide my perspective as an East Asian American woman, right? Like, I was the only one, so I felt very responsible to say something, but also my natural inclination was not to say anything. So that was very isolating, and not a lot of people could understand what I felt, and there was no East Asian American leadership either at my school, so there was no one to really turn to, except within the community, which was really helpful. But, yeah, I just wanted to share my experience with that, and it also makes me think of, like, regional discussions about these type of things. I was very grateful to see the session on here, just coming back to the West Coast, because these discussions aren't happening over where I am in Texas. I'm in DFW. I go to TCU for context. And I've learned a lot about, I guess, like, pro-love, pro-compassion, because of such a different environment that I was forced into. I have a lot of compassion now for people very different from myself, but it makes me wonder if we should be going out into communities that we're not used to going out into to talk about these things more, to expose ourselves more, because I feel like there might be, like, more of me out there in these, like, I guess you're from Tennessee, too, so I don't know if you can speak on that, but, yeah, I don't know. That's what I was thinking about. That makes me a little bit sad to hear that it's both a responsibility and what comes with that, also a burden inherent to responsibility, to feel like you need to be seen, but doing that, if you're a minority in a particular room or circumstance, does take something out of you. So it's a double-edged sword, and it replays. So thank you for speaking about that. Thank you for sharing your experience. I won't speak too much on that, but I think afterwards we can talk a little bit more about how to, you know, advocate for yourself in these spaces where you don't feel like you have someone you can really confide in, in a safe space that understands your experiences. So I want to move our discussion along here if there are no other points, but thank you so much to everyone for sharing along with us. We're going to move on to patient care here, and I don't want you to read all this text. I want you to know that there are plenty of studies that suggest that racial and ethnic incoordinates in patient satisfaction are highly correlated, and that is true. I mean, the data shows that it's really helpful to have someone that looks like you speaking about in training. But when it comes to patient care, that has also been shown time and again. Working with therapists, looking at ED admissions and hospital admissions, patient satisfaction scores in the elderly, but I want us to really look at the giant words at the very bottom. But you don't have to look like me to treat me, because when we exist in these different places, wherever we practice or wherever we see our patients, we should not necessarily say that we have the competency to know what everybody's experiences, their lived experiences are. I might be East Asian, but that doesn't mean I know what all the East Asian experiences are like. And there's plenty of the studies. Specifically hooked in 2013, this study looked at cultural humility versus racial incoordinates, and actually found that cultural humility was more important factor in predicting patient satisfaction in care. So, when we look here to the left, culturally competent care. Who has heard this in their health care systems? Who's heard this on their banners? Who's heard this being toted around by their different organizations? Yeah, we want culturally competent care. Well, it's to me very intimidating. It suggests kind of mastery, this idea that you must be proficient in order to be a good doctor, right? So, I would posit, maybe we don't use the word culturally competent care, and maybe even go back all the way to travel in 1998, when a major discussion, major terminology came around with cultural humility. Is anyone familiar with this term? Yeah? It's not a new term. Not a new term. And what about speaking of that cultural formulation interview? Has anyone heard of this? Well, if you haven't, I have a QR code you can scan in, that if you want to use it, the APA has published, Francis Liu and a lot of his, the team has worked really diligently on a cultural formulation interview, and it really incorporates, if you don't feel like you are culturally competent like me, with a lot of different ways, it's not necessarily having that competency, but this gives you a good framework to work from as you start. I'd love to talk off the mic more about the cultural formulation interview and its impact as well. But, that's the QR code, if you would like that, you can save it to have access to the cultural formulation interview. I had to use my humility to scan the QR code, and when I did, I saw that, you know, this two, three page document, it's not that long actually, some stuff I was already doing and saying, some stuff I was not, and so this was very helpful in providing language and how to speak to someone who you're not familiar with it, culturally or not, I think it applies in the ways that we're different and when we meet different people. Has anyone used the CFI or the cultural formulation interview in their practice? We can show our hands. Excellent. Well, I encourage again, everyone to use the CFI or consider using it, and we can talk a little bit more about that after this, if you'd like. Shifting that discussion for the two terms here, cultural humility, cultural competency, again, I borrowed this image from Project Ready, and this was more based for family therapy and therapy working with children and adolescents, but I wanted to kind of bring your attention here in