Okay, so I'm really excited to be chairing or co-chairing this session, which is a Roadmap for Psychiatry at the Intersections of Culture, Resilience, and Mental Health Equity. I think we have a really, I think, interesting and exciting set of presentations. So I'm going to introduce all of us at the beginning so you know who to be excited to hear from, and we'll go one by one. So I'm Lisa Fortuna. I am here based at University of California, San Francisco. So welcome to all who are visiting us here in San Francisco, where I'm professor and vice chair of psychiatry at UCSF, and I am also the chief of psychiatry at San Francisco General Hospital. So it's a real pleasure to be here. I'm going to introduce my co-speakers. So we have Dr. Germán Vélez, who will be going up first. Dr. Germán Vélez attended medical school in Colombia prior to pursuing a residency here in the United States. He's currently a resident at Boston University Medical Center and will begin his CAP training or child and adolescent training at the New York Presbyterian Columbia Cornell in this next academic year in July. Dr. Vélez is a recipient of the ACAP Research Pilot Award for a project on undocumented child migrants and is currently on both the APA Board of Trustees and the APA Council on Children, Adolescents, and Their Families. And then Brenda Cartagena, MD, is a child and adolescent psychiatry fellowship, finishing up your first year now, at the University of Washington, Seattle, and Children's Hospital. And she's modest, but also an author of children's books, which she'll be talking about, and many, many, many other things, Brenda Cartagena. I have been working together with Brenda and Germán for some time now, and they're just sort of extraordinary trainees that gives me much, much hope and enthusiasm about the future of our field, to have them both entering as psychiatrists. And then we have a wonderful opportunity also to have some community partners that are from San Francisco, which are the Somos Esenciales investigators, including Adriana Camarena, who is the facilitator of their participatory action research. And Adriana Camarena is a writer, a human rights defender, and a governance consultant, and a community member here from San Francisco in the Mission District, and a curler. Okay? She's probably part of the Mexican National Curling Team, right? And then we also have the Somos Esenciales investigators, Connie Rivera, and Anna Alfaro, and Martin, I think, is coming, or maybe, Rodriguez. So we'll hear from all of them. And we're going to start first with Dr. Germán Vélez. Buenos días. Thank you, Dr. Fortuno, for that kind introduction. For us, it's a pleasure working with you, always, and we're very fortunate to have you as a mentor. So we're going to start talking about the objectives for today's presentation. We are going to first talk about a framework that we use for this presentation and how we see our work. Then we're going to learn about different ways that culture helps foster resilience in different settings, in different ways. Then we'll see some great examples of how psychiatrists can use these tools to promote resilience and to promote health equity through the promotion of culture. And we will then describe ways of engaging with Somos Esenciales, and we hope you actively participate throughout the presentation. So, if you can scan the QR code, and we would like you to share with us what aspects of your culture make you resilient. Thank you for sharing. And I think this aligns with our topic today, how resilience is also a community trait. It's something that is associated with the people that we care about. And that was our intention, but how do we make this a part of our everyday practice of mental health? Something else that we wanted to be clear, when I started residency, I was thinking of ways to approach prevention and promotion in mental health. And resilience to me made sense as a migrant. I moved from Bogota, Colombia in 2016, 20, for residency. And resilience made sense, but resilience became a little... I heard that, okay, maybe it's a word that I couldn't, I shouldn't use, because when you talk about resilience, sometimes it's associated about having to overcome adversity. You're resilient because you overcome adversity, and kind of, it's seen as a retrospective value rather than a prospective value. And here, we're talking about resistance as a prospective value, more as a state and not a trait. You're not resilient because you went through adversity, because you shouldn't have to, but you should have the tools to be able to face adversities in the future. And so we see resilience as resistance, as nurturing, as family, as community. One of the ways that we're going to talk about culture and resilience, an example is food. And I'm Colombian, so I'm going to talk a lot about food, and my co-residents have all been exposed to this soup that every time my mom visits from Colombia. It's called changua. It's very polemical because it's hot milk with cilantro, garlic, eggs, and it's an indigenous interpretation of Spanish ingredients. And every time my mom visits from Colombia, she makes this for all the people I care about, so it has a very strong value for me and for the people around me. And something that I wanted to bring up in the APA Healthy Minds Monthly, they did, in the poll, it showed that people, Hispanic and non-Hispanic, were as likely to change their diet to promote their mental health. But Hispanics, 91%, knew the association, knew about the association about mental health and food compared to non-Hispanics, which was 60. But it wasn't about vegetables, water, food, non-processed food. It was something else about our culture that makes food more important. So different examples that also food interacts with our body, the microbiome in our intestine creates neurotransmitters, and their unbalance also affects our mental health. So, this is another, more food. This is the different ways in which food interplays with mental health. We make individual choices based on personal preferences, health concerns, and cultural background. But also there are family and community practices, like we saw at the beginning. And these family and community practices could be things that we do together as a family, such as I mentioned with the Changwa. Also cultural identity and food. We always look for things that we associate with our country of origin, such as, in my case, that picture is Abandeja Paisa. So everywhere that you go to a Colombian restaurant, that's one of the things you're going to see. It's not directly associated with my family, but it's something that it's associated with my country of origin. And that gives me some comfort when I want to go out and eat, and maybe I have Abandeja Paisa. There's also food as a cultural symbol, religious. I was raised Catholic. So La Comunión was important, and it was a way to share