Assembly Select Committee on Select Committee on Mental Health Accessibility within Non-English Speaking Communities

There it goes. All right. Good morning, everybody. We're going to go ahead and get started. I know that we've got a couple of other Members that are going to be popping in. There's other Select Committees that are happening right now and other Committee hearings that are going on at the same time.

And so we'll have a couple of other Members kind of pop in for a bit. We'll go ahead and get this Select Committee for Mental health accessibility with non English speaking communities started. And today for this hearing, it's specific around our AA and HPI communities. I'm assembling Member Stephanie Nguyen.

I want to thank those that are here today for being here.

Just a reminder that this is just an informational hearing, which means that the information that is shared today, the information that is given today will be information that our legislators, our Assembly Members specifically will be able to take the information and not only share it, but it's an opportunity for us to hear from our communities as well, too.

I ask that we keep applause, you know, after speakers to ourselves. I ask that, you know, we not shout or whatnot. You all look like a great group of folks that probably will not do that, but I have to mention it anyway.

We are on a time crunch, and it's an hour and a half hearing because we want to be able to be respectful of not only your time, but other Members time who have other areas they have to be. And there's a big event today for our nonprofit organizations, actually today that we're celebrating.

So we'll go ahead and get started. I want to go ahead and let our Assembly Member introduce themselves. Great. Thank you, Assembly Member Tri Tong. I'll go ahead and ask our presenters to come forward and introduce themselves, and then I think there is an order in which you wanted to present the information. Testing. Okay, great. Thank you, Andrew.

Thank you to this Committee for holding this important hearing on the mental health needs of the Aanhpi communities. I want to especially thank chair Stephanie Nguyen for championing this opportunity for us. My name is Tu Quach. I am the President at Asian Health Services.

We're a federally qualified health center in Alameda County, and we provide medical, dental, behavioral health to 50,000 patients in 14 different languages, 12 of which are Asian languages. And we've been around for 50 years. This is our 50 year anniversary.

We have long seen the importance of mental health services for our diverse patients who have experienced so much past and present trauma. Yet there are many barriers that prevent them from seeking and accessing much needed mental health care.

Because of the unmet mental health needs, as well as other priority areas such as language access and data disaggregation in 2022. Asian Health Services founded and established I'm just trying to see what that noise is established the California AA and HPI Health Equity Coalition, a statewide coalition with other lead organizations including Asian Resource Inc.

Center for Asian Americans in Action and Orange County Asian Pacific Islander Alliance, OCAPIA. To advance on a health equity agenda that is inclusive of the AANHPi communities, we have over 50 organization Members. You'll be hearing from two of our coalition Members, Peter G. From Little Tokyo Service center as well as Natalie Asun from rams.

In addition, a number of our coalition Members and partners are here in the audience to show their support. As a coalition, we recognize that mental health is a priority issue for for the AAHPI populations.

These communities face compounded impacts of migration and intergenerational trauma, experiences of othering and discrimination, and the model minority myth that gaslights the many challenges ANHPIs face. Yet, underutilization of mental health services and under diagnosis of mental health illnesses have been consistently documented.

Cultural factors such as stigma as well as structural barriers like language access, lack of language access, culturally responsive services, health coverage and access and knowledge of the complex mental health systems contribute to these disparities. In addition, the lack of disaggregated data masks within group disparities.

As a result, the challenges faced by AA and HPIs become invisible, and this perpetuates the model minority myth. This has concerning consequences, including minimizing resource allocation, dismissing the need for targeted strategies, and promoting self doubt about seeking professional help, all of which in turn feed into a vicious cycle that further contributes to underutilization and under diagnosis.

Today, I want to focus on two major issues, data equity as well as workforce shortages. A major underlying factor perpetuating the model minority myth lies with the inaccurate and inadequate data on mental health needs for AA and HPI.

Lack of disaggregated data masses disparities within and among AAHPI groups for example, despite significant mental health stressors, the statewide California Health Interview survey shows that 16% of Asian Americans reported the need for mental health support, which is lower than the California's overall population of 24%.

But when the data is disaggregated by ethnicity and by age group, we see that more apparent disparities, such as 43% of Southeast Asian adolescents reported needing mental health support compared to California's statewide adolescent average of only 34%.

Similarly, while 6% of all Asian older adults thought about suicide in the last year, Min disaggregated 16% of Korean older adults contemplated suicide. In addition, there has and continues to be limited mental health research that includes AA and HPI's. Those studies that do include these populations often only have small samples with insufficient disaggregated data.

Furthermore, many surveys are not conducted in language, thus excluding AA and HPI populations with limited English proficiency. Some studies that utilize in language survey and screening instruments have shown greater mental health concerns and underutilization among AanHPI respondents, underscoring the need for more linguistically inclusive research.

For decades, our communities have advocated for accurate data as is paramount to advancing health equity. We can't address disparities impacting communities unless we can uncover the true inequities. The other issue is really around workforce the pandemic exacerbated the need for mental health services while exposing our nation's severe mental health workforce shortage.

The brunt of that shortage is borne by communities of color who have the least access to high quality mental health care. I want to share one client story from Nicole staff Member Charles Yeh, who I know is in the audience amongst our parents generation that immigrated here to the United States.

A lot of them are not even sure where to start with accessing care. There's also a gap in describing what they're suffering from based on research findings and my personal accounts asking my mom and friends.

Mental disabilities often manifest in physical pains for their generation, conditions like depression or anxiety will be instead described as stomach, back, and or hip pains, generally more physical ailments. I do hear them use the term yaye, which sort of refers to like an oppression when I discuss mental health with my mom.

Just being able to find bilingual providers that provide mental health care that accept their insurance is seen as a barrier for some older Asian folks that my mom knows. The reality is, regardless of the pipeline investments, there will remain a dearth of culturally and linguistically congruent mental health providers.