the audience today to maybe kind of shift our focus, and maybe this is like a pyramid scheme, but we're going to do like a reverse pyramid scheme. Most pyramids are built from the bottom up, makes sense, and that's kind of how I think our traditional healthcare system, people, the powers that be, suggest that we should probably approach working with patients that are marginalized, but I would posit again that we should flip this upside down, where instead of cultural competency being that base or that foundation, I say we actually start from cultural humility, and what I mean by cultural humility is being open-minded, again, that lived and shared experiences that your patients have. You're not going to know everything about them, and you shouldn't start and think that you know everything about them when you see them in your offices or if you see them by bedside, so I would say that's kind of the scope where we should build up or build down from. We should start from this point. Everyone should be reaching this point first before we build on cultural competency. By approaching from cultural humility, we can say, hey, I recognize that you have a different experience. What is going on in your perspective? I want to know, and as you get more and more comfortable and you see more patients, and maybe there is a level of block that you can build upon this, a level of cultural competency. Again, I don't think there will ever be a foundation that you're finally hit. I think you just keep building and expanding, and with this model, I think you're no longer saying that you have built that base, and that's where you're going to build everything else, because then you're going to reach a finite point. By doing this, you're just constantly going to, just like a good learner, you're going to continue building your base until probably the day you die, and I love that kind of idea. I absolutely love the term humility and cultural humility, but unfortunately this term, I don't know, any of these things can become buzzwords, and I've seen the people who listen the least just spout these words like cultural humility and not actually practice them. So anyway, that's... Practice what you preach. You've got to walk the talk. So Adam has, this part of our talk is about patient care. You talked about patient satisfaction, you don't need to look like me to treat me, and also this concept of cultural humility, which is hopefully not just a concept, but an active way of treatment. Well, let's talk a little bit about the barriers to even providing this treatment in our country. So as Adam said before, 6% of our population identify as Asian American or Pacific Islander, and that trickles down into about 1% of AAPI receiving mental health services. Why is that? Well, there are some barriers to care, and I can't list all of them, but I'll start with a few. So mental health is a Western concept, at least I'll talk about how it's a Western concept here. And particularly for immigrants, when you come to our country, this country, I can say my country, when you come to our country, it's already difficult enough acclimating, assimilating, what have you, and universally mental health is a stigma. I'll share a personal example. So I'm of Chinese descent, and there is a concept of losing face when you reveal a personal weakness, a psychological weakness. And I'm sure there's a version of that, a version of that shame in whatever person's culture or ethnic group. Another potential barrier for individuals accessing care is the lack of care that's tailored to them. If it's not in your mother tongue, for example, if it, again, while you don't need to look like me to be treated by me, sometimes it is helpful. Like what does the programming look like? What is the advertisement? What do the clinic pictures in the clinic office look like? So again, there's some of that just to bring people in to get them through the door. Another way I think of mental health as having a, mental health can be Westernized is that typically it's a one-on-one treatment. It's individual treatment. But some of the communities that we're thinking about, Asian communities, come from a more collectivistic background. So where communities and group-based sort of activities and even healing are more relevant and more familiar. So perhaps having more of these group-based activities would be helpful. But there's a dearth of them. For example, I lead Asian therapist process groups, and I don't know too many out there. Yes, it's super niche, but there aren't too many, and I hope that will change over time. And like our woman from Texas has mentioned, there is an issue with research. Asians have either been lumped together or they've been excluded from data or weirdly put together in such a way that is a little bit of both. But the problem is, as Adam mentioned, is that different Asian ethnic groups are different from each other. For example, the Hmong people, which is a cultural group associated with China, they believe that seizures are a form of spiritual transcendence and experience. In my culture, that's not the case. And so one has to be sensitive to how you might want to look at a study when they say Asian Americans were part of the study. I would challenge you to say, okay, how do you define Asian American? I actually really appreciate, I came across a study that was talking about interracial relationships, and they were very specific. They were looking at Chinese Canadians. I was like, I got it. I'm with you. I know how this may or may not apply to me. So what's something that you can take with you today? What's something that you can implement when you go back home tomorrow, next week? Hopefully you have a nice long vacation after this. But like I mentioned, whether