family connection on Sundays, and like the different La Prima La Comunión, it's a big family event. So it also has a strong cultural value associated with the country of origin. And there are also systems that affect what we eat, what food is available, the nutritional value of the food that's available, food deserts, and the quality of food. First we'll talk about music. This is an artificial intelligence-generated image, and it's well known that music helps social-emotional development across the lifespan and affects well-being, quality of life, behavior, connectedness, and emotional competence. So this is the different ways, and the reason for this image is music and things we're talking about culture seems very abstract, but all these things are very complex, and they affect our biology. They affect our brain, our structure, and that's the way we think it also promotes resilience. It's a social construct that we foster, but also it affects the human mind, the human brain, the human brain structure in ways that is very deep and that we could explore more, that we could do a better job at exploring and looking at different ways in which we could affect brain structures through culture, through music, through community, through food to promote mental health. So one example of the ways that music promotes resilience, it's a song called Cancion Sin Miedo. Cancion Sin Miedo is a song by Bibi Quintana, who is Mexican, and it was created because in Latin America, femicide, it's one of the biggest, biggest issues. There are one-fourth of women in Latin America face gender-based violence, and Cancion Sin Miedo in October of 2020 in Mexico, there was a big strike when women stopped doing everything they were doing. So 80,000 women stopped to demonstrate how important the role of women in society is, and the hashtag was, so this is some numbers, about 137 women are killed by their partners or family members daily in the world, usually 15 to 29 years of age. Most of them are committed, more than 4% are committed against girls under the age of 14, and there are a lot of children left behind due to this tragedy. So what I was talking about in Mexico, the hashtag was, Un Dia Sin Nosotras, Un Dia Sin Mujeres. And this demonstrated how important women are, especially in Latin American societies. And this song became a world phenomenon in every country, at least in over 50 languages all over the world. And when I hear this song, it really moves, because as you hear it, we have some subtitles, but it names the girls in each of those countries, the women that have been affected by femicide and by gender-based violence. So we have some examples from different parts of the world that we're going to show you now. I am the one who will make you pay the bills. It is in the nights that I was walking alone And I need to get my mind to calm down And when I want to get out of my house We all move together in front of me You don't have the right on my body And I'm telling you why I'm going and what I'm doing The pain and the violence will never stop We will never stop We will never stop And if you don't understand it, you don't understand it I'm telling you that I'm telling you from my heart ♪ Machi puna, sincho machi puna. ♪ ♪ Andamos sin miedo, pedimos justicia. ♪ ♪ Llegamos mordadas, desaparecidas. ♪ ♪ Que el reto mejore de los que hemos sido. ♪ ♪ He caigado en fuerza, el feminicida. ♪ ♪ He caigado en fuerza, el feminicida. ♪ ♪ Y retienden sus centros la tierra. ♪ ♪ Al sonoro rugir del amor. ♪ So, that song is, I think, for all of us that, me personally, being Colombian, I know how many women in my family, women I know have been exposed to gender-based violence. And music is a way to connect, to create community. We're all moved. We need to connect with that emotion. We need to connect with that sense of wanting to do something to help others, to be a community, to be our families, to protect. Seeing little girls have their community support, be part of this project, singing this song about remembering the women that have been hurt, but also thinking about the future and how to resist. So, one of the things that we wanted to convey today was resilience is resistance. It's a way to resist oppression. It's a way to resist violence. And we can draw on cultural elements to resist and to look for a world that's more equitable and that protects people that have historically been marginalized or that are vulnerable for any reason. I would normally stand up, but I just don't want to move the computer in case the cables get disconnected. Okay. So, I want to tell you a quick story. It's the story of six blind men in a village in India. So, the story says that there was a group of blind men that, you know, they never came across an elephant and they were very curious about it because they heard many things about how an elephant looks and what they do, how humans use them. So, one day they decided, like, we should just ask a child, you know, and, you know, we can ask the child to take us to meet a real elephant. And what the child did is that he put the blind men around the elephant. One of them was at the tail, and that man said, like, wow, elephants are really stinky and super hairy. The one that was on the side of the elephant said, elephants are actually very gentle and soft. I can totally see how a prince could ride it. But the one that was at the front of the elephant said, elephants are extremely dangerous. Just feeling the horns and how sharp they are, they can totally kill a man. So, what this story is telling us is that we perceive reality based in our own experiences. Now, our own experiences are influenced by primary groups, like our family, friends, secondary groups, like school, religious institutions, government, and mass media. Now, there's no longer a debate of the impact of media in our daily life. You know, it impacts the way we think, it impacts the way we feel. And I want to show you, like, how this is... how media is influencing cultural resilience in the world. So, I want to show you this diagram. This was done at the University of Munich by the communications department, and it's the recovery and resilience in entertainment media use model. So, to understand it, let's think about, you know, an event where someone is facing challenge. And, you know, that person gets exposed to media. And media can be divided in two categories. We have the hedonic media and the eudaimonic media. So, what's the difference between the two of them? Hedonic media talks about, you know, personal gratification. You know, it's the type of media that we use to, you know, to feel good. It's like the feel-good shows. Think about it. And the eudaimonic media is the type of media that is meant to create personal growth. It talks about how we as humans, when we face challenge, how can we get new tools, new skills, and once we get those tools, you know, then we are able to face