We need culturally and responsive mental health counselors who understand that when a Vietnamese former soldier shares about his chronic headache, he's actually referring to his depression since leaving his home country. Or when a kmai grandma complains of stomach pains, it is the pain manifested from the trauma while watching her family Members killed in the genocide of Cambodia.

The shortage in licensed mental health professionals has increased interest in non licensed paraprofessionals such as community mental health workers and lay counselors. These paraprofessionals have been shown to reduce stigma around mental health utilization. Increased knowledge around accessing services, strengthen client provider relationships, and improve the client's mental health and social functioning.

These lay counselors can help connect the dots for marginalized communities to finally come into care. These paraprofessionals are more likely to be culturally and linguistically congruent with communities of color, which often experience a shortage of representation in the licensed mental health professionals.

This need for expanding our mental health workforce became most apparent for Asian health services in the last few years since the pandemic, when we saw how many in the Asian communities were targeted between 2019 and 2022, according to the California Department of Justice, the number of hate crimes against Asians increased by threefold.

As a result, we saw a 2.5 fold increase in mental health needs among our patients. In 2021, in response to the many victims of anti Asian violence, Asian Health Services launched our community healing unit to provide mental health and wraparound services to those impacted by violence. To date, we've served over 300 survivors.

We observed that initially these victims of violence will refuse any mental health services, but through our model of bilingual, bicultural, holistic wellness and counseling, they are more open to talking to a community health worker who they feel they can relate to and is breaking down stage stigma and structural barriers to their care.

In one instance, an elderly couple experienced being robbed four times in a short period and felt very traumatized by their experience, yet they didn't want to seek professional help. Their daughter shared that her parents went inward and didn't want to talk about the experience, even though it greatly impacted them.

Through intentional support of our lay counselors, their silent suffering ended when they finally started seeking clinical therapists. This story underscores the critical role of lay counselors in responding to mental health need and in effectively linking individuals to effective mental health care. Thus, we need a payment model that invests and sustains this important segment of the workforce.

So to conclude, I want to lift up two high level recommendations. One is really to collect accurate, disaggregated data that reflects the mental health needs of AA and HPIs. Data can be power, but lack of accurate and disaggregated data create invisibility for our communities.

Second is to expand the mental health workforce by investing in non licensed paraprofessionals who are more likely to be culturally congruent with underserved populations. So with that, I'll pause to see if there's any questions before passing it on to my colleague Peter.

Thank you so much to Chair Nguyen. Assemblymember, Ta thank you so much for your time and being here. My name is Peter Gee, my pronouns are he and him, and I'm the director of service programs at Little Tokyo Service Center in Los Angeles. I'm also a registered nurse.

LTSC is honored to be here representing the Asian American, Native Hawaiian, and Pacific Islander Health Equity Coalition. The diversity of the AANHPI community is vast. We reflect over 50 distinct racial subpopulations and cultures with over 100 languages, varied immigration experiences, naturalization rates, English proficiency levels, and other socioeconomic factors.

My testimony today is just one snapshot based on what LTSC is observing on the ground. We know that there are countless other stories and trends within the AANHPI community, and I want to acknowledge my many colleagues in the audience today who are working on these issues in the communities across the state.

I want to start out by sharing the words of a then fifth grader, Nick Song from the San Gabriel Valley. In a school project under future goals and ambitions, he wrote, I have many ideas and dreams of future careers. I'm hooked on the idea of being an oceanographer. Ever since I was a little baby, I loved water and decided to be involved with water in my future. I plan to become a marine biologist or an environmental oceanographer. As a marine biologist, I hope to study aquatic animals in their natural habitats.

As an environmental oceanographer, I hope to become an inventor to save the polar ice caps. I think I'll be suitable for these jobs since I'm a strong swimmer and I'm determined. I snorkel all the time and I love being around wildlife in nature. These are my dream careers.

This fifth grader went on to excel in middle and high school. He thrived in his academics, was a strong student athlete, an active member in his church, participated in countless community activities, and was known to be an incredible son, brother, friend, and student. He went on to attend UC Santa Barbara with a determination to turn these fifth grade dreams into a reality. He never lost his passion for the ocean. What many did not see is that Nick was struggling. After taking a semester off because of his depression and anxiety, Nick died by suicide on April 27, 2021.

Last year, over 600 participants went through our Changing Tides Anchor program, a free suicide prevention training with the QPR Institute. This program was created because suicide is the leading cause of death among AANHPI youth ages 10 to 19 and the second leading cause of death among those ages 20 to 34.

Youth suicidality is at an all time high, but less than one in five youth who have suicidal thoughts behaviors receive mental health care in the community. Fewer than half of youth who attempt suicide receive mental health care within one year after their hospital discharge. According to research from the California Healthy Kids Survey, Asian American, Native Hawaiian, and Pacific Islander youth all reported high rates of chronic, sad or hopeless feelings in the past 12 months. This data has only gotten worse after the pandemic. This demonstrates the high and consistent level of mental distress among our young people.

Public mental health systems are not resourced to address this increase in youth suicide, and we see these disparities for youth of color in Los Angeles County. A 2023 analysis found that AANHPI youth in LA County's mental health programs are represented at higher rates in the mobile crisis response programs compared to outpatient mental health services.

This suggests that AANHPI youth may not receive care until their acuity is too high. Among all racial and ethnic groups, AANHPI youth in LA County are least likely to receive follow-up therapy overall, including after a mobile crisis response. Our coalition asks for better transparency and inclusiveness in how government agencies define priority populations.

LTSC has recently joined with Ari Ocapica PACs, the SoCal Pacific Islander Community Response Team, the Racial and ethnic mental health disparities Coalition, and nearly 60 other groups to advocate for the California Department of Public Health to use better data for decision making.

Two concrete areas of concern are conversations last summer with CDPH highlighted the fact that AA NHPI youth were not considered a priority population in their suicide prevention programs. Because CDPH looked at data on death by suicide from the California Comprehensive master death file, a data set that does not accurately reflect the trends we see as service providers.

