As Paul Hoang watched the televised scenes of panic and chaos unfold at the Kabul airport in Afghanistan in August, memories flooded back to him. He remembered the stories of beatings endured by his father, who fought with the defeated South Vietnamese Army, his family’s perilous escape by boat in 1987 when he was 7, and his own years of mental suffering and suicide attempts as a refugee growing up in Orange County, California.
Another feeling also emerged: the resolve to take those experiences with depression and post-traumatic stress disorder, and his skills as a social worker, and put them to work helping Afghan refugees coming to the US. Some 37,000 Afghans are slated to be in the first group resettled nationwide, with 5,225 expected to come to California.
For his part, Hoang is helping to organize a volunteer effort called OC GROW (Orange County Growth Resilience Opportunity and Wellness) to welcome refugees. In August, he quit his job as a service chief with the Orange County Health Care Agency to devote his energy to building community programs and assisting refugees. The group hopes to use a stretch of land in Garden Grove owned by the county transit authority to create a center that will offer services to the community, especially newly arriving Afghans.
For Hoang, the images from Kabul were both searing and triggering. “Seeing the pictures of the children, the women, the families being separated…” – he can’t finish the thought.
“My family was separated, my mom and my younger sister were left behind when we escaped. It caused devastation.”
Hoang grew up in a tiny village in South Vietnam in the aftermath of the Vietnam War, hearing stories about torture inflicted on his father and reprisals against family members caught trying to flee. When 7-year-old Hoang and his father escaped on a 21-foot fishing boat with 27 others, the engine broke and they floated for 30 days, at the mercy of the sea. They ran out of food, were attacked by machete-wielding pirates, and finally rescued by Indonesian fishermen. They were transferred from one refugee camp to another, finally ending up in the Philippines.
In late 1989, Hoang and his family were resettled in Orange County, home to a large Vietnamese community. But that was not the end of his ordeals. Starting in middle school, he was teased and bullied in school, called racist slurs, and sometimes jumped in fights.
Hoang spent much of his adolescence in pain and anguish, with little insight as to why certain experiences triggered him. “Every time there were clouds or a rainstorm, my whole body would start shaking involuntarily and I’d get this intense fear and anxiety,” he says. “When I would go to a body of water or swimming pool, my body would lock up and I would sink down to the bottom.”
Hoang became angry and depressed. As a teenager, he thought about developing an atomic bomb to blow up the world and contemplated suicide. Once he even took his uncle’s handgun from its hiding place and put it in his own mouth. “My whole body locked up,” he recalls. “I heard a voice: ‘Stop, it’s not your time yet.’”
Years later, during a psychology class at Catholic seminary college in Iowa, he had an epiphany: the feelings he had experienced were actually symptoms of post-traumatic stress and depression. Eventually, a professor convinced him to go to Loyola University in Chicago and study social work. He did, and it resonated.
“This is what I was called to do — to be in the secular world and work with people,” he realized. “I didn’t want to fish people out of the river as a missionary, I wanted to find the root cause of why people were coming down the river drowning.”
After earning his social work degree, he returned to Orange County and saw the necessity to address the Vietnamese community’s mental health needs. He conducted a needs assessment, started a television talk show for the community, and eventually launched a nonprofit group called Viet Care, focused on prevention, early intervention and advocacy.
“Our goal is to improve the lives of those suffering from mental illness and their caregivers,” he says. “Our three key values are compassion, empowerment and collaboration.”
He also began working to increase the number of Vietnamese people working in mental health and to encourage community members to help each other by providing mutual support. “There are not enough providers in the community,” he says. “And if they burn out, it’s a huge loss.”
Over the years, Hoang has developed several specialties. For Orange County, he provided crisis response, working with people experiencing psychiatric crises, and collaborating with police responders as a hostage negotiator. He also runs a training consultancy that uses simulations to engage trainees and make their lessons memorable.
In recent years, he has also focused in on the high rates of gambling and alcohol addiction in the Vietnamese community. Both, he says, are underreported and underdiscussed. “The community doesn’t talk about it as a problem and it leads to divorce and severe financial impacts,” Hoang says. “Individuals with gambling addiction are three times more likely to commit suicide compared to any other form of addiction.”
He also has organized food distribution for people in the Vietnamese community who are suffering from mental health challenges or have lost jobs to the Covid-19 pandemic. Now he is turning his attention to the newest group of refugees and trying to anticipate the challenges they will face.
One will be profound culture shock. “They have grown up and lived in a culture and lifestyle which is completely different,” he says. “Not knowing what to do, what’s safe, what’s not safe, that reinforces that sense of uncertainty, fear and anxiety.” These feelings, he says, “trigger the floodgates of their own trauma” from their experiences back home.
The best ways to help newcomers settle and adjust, he says, is not so much to offer mental health services or counseling but rather to focus on helping families meet basic needs and connect in community. “We need to integrate mental health care into every aspect,” he says. That means being aware that something as seemingly innocuous as going to get driver’s licenses at the DMV – a government agency and outpost of authority – can trigger anxiety in people coming from a repressive country.
He advises community leaders and agencies to provide a “soft landing and soft engagement” for the new arrivals and to create a safe space for the children of refugees within the community. Addressing their mental health needs will also be complicated by cultural differences in help-seeking.
Like the members of his Vietnamese community, he says, people coming from Afghanistan are unlikely to seek mental health services from outside professionals. “If we have problems, we talk to an elder, to someone in the community, rather than going to an office space,” he says.
Another challenge is the disproportionate number of female social workers and therapists. Traditional male Afghans may be reluctant to accept medical or psychological help from a woman. And for Afghan children, interacting with the opposite sex in school will be an adjustment for both them and their parents.
To Hoang, the best way to cut through cultural differences and provide meaningful mental health support is by building a sense of community. This means helping people find jobs and develop career skills, and take part in gardening, cooking classes and physical activity together. Providing therapy can flow from there. The aim is to encourage wellness while removing the stigma of mental illness.
“We need to set up an infrastructure to be able to support their success,” Hoang says.
Veronica Ortega is a community psychologist based in Berkeley. Rob Waters is the editor of MindSite News. This article was adapted from one originally published on the website of the Steinberg Institute.