whatever adversity comes. Now, both types of media have short-term and long-term effects. If we talk about just the hedonic media, we have that people actually feel more relaxed. They have some experience of psychological detachment. And one example of that is the TV show Friends. By the other part, like the eudaimonic media, we have that people that, you know, when we see the characters in the shows, we see the adversity that they're going through. We see how they develop new skills and how they master them. And once they master those skills, they are able to remain in control. They feel control over the situation, even if that means that it's only in the inside world. And one example of that is the movie The Life of Pi. Now, both of them have effects at the long term. One is creating positive emotions, right? Like hope, optimism. The second one is having a sense of self-efficacy, social support, and sense of coherence. And all these affects the development of resilience. Now, the COVID-19 pandemic was a culmination point emphasizing the importance of entertainment in people's lives. However, during this time, a very interesting phenomenon happened in the Latinx community. So this is one of the headlines in the New York Times. This was in October 14, 2020, and it says, Less sex, more viewers. Pandemic boosts Mexico's flagging telenovelas. Dismissed as too old-fashioned to compete with streaming services, the melodrama have been viewership search for Mexicans seeking the familiar in a distressing time. Same year, the NPR released this episode. It says, Pandemic finds audiences glued to Mexican telenovelas. Now, if this was a big deal, the question would be like, well, how many viewers are we talking about? It's an estimated that they were up to 10 million viewers per episode in Latin America, which is crazy. But what are telenovelas? Well, telenovelas are the Latin American's iconic sub operas. They air on broadcast channels, and they are daily ritual for most Latinx families. Sorry. If you look at the picture, this is a very common picture for anyone that is Latinx, because this happens almost every day at home. I see some people laughing because it's true. families make, they modify their schedules based, you know, on the time that the telenovela is gonna be broadcasted. And it's very common to see, you know, that they're like kids, they are parents, they are grandparents, while they are having dinner and watching the telenovela, and of course, at the end, everybody has to talk about what they think is going on with the characters of the telenovela, right? Like in short, we like to discuss a drama. However, let's not underestimate the power that telenovelas have in the political arena. These are some examples of articles that talk about the impact that telenovelas have had in political movements. But no, I want to share with you an example of how telenovelas can be used as a cultural vehicle for social and family dialogue on LGBTQ plus acceptance. Some of you are familiar with this show. Well, for those who are not familiar, let me introduce you to La Rosa de Guadalupe, or the Rose of Guadalupe. Now, what makes this show so unique? Well, there are two things. One is that there is a religious title, because the Virgin of Guadalupe is what is equal to the Virgin Mary in Latin America. And second one is that normally a telenovela talks about a story, you know, and it goes over many, many episodes. Here, every episode is different. And it's estimated that right now, post-pandemic, there are 3.2 million viewers daily of this show. So, you know, what is it about, you know, what happens in every single episode? Well, someone face a problem, they pray for help, and a white rose appears, saintly wind blows over the person who is asking for help, and the troubles are over. You know, but let me show you a clip that has pieces of multiple episodes. So you have an idea of what's the show like. Okay, try to not laugh. You don't speak to us like that. I'll speak to you as I please. I'm the queen, so obey me. No, you won't, obey me. Fight. You were mine. Leave her alone, you coward. Mind your own business, because I can make life even harder for you. What are you going to do to me, hit me? What do you want with my son? You remember that day that you dumped me? Well, you told me to get someone else, didn't you? Honey, you're overreacting. It's for her own good. You would understand me, if you misunderstand how things are. It's you, you put yourself in danger. Why is life so hard on me? How I wish I could be happy one day. I don't want you crying or talking to anyone out there, because that's where I'll kill you, and also your little brothers. Oh, dear Virgin of Guadalupe, what am I going to do? Please, blessed Virgin, help my daddy. I beg you, to please help my daughter, and you, Virgin of Guadalupe. Please, Virgin of Guadalupe, make them see the truth. That's the white rose, and the wind. You don't speak to us like that. Now, in 2017, this Catholic show released an adapted version of the short film, In a Heartbeat. I don't know how many of you watched this short film, but it talks about the love story of two gay guys that fall in love when they're at school. And this is a picture of the Rosa Guadalupe episode, that talks about it. You can imagine the impact that it had in all the Latinx families when that episode was released. They were so criticized by the Vatican. They were criticized by a lot of Catholic websites. However, I mean, people didn't stop watching it. Actually, I think it attracted more people, especially the younger ones. And in 2022, so this just happened last year, December, they released the story of a non-binary adolescent that was bullied at school. It portrays that the parents accepted them, and actually, they were fighting for their school rights. This is a tweet of an influencer in Latin America, and somebody says, wow, I cannot believe the Rosa Guadalupe is talking about gender inclusivity, and is using also language that is gender inclusive, which in Spanish, it's challenging. And at this, up to date, there are more than 20 episodes that talk about LGBTQ plus inclusivity. Now, I just want to put you a short clip of that episode that portrays a non-binary adolescent. The impact of media is very powerful. Now, think about an 80-year-old grandmother watching this episode, and now suddenly, she's introduced to what is being non-binary. Isn't that incredible? And it is, of course, that opens the conversation in the families about what is the difference between gender? What's the difference between your sexual orientation? So, what has been the impact of the Rosa Guadalupe in the Latinx community? Well, it promoted visibility, first, of the LGBTQ plus community in millions of Latinx households. It challenged the society's views of gender and sexual orientation. And this is very important. It created a new paradigm of what is to