you have a virtual office or an in-person office, what you provide in written communication can be in English, but if there is a mother tongue present, it can also be in that. So it doesn't have to be one or the other. And because we do have virtual access to all sorts of things, I think there's less of an excuse not to be more culturally tailored. Another thing about working with an individual is acknowledging the different parts of them. And one part that has come up for me is the spirituality and the religious role when working with my patients. So as a Chinese descent individual, there is the concept for me of my ancestors and how I think about that and how I think about them and how I honor them. That has also some individual tailoring that may not be the same for another Chinese individual. So ask. Ask and be open. I still ask and I'm open because I just don't make these assumptions that I'm the same as Adam or Bob, for example. And this also, if you're going to be open and you're working more in a hospital setting or anything that allows you to communicate with the relevant support network, consider that it doesn't have to be the parent or a family member. It could be a spiritual leader, a community leader that can facilitate the mental health treatment. So religion and spirituality are often very grounding for people. Another very grounding thing is just knowing who you are. And sometimes culture and ethnic identity give you that. And that's what I would consider a strength. And so if you see that these are things that are helpful to your patient, that help them feel like they belong to something, even if they're in a new country, even if they're in a new space, I would encourage that. I would discover that. And it doesn't have to be ethnicity or culture. It could really be anything. OK. Is this for discussion? OK, there we go. So I want to lift Adam's other slide. You know, you don't need to look like me to treat me. I have been in analysis for seven years, seven, eight years, with a white presenting psychiatrist. And from day one, I have never felt superimposed by their views. I have felt that they've led with this idea of cultural humility. And I don't even think that they know what that is. They don't know this term. But what my psychiatrist, my analyst, has taught me, and I think it's very, very helpful, is that she says, Teresa, you still have mysterious parts. I'm not going to pretend like I know you. I know everything about you. And so she's really come in with a sort of, I don't know. I don't know. And I think that's such a humble approach, humble and open approach to learning about someone, whether you're patient or not. I think I'll leave it at that. Thank you, Teresa. Approach with curiosity. Check those assumptions at the door. Health care delivery. There are three prongs, as we had foretold earlier. Insurance, status, delivery, system reforms, research funding. Historically, Appy Plus has had challenges in assessing health care and insurance. 7.4% of all applications have been assessing health care and insurance. 7.4% of Asian-Americans and 9.4% of Pacific Islanders do not have insurance. I think this was as recent, this was a 2017 data point. Language barriers, like Teresa was saying, may contribute difficulty in finding these kind of services. I thought this was a very interesting statistic, that almost 33% of Appy Plus don't speak English fluently or have LEP, or limited English proficiency, by Department of Human Health Services. So even in 2021, almost a third of Appy Plus communities don't use English or don't speak it fluently. So please be mindful of that language barrier as you engage with your patients. Appy adults are the racial group that least seek mental health services. I want to really drill that in. Even though, again, we make up 20% of the workforce, we saw that 6% of the US census is American and Pacific Islander. Again, like Teresa's slide showed, only 1 out of 100 actually will be able to get mental health services, or about 10%. So it's a very low rate, three times less likely than our white counterparts. Of Appy adults with mental illness, 73% didn't seek mental health services versus 56% of the overall population. Moving along, I want us to draw attention. This is from another organization, Appy Data, back in 2014, right when they were trying to measure the ACA, the Affordable Care Act. And I want to, kind of looking at the disaggregated data, just take a moment just to kind of appreciate how far distributions this looked. So from Japanese, 5.3%, not having health insurance, to the Tonga population at 27%. Look at that distribution. And then putting that in context, back in 2012, before the ACA was rolled out, unassured rate for whites was 12%. General population was almost about 15%. Asian-American, by and large, 15%. Black Americans, 17%. Native Hawaiian and Pacific Islander, 18%. Native American, 27%. And at the highest was the Latinx at 29% here. If you remember from a little bit earlier, we had talked about COFA, when we had talked about the Micronesian states, the Federation of Micronesia. We had talked about, if you look here, by and large, a lot of the Appy-plus communities actually responded really well to the Affordable Care Act, with a lot of the uninsured rates going very much down over the years. There are some instances where this had actually peaked back up again, which I thought was very notable. Let me see if I can point it here. I'm not the best at using a pointer. But when we look at Native Hawaiian and Pacific Islander, it actually jumped back up again in 2018. And this was the year where, throughout this whole period in 2018, this was a big discussion of actually they would be included in Medicaid expansion again. So for many