Troubled Immigrants Find No Where to Turn : Mental health: The deaths of an Asian woman and her children focus attention on the lack of counseling for minorities in the Valley.

Two weeks ago, when Ophilia Yip, a 34-year-old Chinese immigrant from Sepulveda, drowned herself and her four young children in Los Angeles Harbor, the city was shocked.

But the murder-suicide didn’t completely surprise mental health specialists who have been struggling to find multilingual, culturally sensitive counseling services for the growing Asian and Latino immigrant population in the San Fernando Valley.

“With victims such as Mrs. Yip, if there were more outreach programs, we might be able to avert the tragedy,” said Gladys Lee, director of the Asian Pacific Family Center in Rosemead. “She went to see a counselor, and they didn’t understand her” problems, even though she spoke some English.

Yip quit going to a counselor after the second visit, her husband said, telling him that because of her Chinese upbringing and heritage, only someone from her culture could understand her problems.

But psychologists and therapists say there are no mental health or family service programs designed for Asians in the San Fernando Valley, and while there are several geared to the Spanish-speaking community, most of these only accept the chronically or severely mentally ill for treatment.

Immigrants who come to Los Angeles typically are at great risk of developing emotional problems, said Augusto Britton del Rio, Ph.D., clinical program director for Hispanic mental health services at Valley Hospital Medical Center in Van Nuys.

Of 400 Latino immigrants interviewed in a 1987 study by Cal State Northridge, 72% were thought to have suffered from traumatic stress disorder, Britton del Rio said. Their stress comes from the political upheavals and war in the countries from which they came, the poverty they experienced and continue to face, their inability to speak English, and the loneliness and discrimination that come with being new to a country and to a culture, he said.

About 90% of Vietnamese immigrants suffer from anxiety, estimated Hao D. Doan, a social worker and past coordinator of the Southeast Asian Community Center, which closed in July due to a Los Angeles County budget cutback. Doan, who fled South Vietnam in 1975, said the majority of about 10,000 Vietnamese who live in the Valley have a fundamental lack of understanding of mental health care.

Even if the services were available, “the Vietnamese have a different concept of mental health. They see it as a state hospital, for crazy people only. In Vietnam, we don’t even have a department of psychology in any university. These people don’t know the idea of psychotherapy,” he said.

That’s a problem common to many immigrants to Los Angeles, experts say.

The Asian clients that Lee said her center encounters carry myths and fears about counseling. “They wonder if perhaps one of their ancestors did something wrong, or if it’s a failure of theirs that they can’t handle the problem within their own family,” she said.

Nilda Rimonte, executive director of the Center for Pacific-Asian Family in Hollywood, said the Asian concept of mental health care is so vague that “we don’t even have words for depression.” She agrees that many Asian clients believe that the only time people should “seek mental health care is when they’re raving mad.”

Three issues stand out in mental health care for immigrants: availability of services, access to services and, perhaps most importantly, breaking down the cultural barriers to the services that do exist, Rimonte said.

“If the client is not acculturated to seek help, having it available is not enough,” she said. “You need community education, and now it’s almost as if community education is a luxury.”

Studies have shown that centers with staffs who speak the client’s language and are part of the client’s culture are used more consistently than others, Lee said. Even when a center has culturally sympathetic staff, Lee said it still takes time to build credibility and comfort in the community it serves.

To further complicate the problem, Rimonte said there are 40 languages in the Asian culture and 23 ethnic groups. That diversity makes it virtually impossible to ensure that a given center will have a counselor available who speaks the client’s language.

If the person providing mental health services cannot speak the client’s language, the counseling cannot be effective, according to Sergio Martinez Romero, Ph.D., clinical psychologist at the San Fernando Valley Mental Health Center, a Los Angeles County-funded agency, and president of the 200-member California Hispanic Psychological Assn.

“It is impossible and unethical to provide therapy in a different language, even with a translator,” he said.

Other experts agree. Herman Rodriguez, Hispanic services coordinator at Valley Hospital Medical Center, said translators are ineffective because they can mistranslate, conveying the literal meaning of a word rather than what the client was trying to express. Just having a third person in the room, overhearing the conversation, can limit the client’s freedom to open up.

Luis Rubalcava, associate professor of educational psychology at CSUN, explained how complex the cross-cultural barriers can be. A few years ago, his sister called and asked him to counsel a Mexican family with a teen-age girl--a family friend--who had severe stomach pain, but no medical problem could be found by her physician. Rubalcava said his first inclination was to say no--you can’t counsel people you know--but then he realized that this family probably wouldn’t be comfortable talking to someone it didn’t know.

So he called the family and was surprised when he was asked if he would meet the family at its house. “I thought, ‘How odd, they’re supposed to come to my office.’ But I went anyway,” he said. Once there, he realized that it was a great opportunity to see them in their home setting, to watch how they interacted. They had refreshments together and talked. After that meeting, the family was ready to drive the 15 miles to his office for their first family session.

But that sort of flexibility is almost always impossible with the tight county mental health services budget. According to Martinez Romero, the San Fernando Valley Mental Health Center has only enough money to treat the chronic or severely mentally ill. At Manos Esperanza clinic in Van Nuys, Walter Buitrago, manager of Hispanic services, said “the demand is much, much greater than the ability to provide by county and private services.” His program serves between 150 and 200 clients a month, and he said he has to turn people away because the program can only handle the high-priority chronically mentally ill.

Not all programs, however, are full. The San Fernando Valley Community Mental Health Center in Van Nuys accepts MediCal patients and has county contracts that make rates very affordable--”as low as $1 to $2 a visit,” intake coordinator Jan Claypool said.

The center has a staff of 215 and provides a range of services, including outreach, a homebound program, day treatment, a homeless program and adolescent care. As for the lack of a program geared to the Asian population, Claypool said: “It’s real difficult for people to get over the hill and it’s almost impossible for them to get services. The demand is there.” She estimated that between 3% and 5% of the population in the Valley would use Asian-specific services.

There are new services, too. Valley Hospital Medical Center opened a 40-bed inpatient Hispanic mental health program in December. The program provides group and family therapy, in Spanish, and a 12-hour-a-day, five-day-a-week Spanish-language crisis line. The hospital only accepts patients with insurance, but refers uninsured clients to other community programs.

Rodriguez, the Hispanic services coordinator, said the hospital has found that 75% of the people who have jobs in Valley factories also have mental health insurance coverage, evidence that the “Hispanic population has become an economic reality.”

“That population has come out of the underground economy and they are part of the mainstream economy,” said Britton del Rio, clinical director of the program. “Other hospitals will have to change their focus to Hispanics or their bottom lines will suffer,” he said.

Doan, coordinator of the now-closed Southeast Asian Community Center, is working with leaders in the Vietnamese community to set up a new Vietnamese community center, probably in Reseda, with a range of services, including social services and youth programs. Plans are still indefinite.

Doan favors programs that provide social services in addition to psychological help. Many of the Vietnamese immigrants face institutional barriers--an inability to know or work within the social service system--and a user-friendly, culturally sympathetic program could help, he said.

Lee of the Asian Pacific Family Center agrees. “When clients first come in, we help them file for Social Security, get an attorney, whatever they need. In order for us to hook them in, we have to provide concrete services. They won’t come in for something abstract,” she said. Once those basic needs are met, she added, the trust level with the center builds, and the staff can begin to deal with the clients’ emotional problems.