be a good Catholic, because this show, what it's portraying is that to be a Catholic means that you are loving towards the queer communities, that you are accepting towards the queer community, and that you are respectful towards the queer community. And overall, it promoted resilience to all sexual and gender minorities by portraying stories of Latinx LGBTQ plus characters that were able to find acceptance in their community. You know, let's not forget that resilience is not bouncing back. Resilience is renewal. And when we talk about renewal, we are talking about that it involves applying learnings, it involves innovating, and it involves emerging stronger. Now, let's talk about what are the opportunities out there for psychiatrists to engage in critical community resilience practices at the micro and macro level. And, you know, we want to give you a few examples of, you know, some ways that we, you know, have helped the community in, you know, in promoting resilience. We talk about the impact of media, right? And when we talk about media, that means shows, movies, podcasts, music, books, children's books. And there's a huge need for media that promotes mental health. It can reduce the stigma towards mental illness by normalizing it. And very important, it also break stereotypes. Now, let's just, you know, I want to focus a little bit on children's books. And I just want to point out that the scarcity of children's books that talk about mental health, it contributes to health disparities in the world. And that includes the United States. And good luck if you speak English, but, you know, that's good luck. But if you speak other language other than English, there's even less material out there. So that's why, thanks to APA and the, sorry, one second, I don't know why. Oh, there it goes. Thanks to APA and the SAMHSA Minority Fellowship that, you know, provides money for residents, fellows that want to decrease health disparities in the US, they gave me the money to actually create a children's book that talk about PTSD. And the reason why, you know, this dream has started is because in my own practice, when I was doing residency in New York City, every time that I wanted to talk to a family that were, you know, their kids just suddenly diagnosed that was sexually assaulted or that was bullied severely, like, when I wanted to give resources for the kid and for the parents to understand even what is trauma, what is PTSD, how do you treat it? Like, I couldn't find one in Spanish. And if there was, if there were a few, I mean, the quality was not the best. So I do think, you know, that it's a human right to have access to materials that are, you know, high quality that promote mental health. So this is the cover of the book. It's La Valentia de Pancho, Pancho's Bravery. Actually, Dr. Fortuna wrote the introduction. By the way, I brought a few copies of the book. So please take them so you, you know, and you can, you know, give it to your patients and, you know, give it to, you know, in the clinic where you're working and the hospital. But yeah, I mean, the importance of children's books is huge because, you know, it really shapes the kid's understanding of life in general, right? Like the, you know, the value of family, friends, resilience, the value, right, of actually going to the doctor. And there's a lot of stigma when it comes to, you know, go visit a provider of mental health and don't even mention a psychiatrist. That's, yeah. So this is a picture of Pancho. Here, he's trying really hard not to think about, you know, what happened to him. And this is a picture of Pancho with his child psychiatrist, Dr. Flatface. They are playing Jenga and they, before, you know, they were doing some drawings. So the purpose, for example, of just this picture is just to, you know, normalize for a child, you know, one, going to see a child psychiatrist, two, that is not as scary. Third, you are gonna, you can play with your, yeah, with your doctor. I mean, I'm a fellow and I play with my patients. So it's not, you know, as like in the movie, sometimes portrayed that we're gonna sit on a chair and psychoanalyze them and make hypnosis. I mean, yeah. And, you know, we are very happy that it not only ended there, but once we, you know, promoted the book in Mexico, the government of Mexico pay to have printed the book in all the elementary school in Mexico and also having it translated in an indigenous language. And also, we're very happy that just last week, it got selected to be in all the public libraries in Chile. And this is honestly thanks to my editor also that she's like working really hard. Yes. This is the website, by the way, like if you wanna Google us, you know, lasaventurasdeldoctorchate.com, which, you know, the idea is that it's gonna be a series of books that, you know, the main character is gonna be this child psychiatrist, Dr. Flatface. Yeah, I mean, and, you know, I think we're very happy that we have been able to promote it in different communities, including the Latino Commission on AIDS that is in New York City, which it's, you know, a group of religious leaders that meet every single month to discuss, you know, issues related to health in general. Now let's switch gears. Yeah, so we're gonna, do you want us to switch? Then I'm gonna ask them for a minute. Okay. Hi. My name is Adriana. And I am here to introduce Somos Esenciales, We Are Essential. This used to be my last slide, but they told me it had to be the first slide because we have, oh, somebody's off screen. Dona Elena got off screen. But anyways, we have Ricardo, then Dona Elena is kind of missing. I don't know why. It got disconfigured. Then Martin, and Aide, and over here we have Evelyn, and Reyna, and Dara, and Carmela. And then you see Dr. Elisa on the corner. She was at one of our first presentations to our, our first presentation was to our other community members. And she was there, and then that's me, and then it's Lupe, and Vero, and Paul, who's a bit, he's the instigator of this project. Next to him is Celina Morales, who's with the Southwest Folklife Alliance. And the Southwest Folklife Alliance gave us our initial funding for this project, then trained me, and then in turn, I brought the methodology to the fellows for folklife-based participatory action research. And then we have Ana, and Juan, and Connie, and then, and Danny. So these are the researchers. Los investigadores esenciales, the essential researchers. And then, and Martin's gonna help me introduce our methodology. But basically, we use the methodology of the Southwest Folklife Alliance, which what it means is that we really focused on pulling at the threads of the popular life, la vida popular, our folklife, our everyday lives, as they were impacted in COVID. The grant was to do a research on a topic of COVID. That was it. Martin, ¿quieres explicar, por favor, cómo es que hicimos la investigación? Y