CDPH's Office of Health Equity also does not have a designated staff specialist in the community inclusion and partnership team for the a NHPI community.

Since we're not considered a priority population, even though we do fit the department's definition of a priority population, my colleagues at the ARG, the Public Health Institute, and SSG have been seeking to better understand some of the mental health trends for our youth.

They recently conducted focus groups across the State of California, and even though the report is not yet published, initial findings highlight that our youth faith face additional barriers when talking about their mental health and wellbeing.

This is why we should be building on CDP just efforts to center youth voices in local and state outreach campaigns, and we're deeply concerned by the cuts of the governor's may revision that cuts the children, youth and behavioral health initiative.

Furthermore, the passage of Proposition One that redirects 140 million in population level prevention funding from local counties to the state are deeply concerning because many of these local counties have invested advisory committees made up of local organizations that are attuned to the needs of hard to serve communities.

State entities responsible for designing regulations for these new components must hear and follow recommendations from both experts and people with lived experience. This can be done through the appointment of AA and HPI representatives to the respective advisory committees and through focus group meetings with these representatives.

This includes the Department of Public Health for population prevention, the MHSOAC for Innovation Partnership Fund, the Department of Health Care Services for early intervention, and HCIA workforce. Furthermore, these new Proposition one components must facilitate the funding of community defined evidence practices.

New regulations must not force changes to cdeps in ways that make them culturally inappropriate or less desire for the people that they serve.

I want to point out that certain municipalities, like La County's public health Department, have modeled how to work well in partnership with cbos, and we remain concerned about what will happen if the proposed budget cuts go through with the May revise. Finally, our coalition is committed to the utilization of community defined culturally and linguistically responsive strategies.

We asked for continued funding for the innovative California Reducing Disparities project, which funded 35 cultural responsive projects across the state. These projects include non western approaches, including, but not limited to, traditional healers and community outreach workers, and more.

Highlights from a 2022 evaluation found that does CRDP increase access to mental health services and improve the mental health among participants in unserved and underserved communities? Prevention and early intervention are also cost effective. For every dollar spent during this four year implementation period, about $5 were saved for CRDP projects.

The net estimated financial benefit to the state exceeded 450 million. Nick's story doesn't end in 2021. Instead, his legacy is alive and well. Nick inspired many of his friends to pursue careers in behavioral health, including one who just graduated from USC with a master's in marriage and family therapy.

This past spring, adding one more bilingual provider to our workforce, his parents have become fierce mental health advocates in the community, being key organizers for our annual suicide prevention walk and being a resource to other parents of children who have died by suicide.

Nick's mom joined us at our meeting with CDPH last summer, where she heard their reality that if one looked purely at certain data sets, the AANHPI community are not impacted by suicide. That is not the reality that she and her family live with each day.

Nick's story is a poignant reminder that the mental health crisis in our community is very real. There are young people like Nick everywhere, bright, talented individuals who are silently struggling with their mental health. Government plays an important role at protecting the public from a crisis. What we asked for today is that our communities don't remain invisible.

We need accurate and disaggregated data, inclusive policies and targeted resources to address our mental health needs. Let Nick's legacy be a call to action for all of us to ensure that everyone, especially our young people, get the support that they need to thrive. Thank you so much. I'm going to turn it to my colleague Natalie.

Thank you. Thank you, Peter. Before we turn it over to Natalie, I want to give the Assembly Members who just walked in an opportunity to introduce themselves. Start with Assemblymember Ting.

Phil Ting, San Francisco.

Great. Thank you.

Alex Lee, Alameda and Santa Clara County. Thank you.

Thank you very much, Madam Chair, for also providing the space and opportunity to address an issue that impacts our community with great stigma. And I hope that we can lower barriers in recognizing the importance of public discourse in this regard. My name is Evan Low, state assemblymember.

[Speaking Samoan] That was just my honorary acknowledgement to the heavens, the land, my parents and family, the giants of my community, champions in this hearing and those who are tuning in and this Committee for opening this hearing on AAPI mental health.

Blessed rising and blessings to your health. My name is Natalie Tuolumoso Ah Soon. Born and raised in American Samoa, I served in the US Air Force and I currently live in Hayward in Alameda County.

I am the Director of community engagement and Government relations at Richmond Area Multi Services, which is a nonprofit mental health organization that is committed to advocating for and providing community based, culturally competent and consumer guided, comprehensive services that aim to meet the behavioral health, social, vocational and educational needs of the diverse community of San Francisco area.

With expertise in serving the Asian and Pacific Islander, American and Russian speaking populations, RAMS also spearheaded efforts to recognize May 10 as AAPI Mental Health Day. In 2010, Representative Judy Chu introduced the first congressional resolution in 2021 to recognize the same day.

My hard work, the work of the heart, is I, along with three other fears of Pacific Islander leader women, co founded and I am currently the co chair of the regional Pacific Islander Task Force. We are here to command your highest attention.

I'll be listing out some health disparities that impact specifically our Pacific Islander community, and I will use Pacific Islander instead of NHPI as I feel that is more inclusive of all of us that come from that region. Pacific Islanders are island nations and people from the Pacific Ocean. We are diverse.

We come from many, many islands and atolls occupying roughly 300,000 sq mi. About 1000 languages are actively spoken by Pacific Islanders. We are grouped ethnically as Melanesians, Micronesians and Polynesians.

Our current context is informed by political status in our relations to this relation to the US as a state, territories compact of free associations as sovereign island nations and other non US affiliated nations.

Nearly 2 million Pacific Islanders live in the US, a 31% increase from 2010, with nearly 700,000 people identifying as Pacific Islander alone and even more identifying in combination with other races. More than 10 million live in the Pacific. Different experiences and stories are told in data.

There is a legacy of harm imposed upon Pacific Islanders, the legacy of being unseen, unheard, misrepresented, excluded from research that requires large sample size simply being erased. To be present but not seen is deep trauma.