of these patients, they didn't receive it. And we saw that jump back up. Until 2020, they actually provided Medicaid again for many of these people from the Coffton nations. And if we talk about evidence-based health care delivery, we just talked about insurance. One of an evidence-based approach that I think the APA has really wanted to push out is more of this integrated care model. These are some evidence-based approaches where collaboration and integrative care both are thought to maybe help reach the gap. Teresa talked about the mental health stigma in our communities. And Asian-American patients often express emotional distress through somatic symptoms. And the stigmatization of the mental health in these communities makes it unlikely that they might go to a psychotherapist, or they might not want to go to a mental health center. And so it would also poise the question, if we can have more collaborative care or integrated care clinics, this might be a good way to also address these symptoms and help reduce the stigma. And finally, when we talk about research, AppyPlus data should be, by and large, disaggregated data. These are just a couple of points that we had put up on here, why it's really important when we don't even just aggregate it, where we look like East Asian, South Asian, Pacific Islander. You can find some very interesting correlates in here. So among Korean-American adults, 33% experience symptoms of depression, compared to those that only 16% of Chinese-Americans. Among Filipino-American women, 78% stated that their mental health was excellent, very good, compared to only 45% of Chinese-American women and 50% of Vietnamese-American women. Japanese-American and Korean-American men were at much greater risk of suicide than all other Asian men. This was as recent as 2018. Another coalition group that had done this with CAP. So just even disaggregating some of the East Asian data, you can see there's differences by ethnicity and ethnic origin. And that brings up to the second point of genetic ancestry. These aren't necessarily related to mental health, but these are some notable studies out there right now. The Female Asian Never Smoker Study for Lung Cancer, Meteors of Arthrosclerosis in South Asians Living in America for Cardiovascular Disease. So understanding ethno-psychopharmacology research is very important. Who here knew that maybe you should dose your Clozapine differently for East Asians? Yeah, I'm seeing some hands here. We think about Lamotrigine as well. So there's more studies that are being done. But this goes back to the point of our psychiatry workforce where there's 0%. Not a single dean is from the Appy Plus community. And so where do most of these research trials happen? They happen in academic centers. And so this is not just a systems issue for our workforce, but also for our patients where we are not getting the funding, we're not having the advocacy from the top down. And finally, these are some anti-racist health care systems in action. I've just linked some of these. And if you look in your packets on the APA meeting app, these links are also provided for you as well. So you don't have to take a picture of them here. But I'd like to highlight two things. The Mountain Sinai Center for Asian Equity and Professional Development. So this is a great resource center for those that might live in a New York City area. This was kind of the whole broad basis of being able to do some coalition building. So it's not just within the medical context, but also being able to build out workforce centers, working with other organizations in New York to build up a program that can exist. I think the ultimate goal for that is also to be able to expand that outreach, not only at Mount Sinai, but also for other people, maybe in Texas, maybe in Tennessee, different places where you can have access to more resources. And I think Robbie had pointed out that we should work with other organizations. We should work with other communities as well. And so we have an APA resource document, Advocating for Anti-Racist Mental Health Policies, with a focus on dismantling anti-black racism. Maybe one day we'll have an anti-API plus racism resource document. And we take a lot of inspiration and a lot of practice with here. And this was from the JRC in 2021. So that was pretty recent that this was published. All right. I'm going to turn this over to Bob. Thanks, Adam. I'm going to say a few things about caring for the APA plus health care workforce and APA plus patients in general. Maybe in a way, this will be a super brief APA plus cultural competence 101. So traditional Asian value, it may be interesting that the oldest person up here is bringing up traditional values. But a traditional Asian value is filial piety, respect for, and deference to one's parents, which also extends outside the family to ancestors, as Teresa mentioned, other elders, authority figures. Doctors are authority figures, so this can give us leverage. But it can also mean our Asian-American clients may agree with us in the office, because it would be disrespectful not to, and then just go home and do whatever they want. Traditional Asian values are also collectivistic rather than individualistic, as Teresa also mentioned. My aspiring to get crazy rich may have to do more with showing that my family, a collective, is respectable than with showing off how awesome I am as an individual. What underlies a lot of this is the issue of face, as in saving face or losing face. I love this quote. Abstract and intangible, it, that is face, is yet the most delicate standard by which Chinese social intercourse is regulated. If I don't respect my parents or my doctor, they lose face. If I'm not model, for example, if I have mental