aquí, si quieres. Buenas tardes, no, no, ¿cómo tardes? Buenos días. Está oscuro. Está oscuro aquí. Wow. Especialmente, para empezar, nos unimos un grupo de bastantes personas que ya lo vieron. Salimos a las calles, preguntar a las gentes, en la comunidad, en los centros en los que nosotros trabajamos, especialmente donde nos reunimos todos los, nos reuníamos lunes, miércoles y viernes. De ahí se hizo el grupo que salimos a investigar, preguntar a las personas cómo podrían ayudarse unos a otros contra la salud mental, que no es fácil, por supuesto, pero unos lo hicieron cocinando, otros caminando, otros danzando, otros trabajos manuales, y por último, muchos, muchos nos reunimos a caminatas sobre la ciudad, sobre conocer más que no conocemos. Con eso un poco nos ayuda sobre la salud mental, sobre la vida cotidiana. Y en mi experiencia, yo camino bastante por la playa, bastante, reflexionar todo lo bueno y lo malo. Como grupo, por supuesto, trabajamos en armonía, en convivencia, y etc., etc. So Martin was mentioning that we would gather as a group, we tried to be harmonious. We often, as a group, decided a question, and then we'd go out and ask that question to other people in our immediate surrounding, our peers on the street. At the time, we started the research at the Mission Food Hub, which is a volunteer-based food pantry in the Mission that ended up feeding the whole city in the pandemic, and they were all volunteers there. So was I. That's how we connected. But it was through that experience of asking peers at the Mission Food Hub, wherever at work, wherever we were, we would ask our questions and then bring them back to the group. And that's how we found out a lot about the mental health practices of our community, and asking, like, what are we going to do to help each other? And we found out that people love to cook, to dance, to do manual work, to just a series of things that helped us out as a community. Ah, my cauldron doesn't show. My cauldron doesn't show. There it goes. Okay, I don't know why the pictures do that. Anyways, Ana is going to help me introduce the context in which we found ourselves before the pandemic and in the pandemic that was part of our research, what we found out. Good morning. In our research, before the pandemic, we were already living in circumstances that affected our health. The fact that we were living with domestic violence, not knowing how we were going to pay our rent, was already part of our mental health. And with the pandemic, this became worse. It put us in adversities that affected our health, where we didn't know what we were going to do to be able to carry this. So, having these concerns in my personal life, no saber como iba a pagar mi renta por lo que se estaba viviendo con la pandemia, el estar encerrados, a mi me afecto bastante, porque soy cabeza de familia, y el de no saber como solventar los gastos, me la pasaba pensando como iba a ser. Y esto ya era como una olla de presión que se venía cocinando, y durante toda la pandemia me vino a afectar mi salud, muchas familias empezaron a vivir lo que era la violencia doméstica, muchas familias empezaron ya con la depresión, el estrés, muchas familias enfrentaron lo que fue el divorcio, por toda esa situación que se estaba viviendo durante la pandemia. Esto fue lo que pudimos investigar en nuestra investigación. And I was explaining how we realized in the course of our research that we had been like in a pressure cooker, even before the pandemic. We already had rent stress. We already didn't have, were suffering domestic violence. We were under a lot of pressure already, and you can see the many things that we brought up, including people who had already experiences of isolation and being locked up. And then that spills over into the pandemic to trigger even worse mental health problems in the community. There was so much stress and Ana talks about how she would just spend the days and the hours trying to figure out in the middle of the pandemic, how she was going to figure out how to pay the bills, pay the rent. And all of this ended up in a series of like depressions, feelings of isolation. We knew of a lot of families that broke up and a lot of divorces in the middle of the pandemic. And in this little word bubble, we've put a lot of things, a lot of feelings that came up in our interviews and community, grief, stress, the kids were not doing well. So that's a lot of the things that we found in the pandemic and we can talk about it more during questions. Next up, got it now, Connie, we'll talk about, we've not only researched our problems, we have researched our solutions. We can find ways to vent, to vent our grief, to make community, to share it with new people. We felt identified because we were having the same problems and based on that, we learned again to share, to live together, to dance, to talk, to gossip too. It was beautiful because in all of those moments, we were able to vent, be it laughing, crying, sharing grief. When we were healing, it was a form of healing that this place, the Mission Full Hub, offered us. There we were able to find a place, a cultural center, a place, a space where we could vent, where we could share, where we could help others, all the people, our families. Every day, even if it was three days a week, it was a commitment to ourselves, to our community, to the people, seeing the need that there was. And we would come home happy, with a tired heart, but happy because in one way or another, we helped each other economically, carrying our food, but also mentally. And that is what the Mission Full Hub offered to all of us, a cultural space where, unintentionally, we all built it. One person raised it, but we all built it, from the youngest to the oldest. Thank you. And Connie was mentioning how in the course of our research we realized that we already did a lot of things to improve our mental health and a big one was walking in the middle of the pandemic and we realized that a lot of people like had specific places they go. It was the beach, it was the hills, it was you know just around the city or walking the dog, special moments like that. And if you'll see we have a special phrase that we love in Somos that you will see the desahogar las penas which kind of means just to talk, get out, you know lean on a shoulder. We love that word desahogar. We learned that that's what we did when we got together. We shared our burdens and it was part of our practices to be able to count on our friends and family. There was dancing, there was cooking, there was a lot of gardening and many other and and then there was volunteering which connects us all. I'll speak for myself, I was going crazy at home and I saw that as Connie was mentioning Roberto Hernandez, someone created, started the Mission Food Hub and I was just like volunteering, getting out of the house, I'm in. And we all found ourselves there. It was just, we