By Todd R. Brown
California Health Report

To some immigrants, the details of Western medicine lie in unfamiliar territory, so certain maladies wind up being treated by traditional healers rather than modern medical practitioners.

To remedy that dichotomy between the old world and the new, Fresno County plans to open a holistic wellness center that will link Hmong, Latinos and other groups with spiritually fulfilling as well as evidence-based solutions to mental health worries.

Officials have yet to pick a location for the center, which could open as early as July. But chances are it will be downtown to facilitate public transit access for clients coming from across the county, including the black community in southwest Fresno and Southeast Asians settled in the eastern part of the city.

“Spirituality is necessary to humans,” said Megan Ervin, a staff analyst for the county who has researched the idea and helped determine the center’s goals and priorities.

To sidestep concerns over the separation of church and state, though, she said, “We as the government are not going to provide alternative medicine. The county is not endorsing religion. People who walk in are going to receive information, talk to someone from their own belief system. A shaman, a priest, a yoga master, it just depends.”

The center, conceived in 2008 but finally approved by the city council late last year, will also cater to gays and lesbians, veterans, women and the jobless, although it is unclear from background documents exactly what services will be provided for those groups.

Funding comes from the state’s Mental Health Services Act, which levies a 1% income tax on those earning $1 million and up to pay for “Innovations,” or “something new that has the potential to transform the mental health system.” The center’s projected budget is $2 million over three years and falls administratively under the county’s Department of Behavioral Health.

Staffing will be contracted out, and three groups responded to the county’s request for proposals. One of them, the Fresno Center of New Americans, is a nonprofit that formed in the early ’90s to help Cambodian, Lao and Vietnamese refugees adjust to life in America. Over time it has expanded to aid other immigrant groups as well as low-income residents.

One challenge with such clients is that stoic immigrants and proud blue collar workers tend to stigmatize mental health trouble as a weakness. And in some traditional cultures, including in Central America and Southeast Asia, stress may not be seen as a culprit in emotional distress.

“Hmong believe that the body is inhabited with many souls and spirits,” said psychologist Ghia Xiong with the Fresno Center for New Americans, discussing the non-Western model of mental health. “The whole goal for the body to be in good health is to have these souls in balance.”

In this world view, a traumatic incident can cause a person’s spirit to depart his body, Xiong said. The resulting imbalance, which a Westerner might diagnose as depression or neurosis, is perceived by a tradition-minded Hmong as requiring shamanic intervention.

“They may see a doctor and say, ‘I don’t feel too well, I’m feeling very irritable, and I’m having headaches,’ and the doctor gives medicine for pain,” Xiong said. “Then they might want to see a psychiatrist and talk about how they feel, what they think. But that doesn’t really solve the third issue of their spiritual health, the third component.

“Talking therapy — cognitive behavioral therapy — is evidence-based. But ‘feeling good’ has a cloudy feel to it. The whole idea of spirituality is not part of an integrated mental health model. Some people go to their traditional healer, a shaman, who can ‘bring back the spirit’ to the person or help them be in more harmony with themselves.”

The Fresno plan’s emphasis on spirituality differs somewhat from previous center incarnations. Officials with Mental Health Systems Inc., a San Diego company that put in a bid to run the Fresno location, said their Innovations-themed center in San Bernadino County offers various pragmatic services for clients.

English as a second language, resume writing and job interview role-playing, anger management and parenting skills are all areas that clients from Riverside and San Bernadino counties can access there. Zoomba, a kind of dance therapy, tai chi and accupressure are more esoteric offerings.

“What we’re trying to eliminate is the stigma that is attached to the mentally ill,” said Cheryl Pfent, vice president for Mental Health Systems in the Inland Empire, who oversees the local Ontario holistic center.

She said the center, which began offering services in October and is now operating out of churches and the YMCA until a permanent location is found, codified its priorities with the acronym STRIVE — strength, tolerance, resilience, inclusion, validation and encouragement.

“What the county wanted was really to think out of the box with traditional services,” said James Lepanto, senior vice president for Mental Health Systems. “The foundation is cultural sensitivity and responsiveness.

“A lot of this innovation came from talking to consumers. Certainly for people with mental illness, we know that the stigma is pervasive. How do you provide a sense of belonging, how do you provide wellness recovery, how do you engage them in terms of spirituality.”

Officials are planning to offer a computer lab and a lounge area in the center, envisioned to serve 2,400 clients. There are nine staffers, including a psych tech who can respond to physical emergencies and refer people to a physician, and a licensed clinician as program manager.

Six “peer advocates” are ready to deal with clients using bilingual skills and substance abuse recovery experience. Some staff have dealt with family members suffering mental illness.

“They’re paraprofessionals,” Lepanto said. “It’s about buy-in and having a voice. How do you get people who need these services to see value in this?.”

Pfent said a Indian pow wow planned for May 19 will be a notable foray into intercultural celebration, with Native American dancers and medicine men on hand.

“We’re not closed to anything,” she said. “It is really member driven.”

Funding comes from the state’s Mental Health Services Act, which levies a 1% income tax on those earning $1 million and up to pay for “Innovations,” or “something new that has the potential to transform the mental health system.” The Fresno holistic center’s projected budget is $2 million over three years and falls administratively under the county’s Department of Behavioral Health.

If Mental Health Services secures the Fresno center contract, Lepanto said his group plans to reach out to its partners in Fresno, including the Juvenile Justice Campus and the Hacienda Project, which offers therapeutic behavioral services (one on one coaching) and transitional living arrangements for women released from prison.

For the holistic center, Fresno County officials developed the title “cultural broker” for staff who will have familiarity with alternative healing beliefs and working relationships with relevant community groups and holistic health providers.

Xiong said if his agency gets the OK to run the center, satellite offices might be arranged to offer services to those who can’t commute to Fresno. Staff would knowledgeable in both conventional mental health treatments and alternative therapies.

“We have worked with agencies to cross-train shamans about how Western doctors work, and how does Western medicine treat diseases. And we train people on ‘Here’s how Hmong people think about illness, what causes illness.’”

Further, he said, “We want the staff to be reflective of the underserved community. They need to come in and see people they can identify with. And we want to make sure (staff) can identify if this person is having a psychosis and can say, ‘This is beyond my expertise.'”

The Fresno Center for New Americans received California Endowment funds for its Living Well Program to provide “culturally and linguistically appropriate” mental health workers. The agency also is a partner in the Hmong Health Collaborative, which has trained shaman in Western health matters at Children’s Hospital Central California in Madera County.

Although the Fresno center will not allow traditional ceremonies per se, Xiong said the innovation will clearly fill a need for groups of all ethnic stripes and spiritual persuasions.

“When this concept of a holistic wellness center came up, I kind of felt this is something that would be very appropriate,” he said. “This is an opportunity to help people either go to see a Western health clinician or maybe be able to go to a traditional healer who has been trained in Western mental health services.

“We need to make sure there are mental health services in underserved communities. A lot of the community is left out because of lack of access and a lack of resources.”

A third group that put a bid in to run the center, Fresno-based United One Productions, did not respond to interview requests from calhealthreport.org.