illness, then I and my family lose face. I have firsthand experience with internalized racism. The racist outside world saw me as inferior, and I internalized that and saw myself as inferior. In other words, I got depressed and developed self-esteem issues. Now, thankfully, I'm less split and have more positive views of being Chinese, since, after all, the Chinese invented paper, right? Chinese invented gunpowder. Chinese invented the toothbrush. How many of you knew that? Sometimes I get carried away and tell people, the Chinese invented New Year. I think of it as ethnic pride. Pride is better than shame, but I don't want to go to the other extreme and become an Asian supremacist either. Speaking of the other extreme, there's the model minority myth. Asian-Americans can feel they have to be successful, for example, get into Stanford and then law school or medical school. Like racism, the model minority myth can also be internalized and become part of the ego ideal. There can be both external and internal pressure to succeed, and as a result, anxiety and, again, self-esteem issues. There are differences between first and second generation Asian-Americans. Immigrants, my parents' generation, have left and therefore lost their homes and are outsiders, literally foreigners, in a new country. The next generation, my generation, can feel betwixt and between, neither fully Asian nor fully American. They, we, can also feel ambivalent about being relatively comfortable in the US after members of our families suffered or died in the Cultural Revolution or the Vietnam War or were, in some other way, traumatized. Health care workers, like, for example, us, can also be affected by stigma. We may see our role as helper, not helpee. Having needs may be unacceptable to our model minority ego ideal. We can also be affected by a small world mindset. We may feel we would lose more face seeking treatment because it would be from a colleague. I'm a believer in telehealth and not just because I'm an Asian IT guy. With telehealth as an option, Asian-Americans may not remain the racial group least likely to seek mental health services. Telehealth may feel more private, and stigma may be less of a factor because an AAPI-plus patient won't be seen walking into a clinic or office or sitting in a waiting room. If the clinic or office is a predominantly white space, then they may also feel less other. Even if the API-plus patient has an intake in English, if they can then see a clinician who speaks their first language, as Adam said, 32.6, there's a 32.6 chance they're not fluent in English, they may feel more comfortable, and the communication may be better. Now we're going to share some further thoughts on caring for the API-plus health care workforce. Thank you. Thank you, Bob. In this part of our discussion here, I'd just really like to highlight more so the personal experiences we've had as a trainee. We've had process groups in my training program, and this is not necessarily for API-plus workers, but it has been very impactful for our trainees in our program where we've had process groups. There's still a huge stigma in the workforce where you go get a medical license and they report, have you ever participated in therapy or been treated for mental health? Well, does group therapy count as getting treatment or something like this? So that might preclude people from wanting to participate, even in our own day-to-day as mental health providers. But I found that having a process group was very helpful for our residency program. And for me, even though I'm the only one that kind of looks like me, people were able to hear my story in kind of a safe space and it was facilitated by an outside therapist as well. Other reflections, community solutions. As I had pivoted to talking about earlier, that a lot of our rejuvenation and training, residents and fellows work long hours. And so where do you really find your comfort? It's not going to be in the hospital. I would probably step as far as away I can from a hospital. But just being in communities and finding those, like you were saying earlier, other people that might understand your experiences, but that's not meaning that they have all your same experiences. So other people who have been marginalized in my communities, I've also found just being able to participate in their communities as well, supporting each other has gone a long way. But those are my reflections. So I'm going to give the post-training sort of reflection. You know, the basics of self-care still apply once you graduate. You've got to eat, you've got to sleep, you've got to exercise, do the things that you enjoy that refresh yourself. I think that's one leg of this like three-legged chair. The other leg of that is enjoying your interpersonal connections and deepening that. So that could be your family, your friends, your colleagues, your loose connections and associations. These are interactions and people that you probably see every day by virtue of where you go for work, how you drive, where you shop, all those sorts of things. Now I'm going to talk about the third chair, and this is my chair, not everybody's chair. The third chair is about seeking, seeking out these connections. You can do it by, you know, joining an improv group, going to your favorite bar and like cheering for the Nuggets or the Lakers, or in my particular case, it's finding a group, a community. So a lot of the community spaces that, at least the professional community spaces that I've gone in, you know, I'm usually in the minority, and that's not a bad thing. I still learn, I still receive, I still get a lot out of it. But what the pandemic helped me face and confront was that that should be a choice for me. So I thought more