were a self-selected group that then became a group of researchers. But we found there a space to have a shared life again. We learned again how to dance, how to gossip, how to build community and again it was a place to connect and desahogar, to find connection. And we realized that this was our mental health center for many of us. Which leads us to the next slide and Martin will help us understand better what our goal is. Nuevamente, para empezar, nuestras metas serian y necesitamos que nos escuchen sobre como construir un centro cultural para practicar las cosas que uno puede hacer o puede ofrecerle a la gente relacionado con la salud de la comunidad. More support, more people to listen to us, to all the communities that we need, especially the Hispanics, without excluding anyone else, and for them to really listen to us. Thank you. So, Martin is saying that really it's our goal to create a cultural center for mental health. And that was the name that they gave it in the research group, Centro Cultural de Salud Mental. Because we realized that what was healing us was being part of a community and being in a space that connected us to a lot of our roots with our peers being the same people who were providing the support that was economic, both for the food that we got, but also because it was providing mental wellness. But then we, through our solutions, realized that we wanted to keep this idea of a hub where yes, you go in there and you can find maybe a peer counselor or a friend, somebody to lean on. But then as you're there, you get connected to the things that are causing that boiling cauldron to start with, that pressure cooker. We need to connect and need, even if the solutions are elsewhere, one, it was kind of like the food box, you know, being able as simple as that, getting, showing up in a line and somebody giving you the resource you need. And then through that connection to the Mission Food Hub, having other connections, that's what we want. And Martin asks to please support our solutions. We want the center, we want to establish the center, but we need funding. And we also want to continue our research. And thanks to Lisa, I should add, and also the Southwest Folklife Alliance, we are now having sprouts from our research into long COVID one. And the other one is going to, we're just starting round two. We're going to pick another question. And so we're starting another round of research, but we ask that your support. Thank you. I just want to make some comments as we're getting ready and be able to do the question and answer. So when we started to think about this question and we were invited to do this talk around resilience and culture, we all thought it was very important to talk about, one, how can psychiatry and psychiatrists partner with community and what is already embedded within the cultures to be able to promote this resilience, which is really around resistance and supporting one another and the importance of community and the resources that are already available within the community and to enhance and support that for mental health well-being. I have to say that, for me, it's been a tremendous privilege to be able to work with both Hanman and Brenda in terms of the amazing work that they're doing, because they're definitely examples of engaging with cultural context and using that to be able to promote mental health, including through the books and through music and through arts and many, many other things. Please do take some of Brenda's books before she leaves. She has a suitcase there. And then with the Somos Esenciales, I really want to sort of underline that everywhere that I have gone, and this is sort of a recommendation for psychiatrists and especially learners, wherever you work, go out to your local community without strings attached. Do not go out and say, okay, I want to do a research project or I have a goal and I'm going to go and try to recruit, but more sort of go out and just build relationships, right? And to understand what is happening locally that the community is actually doing for themselves and then see how to support. And the Somos Esenciales, I've actually connected with them through a colleague, another physician at University of California, San Francisco, also based at the San Francisco General. And she says, have you heard about the Somos Esenciales and the work that they're doing? And they're doing this participatory action research and really looking at mental health as one of their principal areas that they're asking their community about throughout the pandemic. And they said, we want you to come out and hear the results of their research and what they are learning and to engage you. And I did go, and with some others who also went, like Michelle Porsche, who's also in the audience, and we learned and we became part of their research process. Because when you go there to the community, even as we're dialoguing, right, that is part of the research process of understanding what we can do. And you saw their recommendations around supporting their cultural center, supporting their research. And we have continued in that partnership, right, as well as sort of connecting with our resources around mental health. So the cultural center is something that's coming to a realization in the Mission District of San Francisco. And then also, Somos Esenciales is part of National Institute of Health research grants that we're doing. So they're on one called Supera, which some of them are actually working as coaches to help other people with depression, adults with depression, Spanish speakers in our clinics, use a evidence-based cognitive behavioral therapy digital intervention, but with coaching as one of the conditions. And so they're learning to be coaches, but also they are creating their own questions around the process of how this is actually working. And that was one of the things that we agreed on, is that there would be Somos Esenciales questions embedded in the NIH research, their own defined research that emerges from the process. And then we're currently working with a wonderful opportunity that we'll see how it keeps emerging, that the National Institute of Health actually has a new initiative called COMPASS grants, which are community-driven research, where the community is the principal investigator and the university is the co-award supporting institution to help with the science, but driven by the community. And so we're currently got a very good score on the first round of things and are actually now sort of working towards the final proposals, because NIH is asking for a little bit of an iterative process in this case, but we're moving towards, and it's very much focused on structural determinants of health in terms of housing and employment and economic justice and community development, as well as culturally-based resources, and looking at the long-term outcomes of