Struggling to Help Troubled Immigrants : Mental Health: Many recent arrivals develop emotional problems, but a lack of services and cultural barriers hinder getting aid.

When Ophilia Yip, a 34-year-old Chinese immigrant from Sepulveda, drowned herself and her four young children in Los Angeles Harbor recently, 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 Los Angeles area.

“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.

Immigrants who come to Los Angeles typically are at great risk of developing emotional problems, said Augusto Britton del Rio, 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 suffer 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 many Vietnamese immigrants have a fundamental lack of understanding of mental health care.

Even if the services were available, he said, “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.”

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 important, 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, she said, it still takes time to build credibility in the community it serves.

To further complicate the problem, Rimonte said Asians in the Los Angeles area speak 40 languages and include 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, said Sergio Martinez Romero, 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, he added.

Luis Rubalcava, associate professor of educational psychology at Cal State Northridge, 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 that 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 to be asked to 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, Rubalcava realized that it was a great opportunity to see family members 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 its first family session.

But that sort of flexibility is almost always impossible with the county’s tight budget for mental health services.

The San Fernando Valley Community Mental Health Center in Van Nuys, however, 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.” 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, trust in the center builds, and the staff can begin to deal with the clients’ emotional problems.