about, well, why don't I have more professional communities that are more representative of me and perhaps even what I look like. So my special third leg is group psychotherapy. I feel like there's something about group. There's the power of group. There's the power of belonging. There's a sort of like mega womb, if you will. A lot of our work is an individual treatment, and group can be intimidating, but it's also exciting, scaring, and nourishing all at the same time. It could be a support group where you mainly get support. It could be a process group where you go beyond support. You go into processing yourself, why you do what you do, and how that might relate to things outside, outside of your family relationships, loved ones, friends, colleagues. So group has personally been for me a very rewarding experience. And I say rewarding because it doesn't always feel good. Sometimes it's difficult and painful. And I will say, like, you know, I try to take my own medicine. I mentioned that I'm in my own analysis. I'm also in my own group therapy. I also seek group supervision and individual supervision as well. So doing some of these things I think helps build empathy and sharpens my clinical acumen. So I'd like to challenge you or ask and invite for more discussion. Like, do you take your own medicine in here? Adam, Bob, do you take your own medicine? Doctors are the worst patients. But I will say that those of us who are members of the API plus health care workforce ourselves, which is most of us here, have the opportunity to set an example. And I don't want to be too grandiose, but maybe make an effort to dismantle stigma by taking care of ourselves and taking our own medicine. I'm in individual therapy and group therapy. If any of you are interested in group therapy, check out the American Group Psychotherapy Association, or AGPA, which is how Teresa and I met, where Teresa and I met. I'm not taking prescription medication. I do drink coffee and I like beer. As an aside, since I've been spending more time in API plus spaces, I've been wondering about treating in my white therapist for one of color. So I'm not in individual therapy or taking medicine, but I am very new to this space. I definitely grew up with a leeriness towards, I don't know if anyone has watched Beef. Has anyone watched Beef? Well, there's a protagonist in there. He said, well, how is this western medicine going to help my eastern brain? Okay, so I definitely had that approach kind of coming into this and going into psychiatry. And I think for me, that process group that we've been doing this year has really opened my eyes as a trainee taking my own medicine. So I'm at that point, and as you've heard from some of the discussants and presenters here, some of them have been many years into this. So I'd like to open it up, if we can, to hearing from the audience about taking our own medicine and kind of our experiences. I wanted to leave time for this in our presentation today, if that's possible. Please use the mics. Don't be shy. For taking my own medicine, when you put the definition up of anti-racism and I read it, I was looking. After the second reading through, I saw what I was looking for, which is that the biggest, well, I don't know if it's the biggest issue, but one of the issues I certainly have to deal with is me because of the things that either I have done or thought about or have not understood that have hurt other people. I can do that as a black person for sure. It doesn't make me immune to be biased, hurl microaggressions at people or macroaggressions or anything at people. For me, that is where I'm trying my best to take my own medicine, working at it, coming to talks like this and trying to just expand what I know because I know now, maybe not then, but now, that there's a whole lot I've got to learn. I want to make two comments. One, on one of your slides, it said views of one's own group internalize racism and devaluation leading to depression, low self-esteem issues, et cetera. Also, the model minority myth. Of course, growing up here, if you're Asian of any Asian persuasion, Indian, Chinese, Japanese, it doesn't matter, Filipino, they always look at you as the brilliant one and usually you are if you're at least where I grew up in mostly white neighborhoods. It was like they always wanted to cheat off you. The interesting thing that you brought up here, the internalized racism and devaluation, is that the issue of microaggressions is so significant that if you are a white individual, you have no idea what it is. Every instance you meet someone, whether it's in school, classroom, boardroom, in your office, you can see people's facial expressions, their interactions with you. You can see, it's amazing. I wear my turban when I go out without my turban with my hair in a ponytail. Totally different reaction. I'm considered almost a white American with my hair in a ponytail. It's always been that way for over 20 years. It's just interesting. I know growing up here, we devalued being Indian. In other words, we were kind of anti-Indian. Even though I can speak, read, write my language, I still look at Indians with a negative view. That's partly being just the American way. We've been acculturated. In America, we look at others, which is the rest of the world, as less than us. I see that society has really affected me. It affects all of us. I thought it was really amazing that you brought up that point. I've never really seen that type of thing, how we devalue ourselves. The microaggressions, I've known about that forever because of the great Chester Pierce. Many of us have grown up reading about him and his studies. That's my two cents. As far as therapy, I think it's amazing. It helped me get through my divorce. I did