that for mental health and health. So my message is that there's a lot of opportunity for psychiatrists to collaborate and engage with the community and these cultural resources and let the community drive that mission with you and to collaborate. So I just wanted to talk about that. And so we're open for any questions or comments or anything. I think they, if you can want to go up to the microphone or otherwise, but any questions or comments. Hello. A comment. My name is Francisco Araniba. I'm a member of APA International and I'm from San Salvador, El Salvador. For me it's very important to the mental health in Latin population because here in the state of California there is most people of Latin America, Mexico, Guatemala, El Salvador. The work that you are making, the work that you are doing with all of this is very important to increase the mental health. We, the Latin American people, have a culture very established with a lot of things. I am very glad to see the food, to see the music, to see all the things that are important in the mental health. And are healing or are not good for mental health. We, like psychiatrists, need to know. We have the words, we have the knowledge to know what of these things is going to heal or going to get more ill for the population. Because when I'm Salvadorian, when the people see the pupusas, wow. But we are very, very, with very psychotherapeutic knowledge to encourage this. And I'm very happy for all the work. We are essential. Bueno, nuestra salud mental es esencial. Sigan adelante. Espero que tengan todo el apoyo y sigamos los latinos aquí en Estados Unidos. Adelante. Hi there, my name is Jake Cross, I'm a third year psychiatry resident in Chicago. I predominantly work with Spanish speaking populations in my outpatient clinic. So thank you all for this amazing work, I think this is really important. I had a question for the We Are Essential team. Es una pregunta que, ¿cómo podemos conectar con la gente si estamos tratando de crear un centro? Por ejemplo, si entiendo que con la comida la gente va a venir, pero ustedes están usando como social media o otras formas de comunicar sus metas y hablar con la gente. So is there any way that you're using social media or other ways to communicate and bring people to the center? And I'm just very curious about that process. How did you connect to the film? How do you want people to connect? To connect is to have the opportunity to go out, to speak, to meet with anyone, to ask questions. Social media is a more advanced thing that many people don't have it yet, they don't understand it. You have to communicate with yourself in person, it's much more pleasant, more sociable. That's what I think. the contact with eye-to-eye and talk to people directly. It's not just like me and a phone and, oh, can I ask you some questions for this and that. No, for us, it's like going to the doctor. We really want to see the doctor. We don't want to hear the doctor by phone. It's so important. You don't know how much change in fact in our lives when we talk directly to the person. And the way we did the research, we went directly to the people. We walked in the neighborhood. We walked in the house. And that's the way, that's how we got. to communicate with the person, to have that communication. And in fact, right now in my essential health centers, a walk is being organized. And personally, I already talked about it to the sisters, and we're going to go for a walk. So, making community, sharing information, bringing those resources to our community, makes changes happen, to be able to have our mental health, of the community, of how important it is to be united to be able to. Social media might be a little bit more advanced. In putting our research into practice, people said they like to walk, so we organized hikes in the city, like walks through nature in the city, and even the walks have been learning opportunities, but she's already told her sisters, and we have already told our friends, there's going to be a walk, and in the walk is a way of building community. Right. And I would add that you made the connections with me, right? I mean, you sort of reached out and I think the events in the community, the gatherings, the walks, eating and being together. A lot of eating. So the food in our title is big. And so that was really the way that we've continued to be able to connect, I think. And then the other thing is, is you also represented your research findings through arts, through theater. There was a whole theatrical event where the sort of the experiences of the community throughout the pandemic were presented in more sort of performing arts type of way. And they also have a report, you know, there's a written report, but also the theater and a documentary. So multiple ways of disseminating the information of the work that they're doing as well. And to clarify, we do a lot of video notetaking. I keep up an archive, but it's their information. And those transfers were used by Paul Flores to do a theater production about the lived experience of everything you mentioned. Yes, please. So did you have the center? I don't know, do you have a center that you would all meet and have the food? Where did this take place? I don't think we didn't have any center, but this place was, like I said, founded by Roberto Hernandez, which is the person who created it. He's from the neighborhood, and he asked for help, and we reached for the place, and that was a very... 701 Alabama Street. 701 Alabama, but it's very historical, because that place has been in the 70s, 60s. It was the Centro Social Obrero, the social workers, social center. And that's where they let us use that place when we can distribute food for more than 5,000 people three days a week. And then three days a week, and that's our place, still our place. We only give it once a week now, but that's where we meet each other. They let us use it once a week, or twice, or three times, and that's our place now. We have a center where we distribute food. And I think what I would add is that that's where we also met. They would hand out food Monday, Wednesday, Friday. I kind of dropped off once I was in the project, because I had a lot going on, but they kept on going through, until very recently, providing food. Right. I mean, and the Mission Food Hub was essential for feeding the community that, you know, as you can imagine, had the city, really, because really there was a lot of food insecurity and it became this multi-support setting. Good morning, Thomas Peen. Thank you very much for being with us here. An idea that we have used in Panama and other countries in South America is to have a sponsor for each month. In January it's McDonald's, in February it's Ookla, etc. That works very well because no one is there for a year or a month, and the companies go for that. It's just an idea for you. I'm Jose Zaglul. I'm a psychiatrist