A little more is known about other health status of Pacific Islanders, but even less is known about our mental health, especially among adults. A study by Doctor Sepika and his team showed that Pacific Islander adults are at a high risk of problems such as depression, substance use disorders, and suicide.

The small population paradox deeply downplays the health needs of islanders. Data aggregation has terrible implications for Pacific Islanders. It hurts and keeps Pacific Islander communities at a severe disadvantage and perpetually put us at high risk for health and mental health disparities and across other health and social indicators.

Our needs are not addressed specifically and adequately because we don't exist in the eyes of policymakers, funders, health planners, and so forth. We are left out of opportunities to elevate our communities, elevate our positions. In diaspora, data is personal, not just a number. During the pandemic, we lost many elders and community leaders.

Many are family historians, cultural conservators, innovators. Some families lost two to three generations due to the pandemic. Data equity every community, large or small, has unique health challenges that can only be overcome if we have opportunity to identify and understand critical mental health needs, but also their assets and strengths.

A mere .07% of Asian combined Asian and Pacific Islanders entered public treatment services in 2015, but there are no studies to examine the need for SUD treatment and recovery programs. During the pandemic, Pacific Islanders experienced a disproportionately higher burden of COVID cases and deaths than any other racial groups, including black and Hispanic populations.

In several states with available Pacific Islander data. Covid exacerbated longstanding issues and disparities experienced by Pacific Islanders. And that was even without the pandemic.

Pacific Islanders were already wading in deep water, fending off threats and keep afloat to survive cultural conflict, discord and disconnect, often between cultural values and perspective on how we want to live our value systems. We see this play down in politics and policies that disadvantage communities.

Preserving and protecting our natural and cultural wealth, identity, customs, traditions is stressful. Reacting to stress, to threats affecting our well being, ability to manage wellness, connection to nature and environment because we don't have necessarily access to them or they're being overdeveloped or damaged or gentrified.

An assessment in San Francisco identified Pacific Islander youth, young adults, parents, and community Members identify violence as a major barrier to health and wellness. Issues such as domestic violence, sexual violence, and gun violence were all identified as issues that are experienced by youth in San Francisco. Gun violence is a pressing issue that is greatly impacting the community.

The prevalence of violence of gun violence in the community has also led to violence being normalized. Substance use, incarceration violence leading to single parent and split households also impacts our mental health. The loss of prevention funding at the local level, the chasm between spoken commitments and inadequate funding.

Changing funding priorities condemns us and contradicts the reality we see. Changes to BHS from MHSA shifts priority to downstream instead of upstream approaches. Taking funds from prevention early intervention programs to address housing treatment services may lead to program closure and contract termination. Not that we don't value housing. We believe in housing is a fundamental need.

Working community defined practices that reach hard to reach and appropriately serve unserved communities are at risk of losing funds and having another set of criteria to follow. Burdening providers medical model counters PI Pacific Islander cultural values we value connection to and with others ay ba with nature. We cannot lose people to preventable health risks.

Some best practices for addressing mental health needs among our Pacific Islander community there is a samoan saying that says the spine of a crown thorn starfish. When you get stung by it, you turn it over and put it exactly where you were stung and you will be okay.

That means the solutions to solve the issues of our communities, not just Pacific Islanders but our Asian American communities, are within the same communities rams as to prevention and early intervention programs, one in San Francisco and one in Alameda County, that many of the customs, traditions, values, and verities are woven into the designs of these programs and the activities.

We want to empower others who are ready to serve. We want to have multiple workforce development pathways where we have health navigators, peers, therapists, western mental health services work for many, but it is not for everyone who view health as wholesome.

Where the spirit, body, mind, family, environment, vaatau, nurturing relationships are all part of the cosmos of health. Language is a health determinant. Meeting communities where they are, acknowledge their customs, traditions and values are part of their health. Unifying our voice, banding together to demand change. Cultural solutions to counter cultural trauma.

Some recommendations that have already been stated by Tu and Peter I want to mention just a few. We cannot move singularly, but collectively. I like what Doctor Kaholakula advised Pacific Islanders and Asian American of collective cultures. Our relationships with others are valued and matter a lot and we need to revisit those values because those are protective factors.

Countries that an example I want to bring here. Countries that were best equipped to mitigate and control the spread of COVID were traditionally collective cultures versus individualistic cultures because they easily complied. Also, countries with successful efforts were also led by women. Yes, to women. I also, one last thing.

I'd like to hold the resource allocator and holder of a resource allocator and holder accountable to implement and enforce OMB 15, the federal mandate to disaggregate Pacific Islander and Asian American data. Specific experiences, stories of people can help design programs that appeal to the heart and soul of people.

Careful policy, decision making and their future implications must also be considered. Reversing mental health disparities is our call to action. The notion that we continue to talk and talk to our representatives, but politics can block progress and that is not democratic. [Speaking Samoan] I'll defer it back to.

Thank you, Natalie. Thank you.

I want to give the floor to my Members here in just a sec, but I want you to know that I love that you spoke in Samoan and I want you to know that I'm educated, reminded my team is about the Pacific Islander community because right next to to you is Ty, right there, sitting right there.

And he's on my team and he is from Samoa and he educates us and he ensures that we don't forget about the Pacific Islander community because as API communities we are often left out. We're often the model minority that people think to this day that we're doing fine.

We don't need the help, we don't need the assistance, we don't need the resources. But the Pacific Islander community is even more so that right, we're so forgotten.

But I'm reminded every day through Thai here in my office that do not forget about my community here and so I want you to know that there is somebody who is from Samoa and is Samoan that works for the Legislator today. Right. And he's right here. I wanna thank you for everything you all said.

And I know we were gonna take it to public comments, but before I was even, there were Members before me who advocated for our community, who fought for our community, disaggregated data. Those were issues that they knew then and were fighting for here in this house. And they're here today. That is Assemblymember Ting, Lee and Lo.

And that I'm glad that they're here to hear this, but I want to give them an opportunity also to speak, because assemblymember Ting, prior, in his previous life, he also ran a nonprofit organization, and that was an issue back then, too. And that was just a few years ago. Right.