it for five years, dropped out. After that, my therapist retired. Fifteen, twenty years later, I got into it again recently due to kids' issues. We'll leave it at that. It's amazing. I highly recommend it for everyone. I've been in some form of therapy since medical school because I needed it. I've also undertaken mindfulness and self-compassion, loving kindness, meditation, and use that on myself as well as teaching my patients. I definitely eat all of that. I think we're all works in progress. I think our own growth helps our patients grow as well. They help us grow. I would say that we've got a long way to go in terms of really creating community amongst Asian Americans. Can I shorten it to A-plus? Will that be better branding? I think this is great. There's probably at least half a dozen Asian American-oriented things at this APA. I've attended as many of them as I could go to. There's been, I guess, relatively sparse attendance at all of them. Even though they're great topics, they've all been presented well, I think. There's a question of even Asian Indians are the largest sub-population of Asian psychiatrists. Yet, not many of them identify. Not many of them attend. The same thing is true, I think, for other Asian groups as well. It's like this question. I don't know why are people just not identifying or they're avoiding each other and these issues, even though we're psychiatrists. Do they think they already know enough about it? They say, well, how can I apply this to my treatment of my patients? Maybe there are all these questions. I don't know. The questions of affiliation, affection, and appreciation within the Asian American community, I think, are ongoing. In response to what you just said, I think, again, it points out to the whole thing that you brought up is devaluation and internalized racism. That's why you see a lot of us not gathering together and, I think, being supportive of these programs. You're right. The programs are amazing. I think everybody should be able to learn from this. I know we know a lot about African American racism and stuff because it's been talked about so much. But about the Asian experience, it hasn't been discussed, and it's finally being talked about. I think someone wrote that this was one of the first years that a lot of Asian programs were being presented. I think that's fantastic. I think the more people become aware of it, maybe in the next five years we'll see more attendance, hopefully. But I think the big problem is what you brought up. I think that hits home for almost everything. We devalue ourselves. We look at ourselves less than what we really are. I just agree with you about, you know, we almost internalized, in some sense, sort of like a devaluate. That's personal experience. I remember when my father-in-law came to help out with my kids. I forgot exactly what my husband said. Something about the fair and unfair at the workplace. My father-in-law said, you live under someone else's house. In Chinese, you're under someone else's. You better just be humble. You really just consider yourself as a lower part. If your parents kept telling you that, you kind of feel like, okay, yeah, we are the lower one. That is a part, I think. Also, you said Bob. I should have remembered the last name. You mentioned about internalizing a lot of things regarding the culture. Regarding how we internalize things. That's almost generation to generation. How do we coach our children? How do we educate our children? The way of Chinese parents raise children also. We usually are not self-esteem enhancement oriented. Improvement oriented. Always, you're not enough. You've got to do better. That sometimes impacts self-esteem. Related to leadership, you never feel assertive enough to be a leader. Regardless of how good you do. These are just a few comments that I have. Regarding my personal treatment. Very interesting. During my training, I had a very rich resource. I was able to ask my teacher, do you have a good psychoanalyst? He just said, yeah, I have my friend. You go to get therapy. When I moved down to D.C., no connection. I really love to hear the group. I think maybe I can start from that. I think we all need that. Just for the burnout, the support, the very basic thing. Also, enhance our ability to help our patients. I think it's very important. Never forget, don't make assumptions. Like Teresa mentioned, you're not know at all. The longer you practice, you feel like, oh, I know everything. Thank you. I think all three of you have brought up how there's so much negotiations one has to do internally and externally. Whether you wear your turban or not. Whether you're in an interracial marriage. My husband is Indian. We have Chinese and Indian, and we're in America. Not only are we navigating east-west and together, but also even within the diaspora, navigating that and learning about differences and how we want to raise our children. I think it's such a rich conversation. I think the attendance of a certain number, I think that's just a reflection of hope. Hope always starts out small, and then it grows. I think we're just lucky to be here at the beginning of this journey. I'll live long enough to see that it grows further and further. I want to also be respectful of everybody's time here today. This has been a really engaging discussion. Thank you all. Adam, would you like? I just wanted everyone to take a moment to give each other a round of applause. You all have been excellent. A round of applause for everyone here. Around the world.

APA conference

anti-API racism

coalition building

community healing

Adam Chan

Bob Chung

Teresa Lee

cultural humility

diversity

healthcare disparities

integrative care

disaggregated data

internalized stereotypes