from the Dominican Republic. I work in Florida, and I actually want to congratulate all of you because we are, you're talking about things that are very important in our communities and a problem that we share all over Latin America, starting from the violence against women and going with issues of accepting people that are different. And I love the we're essential because it's coming from the community up. But again, in all three talks, I've seen ways that we can do and we can make some changes. I have to say, I don't know if the book that you wrote for kids would be accepted in Florida right now. We have a big problem there. The issue of violence, there's now this thing about almost like a return to machismo as a way of like, this is what we need to do. It's we're losing our culture. But the sense that people have about losing our culture, it's something that we, I think that what I heard here is that we're understanding that in order to produce change, we need to produce change within our culture. When you were mentioning that what happened with this grandma hearing about binary, a non-binary person, it's like sometimes we want to make changes that are like too fast and people then react to that. And I see that this is something to where the community is participating. We're doing some education. We're coming people and saying, this is what your culture is like, and this is something that can produce the changes. So again, congratulations to all of you. And I wanted to ask Brenda, if you could talk a little bit about how you're using your book, because that's interesting. I mean, we all know about even these book bands, right? About talking about different topics and even mental health is getting on that list. How are you using the book to work with families directly or with parents? Yeah, so what I have been doing right now is that, so I got the money to have a thousand printed copies and it's also available online. So what I have been doing is just, you know, talking to other mental health providers and, you know, telling them like, hey, this is, you know, here's some resources that you can use with your patients. The book is about PTSD and we made it, so actually in the story, you know, I was mentioning that there's this little, this puppy, that something happens to him and on purpose we live it to the imagination of the child. So, you know, the book doesn't portray specifically what happens, you know, to that puppy. We're not talking, you know, specifically about sexual abuse, right? I mean, it's, you know, depending on whatever, you know, the child has suffered, that's, you know, what they're going to project. So, yeah, and also I'm very grateful to having been able to engage with the community that New York City, as I said, I was with the Latino AIDS Commission, getting a lot of religious leaders. And it's so interesting, like, they, yeah, I mean, the community listens to them. They have a lot of power, you know, and if the pastor, the priest says, you know, this resource is going to be helpful, they take it. And I was actually very grateful that also some of us in Chalice also helped, Dr. Fortuna, they were also sharing the book in the community. So, yeah, and applying also the other thing is that not only in the United States, but we have been trying to go to different parts of Latin America and apply, you know, for to, you know, there's always like options, you can always, you know, compete with other books so that the governments in the different countries can print the books and make them available to the schools, to libraries. And, you know, so far we have done Mexico and Chile, but, you know, we're hoping that it can be like in all the Latin American countries. Yeah, there's a lot of work to do. And what I liked about your book, too, is that it was translated into an indigenous language as part of the preservation of those indigenous languages. And the indigenous community, I mean, there was a concern that they were like, well, if they learn about this, but then there's no mental health services, right, to manage it. But it seems like the indigenous community that speaks that language still wanted it. Oh, yeah. Because they felt it was a resource to be able to talk within the community about trauma. Yeah, definitely. And it's not only, you know, meant to be as a, you know, part of treatment for PTSD. It's, you know, just to, you know, normalize, right, like going to see the psychiatrist. Right. If you, you know, if you are dealing, you know, with symptoms of depression, PTSD. Right, and talking about trauma. Talking about trauma. That's correct. Oh, okay. Now it's a Guatemala. Thank you. Any other questions? How do you see going forward with this work and looking at culture and as you emerge into child psychiatry and many other things that you're doing? Going back to food, there, I did 17 interviews with undocumented children. And we were looking for cultural factors that promote resilience. And I thought the food was going to be the promoting factor, right? What food is, what's the magic food that's going to solve problems? And as I was interviewing kids, something came up. It was like food that's prepared with love. And at the end, it's not about the food. It's how we share it, how we share it in the community, how the intentionality of food. And I think being able to go back to those concepts that are so basic, apparently. But in mental health, we distance ourselves from things that are just who we are. Food, dancing, joining, seeing community. Resilience not as an individual, but as a community trait. So I think moving forward, because the next step for our project, we're creating a toolkit for primary care providers, mental health providers, community. To how to engage or how to promote resilience in this specific population, in undocumented kids. And they identified three main things when we asked. It was, we called it the three Fs. Family, friends, and fun. So I think the most important is creating safe spaces. And this is a great example of a safe space to share in community and create those bonds. And those things that end up creating culture and fostering resilience. Perfect. Thank you. Any other questions or comments? Hello. I'm a psychiatrist in New York. And I just wanted to say thank you so much for this amazing work that you are doing in so many ways. To impact the community using different media, because that's what we need. The community. Because we are not enough. We need to really incorporate the community and empower them to help us for all the issues that we are dealing. So thank you so much for this. It was an amazing presentation. I just wanted to say thank you. Gracias. Thank you.

psychiatry

culture

resilience

mental health equity

cultural practices

community partnerships

media impact

LGBTQ+ themes

cultural identity

participatory research

community wellness

mental health resources