Assemblymember Ting but, you know, to this day, we're still fighting that same issue, and maybe they can speak a little bit about the updates and, you know, what we're doing now, because again, I want to say that they've made it easier for me.

They set this, got it started, continue to fight it, and they've helped me as to how do we elevate our community. I want to hand it on over to Assembly Member Ting, Lee and Low to give a few words.

Thank you, assemblymember Nguyen. Less about a few words. I think so many of us have been part of this discussion and this struggle for quite a while. I would love to hear from the panelists just their perspective as to why we haven't seen more progress in disaggregated data or in language access.

Language access in particular is a very frustrating issue for our caucus. It's been something that's been a major priority. Diamondly Alatore passed years ago, decades ago, and still we haven't seen much progress.

And so I would be curious, from your perspectives, two seemingly fairly non controversial issues, but for some reason, the state has had trouble implementing both of these ideas. So just I would kind of less of a comment.

I think there's a lot of history, there's been a lot of work on this issue, but to me, we seem to have kind of hit up against the wall. So I'm curious from the panelists what they are seeing as they are talking to both the departments and the agencies, what the struggle is.

So I can start with respect to data. That was one of our big recommendations. We're asking. There's already laws that are in place. AB 1726 has been passed for years, and it was supposed to be implemented in 2022. We're working with the California Department of Public Health.

We should already have disaggregated data, and we're sitting and going into the details of it. And what we're finding is while things are turned on, no one's working through to make sure the data truly flows through that.

Even when the state is saying, hey, you have to have disaggregated data, it's not being carried through for the service providers, for others who are populating that data. And I think that's what we're working through.

We want the state to take ownership that when there is a disaggregated data Bill that you're working through from a through z, not a to c or not c through d, we really want them to flow from the very beginning of where data is collected to how it ends up.

Because this is about raising a very heartfelt, a very passionate issue for our communities because we feel very invisible in silence. I think similarly, with language access, there's already laws in place, and yet when things are not followed, no one is going and saying, hey, what's going on here?

So we know that these issues haven't been implemented. I'm curious as to your opinion as to why we know the what. I think the what's very clear, I.

Really feel like a lot of it, is there's not this sense of urgency while we're hearing about suicides and deaths and so much disparity. There is not that sense of urgency that our communities are suffering. And that's why we came and asked for this hearing.

We really need all of you to help champion and carry that voice through. I don't know if my colleagues have other things to add.

I think it's urgency and a matter of priority. What is the priority for the state? Because I think we've asked and ask, and those many before us have also made the same ask. And it might be an interesting hearing to learn, like who has the power to really pull the lever, but just following up.

Okay, so everybody, and I'm very familiar with this in Budget Committee, everybody says lives are at stake. That's a very common refrain. Right?

And so this is, you know, if you talk to the foster kid coalition that they say lives are at stake, you talk to people who represent undocumented folks trying to get healthcare, lives are at stake. Right. Just, that's a very common refrain. Do you have any anecdotal data or data of your own to demonstrate that statement?

I guess to be able to back that statement up?

Yeah, so we were last summer with the California Department of Public Health to talk a little bit about the issues around youth suicide. And the datasets that they were using were the California master death data set. And then from their perspective, that didn't show that API, the AANHPI community, was impacted by youth suicide.

We provided counter data for that to give a more nuanced perspective that was both data driven and also reflective of the field. But there's been a lack of desire to kind of look at the data that we have provided.

And so we have countered with agencies with specific studies and also quantitative reports to document things, but there's been no acknowledgement from the agencies of what we bring forward.

Can you give the Committee a sense of what this data like? What is this data? Where'd you get it from? And then what did it demonstrate?

There's, I think so there's been a wide cross section of data, but a lot of the stuff that we most recently have shown them was coming out of the UCLA Asian American Study center that looked at some of the things specifically for LA County.

So that is stuff that we, like concretely did provide to them at that moment.

What did the data say? The data set that showed that LA. County is about 25% of the state, so it would be fairly representative of urban California, let's say.

Yeah, the data shows that youth suicide is a huge issue within the AanHPI community.

It showed that when young people that are AanHPi, the Department of Mental Health Services, they're more likely to access it through, like the mobile crisis program versus outpatient mental health programs, which kind of shows that more young people are only accessing services when their acuity is high.

And so we brought things like that and other kinds of real, like reputable, like all things are reputable, but we brought concrete data sets to them around painting the narrative that we do see in the field.

That's great. If you could share that report with us, that'd be very helpful, especially since we as a legislative, like the API Legislative Caucus has also been big supporters of the UCLA Asian American Studies center to assist with that as well. Sorry, we have construction, so this happens quite often, unfortunately.

And assemblymember Ting, thank you so much for asking. I feel like we put together a report that includes a lot of the data and such, but a lot of times, even when we show the data, it's not sufficient.

I think this is about prioritizing and humanizing our community, and we feel like a lot of times we are deprioritized and that is the message that we keep hearing. It's not for the lack of advocacy and heart that's brought to the state capitol and such.

Even the regional Pacific Islander we took on the task of creating three reports, the demographic report on Pacific Islanders in the Bay Area, and that's available. We can share that.

And we also ask for data on maternal and child health, because if anything, that will pop off the data on maternal child health, prenatal care for Pacific Islanders, that number will go off the roof. So we were able to get some data from the California Department of Public Health to create that report.

We also did a needs assessment of mental health during COVID and the Samoan Community Development center also did a needs assessment for youth and their families in San Francisco in 2022.

I also, I know that the East Bay, the Korean community of the East Bay, they also took it apart themselves to conduct their own needs assessment because the data that was available did not reflect the community that they are and also that they were serving.

Assembly Member Lee, any, no questions.

Assembly Member Low.

Thank you very much, Chairwoman Nguyen, and I want to acknowledge the panelists and also those who are attending here today in the State Capitol, the people's house, making sure that our public entities reflect the diversity of our communities.

But I heard a number of observations about the lack of urgency and the disconnect in the implementation, or rather the passage of policies, but lack of implementation due to lack of urgency. My observation has been also such that those in the community, the mechanism to hold public officials accountable, to demand greater accountability, my observation is that there has been a lack of engagement.

So, for example, some of the best practices of other communities are such that community-based organizations would host town hall forums, candidate forums of public officials, to be able to hear from the public official, those in positions to effectuate change, and asking and demanding for the cultural competency and understanding of these different issues.

Are there opportunities--perhaps I'm just not aware--but are there opportunities to which community-based organizations or those that you're also part of, opportunities to host coalition town hall forums or a day at the Capitol or flooding the County Board of Supervisor chambers with hundreds of people, social media campaigns, do those exist already?

I know they do exist, but we will definitely step it up. I know that recently with the passing of Prop 1, the Korean Community Center of the East Bay, who are also right here, they actually went to our Board of Supervisors in Alameda and brought a lot of community members to see the harm that would because by having the prevention funds move from the county back to the state, where they may not know our communities as well as the counties.

But I think that's a great idea, Assembly Member Low, that we really need to be louder than ever because we have constantly not felt heard and our issues are not addressed. So that is a good reminder. Thank you.

Thank you, Assembly Member Low. And I want to recognize that Assembly Member Mike Fong is here. Give him an opportunity to introduce himself as well, too.

Thank you so much, Chair Nguyen, and thank you for convening all of us here for the Select Committee on Mental Health Accessibility with non-speaking communities. I think the panelists have been tremendous. Thank you for your advocacy and leadership. And as Assembly Member Evan Low mentioned, the advocacy here, and great to see so many folks here to advocate.

I know this issue is very critical for us at this time and to really advocate with the California Department of Public Health as well. I know that the efforts, especially with the local nonprofits in the Southern California reached out to me a few months back and so grateful to Chair Nguyen for convening this Select Committee.

We know there's more work to be done around data desegregation, data equity, and making sure that we're serving our Asian American, Native Hawaiian Pacific Islander communities to make sure that we get our fair resources and at the same time, to continue to develop the mental health workforce and to serve our community. So, really grateful for the opportunity to share this space with you. Please keep us posted how we can continue to partner going forward as well. Thank you, Chair Nguyen.

Thank you. Thank you, Assembly Member Mike Fong. Apologize for the noise. As Assembly Member Ting mentioned, we've been dealing with this even during floor sessions, so we're gonna have to speak louder. You know, I heard some of the recommendations, and I will say I'm biased, but I loved when you mentioned ARI, because that's where I came from.

But I think it's one of the areas--I lived it doing the work on the floor with all of you not too long ago, and that I understand the work because it is true that many of the things that you talked about, the community health worker programs, I thought those were the best thing ever because as I worked with many refugees in immigrant communities, you know, they don't trust the government and they wait till the very last minute before they go see the doctor.

And when you're talking about a specialist, I mean, that's even far less than few, and that in some ways scares them, you know, that they're going to go see a specialist. So we avoid that at all costs. And then when it talks, when we talk about mental health, it still continues to be a taboo in our community, that that's not something that we want to say that we struggle with as an individual or even that our family members struggle with.

And so I want to thank you all for the work that you do because it does, truly does take a village, a collective whole, to be able to say, it's okay that you are seeking mental health counseling. It's okay that you're coming to us and talking about it, and it's okay that we continue to advocate for it because other communities do, and it's where they're getting the most attention, right? And our community doesn't do that, which continues to be the reason why we not only get ignored, but we also get left behind.

So I want to thank you again. As you heard from the members here--well, you know, this has been very informative. This has been great. I made sure every single member has a packet. The ones that are not here, we'll make sure we send it to their office as well, too, but we want to continue to keep fighting this. You've got some amazing members that are here that understands the work and that have done the work in the community before, and so your voice is heard loud and clear. I'm going to give it to Dr. Thu to be able to do some final words.

Yeah, thank you so much, and as you heard the very moving testimony from my colleagues that we really try to bring the community to this room. I just want to take a few minutes to summarize the recommendations that we have for this committee, but know that it is in our packet. We know that there's a lot of information. So there are four sets of recommendations. The first: data, data, data. We really need to collect accurate, disaggregated data that reflects the mental health needs of the AAPI population.

And specifically for this committee, we ask that the California Department of Public Health implements disaggregated race ethnicity data collection compliant with AB 1726, which should have already been in place, and also the recently revised OMB SPD 15 for mental health related outcomes and reports out these trends for disaggregated data.

So don't just collect it, but also report it out. We also would like this committee to consider requiring that mental health assessments and screening tools used in health care settings are translated and field tested, because when they're not, they're not getting the right outcomes.

Also, an idea would be to commission a report on the mental health status of API populations in California with an appointed expert panel that includes representation from content experts as well as API community experts. The second set of recommendations is to really invest in culturally and linguistically congruent mental health care professionals, including non-licensed paraprofessionals.

We like to ask you consider legislation that builds a pipeline for bilingual and bicultural licensed therapists and incentivize them to train within working at CBOs serving limited English communities. Also require that the Department of Health Care Access and Information, HCAI, designate at least 25 percent of the funds that are reallocated from Prop 1 going to the state behavioral health workforce initiative with a focus on bilingual mental health professionals.

In addition, help us protect the workforce initiatives under HCAI that are at risk of being cut in the Governor's May Revise, and that includes community health workers and social workers. Really key. Also, consider developing legislation to establish non-licensed paraprofessionals to become billable providers so that they're sustainable.

Additionally, provide technical support to smaller community-based organizations serving the most underserved populations to become qualified contractors so that they can bill for the services that they provide. The third set of recommendations is really to invest in prevention and early intervention services that are more responsive to the needs of the API communities.

With the passage of Prop 1, prevention funding will now shift from the counties, the local counties, to the California Department of Public Health. The process for making funding reallocation decisions must incorporate the mental health needs of AAPIs.

Some examples will be holding listening sessions in our community and establishing an advisory and oversight committee that includes API community representatives. Additionally, we'd like to ask for the same feedback and engagement models for the Mental Health Services Oversight and Accountability Commission regarding the innovations funding. So they oversee the innovations funding.

And the last set is to really utilize community-defined, culturally and linguistically responsive strategies that take into account cultural values, stigma, language barriers, and other systemic barriers to mental health. So this is really ensuring that there is continued funding for the California Reducing Disparities Project, which is aimed at reducing mental health disparities for five key populations, including APIs. This is the one time where we're really included in this.

Also, fund and promote the use of community-based, community-defined, evidence-based practices and evidence-based practices in any request for proposals or grant administered by the state. And lastly, ensure that the Department of Health Care Services elevates and disseminates statewide findings on API populations that are currently being served and integrating those learnings into practice. So those are our specific recommendations for this committee.

Thank you. Thank you, Dr. Quach, and then before we move to public comments, I wanted to acknowledge and give Assembly Member Soria an opportunity to introduce herself as well.

Thank you. Good morning, everyone. Esmeralda Soria, representing the Central Valley and so, just proud to be part of the Select Committee. As someone that is an English language learner and someone that comes from an immigrant family, deeply understand the challenges that many of our immigrant families, the API community, the Latino community that, you know, struggle with language barriers and, you know, many of the issues that you guys have brought up as the panelists spoke today.

And so just grateful to have the opportunity to serve here today on this select committee and look forward to looking at, you know, the recommendations that you guys propose because I think they're kind of in alignment to, with similar the needs that Latino, that the Latino community has along with, you know, some of the other immigrant communities.

Thank you. Thank you, Assembly Member Soria. And just for reference, we decided to split into two hearings. One, because the AANHPI community is so big, right, and diverse and hits so many areas. We held one specific for the Asian American, Native Hawaiian Pacific Islander communities, and then the next hearing, we'll have our Latino community come in and also give their recommendations.

And I agree with her. I've seen some of it, and it's pretty much very almost alignment in what the Latino community is looking at as well, too. At this time, I'd like to invite the public to come up. There is a microphone right in the front, so if you'd all like to come up and introduce your name, organization, and your position. And since we're ahead of time, you can give two sentences. How about that? You're competing against this, so please speak right into the microphone. Come as close as you can and as loud as you can.

Okay. Thank you for this. My name is Priscilla Huang. I'm the Executive Director with the Center for Asian Americans in Action. I'm here to support the testimony of today's expert panel, and I want to share, I'm wearing--three years ago, my niece passed away, and I'm bringing her to this space because we have been so invisible for so long. She was struggling with a lot of mental health issues three weeks away from graduating from high school. So thank you.

Good morning. Stacie Hiramoto with REMHDCO, the Racial and Ethnic Mental Health Disparities Coalition, also representing members of the community members of the California Reducing Disparities Project. Really want to thank the Assembly Member for having this hearing because it is so important, and thank you for listening to the very moving and illuminating testimony of the witnesses. We really need to take action, and we have a lot of ideas, but in the interest of time, I will speak later. Thank you.

Fontaine Low, Alameda County. I support the recommendations. Thank you very much for this hearing. Thank you to Natalie, Peter, for your comments. They ring near and dear to my heart as someone who is supporting her mother, her in-laws in their journey in mental health. I am a daughter of immigrants who have been in that position of translating for my family, for my parents. Thank you.

Good morning. I'm here to share some of my life experience because in the past 40 years, I have a son who, who had a mental health. I have to help him to navigate the system in two different county: Contra Costa Counties, Solano County, and now Sacramento County.

So the accessing to the assistant is a major, major challenge because many, many times at the county level, even though they have the program, but you have to have someone who knows the system, know what to do and to help the person to go to get the help, because now my son is at the board and care in the last seven years, so he's getting better. And I'm here also to represent the ABLE Community Development Foundation. It's a nonprofit organization. I totally agree and support the initiative, but the real happening has to happen at the county level. That's the main, main thing that needs to happen. Thank you.

And we have about 25 minutes and I know there's more than 25 people here, so I know I said two sentences and we're all doing a little bit more than two sentences, and, you know, our members are here and we want to hear you also. If we could just keep, keep it going. Thank you.

Good morning, everyone. My name is Preet Kaur Sabharwal. I am the founder of the South Asian Community Health Promotion Services Program. We're here in support of this mission and I'm also a daughter of immigrants representing the Punjabi American Community. Doing this work has really impacted that community, so I hope we can continue.

[Foreign Language]. Orange County, California. Hello, everyone. My name is Vattana Peong. I'm the Executive Director of the Cambodian Family Community Center in Orange County, California. I'm here in support of 80 years old who jumped off the bridge, committed a suicide in the City of Santa Ana of two years ago. She would have been here in this room with you all if she were alive because she wanted really to bring the cases that she was not able to access the mental health services. Thank you.

Thank you.

Good morning and thank you for having us. My name is Dr. Camillia Lui. I'm a research scientist from the Public Health Institute in Alameda County. Thank you again for taking in all this data, research. It's so important. I'm coming in from the NIH perspective, but I'm also recognizing there's so many community voices that represent data as well, and we really need data desegregation to support what type of services. I also represent the Reducing Disparities Project and the Asian Pacific Islander Hub as well, and want to give a wholehearted thanks to all of you for all what you do.

Thank you.

Hi. Oh, thank you. Hi. Good morning, and thank you so much for holding this hearing. My name is Thuy Do. I am with SEARAC, the Southeast Asia Resource Action Center, one of the Senior California Program Managers, and a constituent in Assembly Member Stephanie Nguyen's district. So I support these recommendations, daughter of an immigrant, immigrant myself, and this is a very, very big moment here. So thank you so much for this space.

Thank you.

Hi. Good morning. Thank you for holding this space for us all. My name is Vincent Chu. I'm a community advocacy manager here at the California Pan-Ethnic Health Network. I'm from Sacramento, but based in the Bay Area at the moment. I'm here really in support of the recommendations that everyone has placed out today. Also the son of refugees here and a representative of the Viet-American community here in Sacramento.

Thank you.

Hi. Good morning. Thank you. My name is Jade MacMillan. I'm from Asian Health Services. I like to consider myself an unofficial paraprofessional as a daughter of immigrant parents and I've had to navigate the mental health system. It's been a challenge, so I support these recommendations.

Thank you.

Hello. My name is Ben Wong with Asian Health Services. Support these recommendations. Also, thank you to so many of your leadership for investing in the Stop the Hate Program, which has provided so much needed capacity and infrastructure to address the mental health gaps, victim support services, as well as allowed us to train and build capacity for dozens of our community partners on lay mental health counselings. Thank you very much.

Thank you.

Assembly Member Nguyen, Members, here to support the recommendations and also just to urge the Legislature as we continue to see a lack of a mental health workforce in the state generally, to continue to prioritize these priority populations. Thank you.

Thank you.

Charles Yeh, health advocate at NICOS Chinese Health Coalition in SF Chinatown. I also support these recommendation. I actually had a friend last year commit suicide, so it can be six days from now. So I'm reminded by the importance of this work. I'm also a constituent under Alex Lee's district, too.

Thank you.

Thank you.

Hi, Assembly Member Nguyen and other Assembly Members. My name is Andrew Minor. I'm with Asian Resources, Inc. As an organization that works closely with Asian Americans, NHPIs, immigrants, and refugees, we're intimately aware of the mental health needs of our community and therefore support these recommendations as well as SB 1078, which would increase access to mental health services through the California Health and Human Services Agency. Thank you so much for your time.

Thank you.

Talofa. My name is Jimina Afuola. I am the advocacy coordinator with EPIC, Empowering Pacific Islander Communities. I support the advocacy, policy, and civic engagement in and on behalf of Native Hawaiian and Pacific Islander communities. I'm just here today to express my support in the recommendations that are made and also want to share too, for Pacific Islander communities that have continued to be exacerbated through Covid-19, that we are still continuing to see that rehabilitation for our community.

And I just wanted to share one out of five NHPI youth have made a suicide plan and so the mental health impacts are continuing to despair our community and I look forward to working collaboratively with you all together. Thank you.

Thank you.

Thank you, Assembly Member for having us here today. My name is Pysay Phinith. I am a program director at Korean Community Center of the East Bay. I support all the recommendations. Wanted to share as well is I, my family, are a survivor of the Khmer Rouge genocide, so a lot of the issues still continue to impact our community today.

Thank you.

Hi, my name is Alina Kim. I live in Santa Clara County. I am part of KCCEB as a MFT marriage and family therapist intern, and I support, wholeheartedly support these recommendations. I have our community leaders lined up behind me. They are part of KCCEB. They represent our community. They are leaders, fighters, and they are here to show their support for the recommendations. They will be speaking in Korean.

Thank you.

[Testimony in Korean].

Thank you.

[Testimony in Korean]. Thank you.

Thank you.

[Testimony in Korean].

Thank you.

I am sorry.

I am very short on my English.

My name is Choi Dong Suh. I am Korean. KCCEB. [Testimony in Korean].

Thank you.

[Testimony in Korean].

Thank you.

Hi, everybody. Good morning. My name is Yong Yi Sun, KCCEB, Alameda County. [Korean].

Thank you.

Good morning. [Testimony in Korean].

Thank you.

[Testimony in Korean].

Thank you.

Hi, everyone. My name is Akil Chan Li. I come to the KCCEB community, and I live in Alameda County, and I like to go to the KCCEB. Thank you very much.

Thank you.

Good morning. My name is Matthew Long, and I'm from Alameda County, and I work with KCCEB, and as one who has seeked mental health in the past and in the present, I strongly recommend, I strongly support these recommendations. Thank you.

Thank you.

[Testimony in Korean].

Thank you.

[Testimony in Korean].

Thank you.

Hi. [Testimony in Korean]. Alameda County. I'm an immigrant and also a first year MSW student, and I strongly support all these recommendations. Thank you.

Thank you.

Thank you so much. As a survivor of a suicide attempt, without organizations like KCCEB, I won't be standing here. Thank you.

Thank you. Thank you.

Good morning. My name is Denise. I'm from Asian Health Services, Alameda County. I am the Child and Youth Services Program Manager. As someone that works with youth, I've seen firsthand how much these programs are needed and access to mental health.

We recently did a needs assessment for our youth, and 13 out of 67 responses expressed that they either attempted or planned suicide. And so, again, I've seen firsthand how our programs have benefited our youth, and so I strongly recommend these--I strongly agree with these recommendations.

Thank you.

Chulu Liao, in support of the recommendations, daughter of immigrants whose grandmother suffered in silence with schizophrenia. So thank you for holding this hearing to really make sure that no one is suffering in silence in our community.

Thank you. Thank you. I want to thank all of you for making the drive out here, traveling out here for such an important issue, topic in our communities. Your words, while I may not have understood everything, I heartfully felt it as well, and so I appreciate--it makes a difference. When you come out like this, it makes a difference not only to me but also to the members that are here, and I know the other members that weren't able to make it, they are streaming online, watching it in their office.

And so it truly does make a difference when you come out as a community to advocate for what you're asking for and what the recommendations for--I want to thank my colleagues and the members that took the time to come out here to hear this today and they have the information that they need.

With that, I'll adjourn the meeting. Thank you very much, and I want to thank the panelists, too. Amazing information that you shared. I know that we were conversation back and forth with our office. Jesse Bermuda is my District Director and Lynn here from the district office, and I have my district office team right back there as well, too. Really worked with you closely to make sure that this was a huge success and this is an amazing success. Thank you again.