By Mahlon Meyer
Northwest Asian Weekly
Ro Lim’s voice on the phone is husky. He asks if you’ve taken a shower, if you’ve brushed your teeth. His easy acceptance of everything you say makes him easy to talk to. If you’re one of his clients, that’s important.
Lim, 46, is a certified peer counselor for the Asian Counseling and Referral Center (ACRS)’s outpatient mental health program. And just the fact that he can call his clients, two of whom are Cambodian, the other Vietnamese, shows the force that the nonprofit has been in the lives of hundreds of thousands of people like him.
Lim was once in the same position as his clients—if not worse. He was in jail when a Cambodian case manager from ACRS came to see him.
“He reached out to me, listened to me, and supported me when I was down and needed help,” said Lim, who told his story at last year’s gala.
Lim’s background is not uncommon among the clients of the outpatient clinic. At age 6, he saw his father murdered by the Khmer Rouge, a genocidal regime in Cambodia that killed millions between 1975 and 1979. Most of his siblings died of starvation. He ate grasshoppers to survive and crawled out over thousands of dead bodies.
“Many of our clients, particularly from Laos, Cambodia, and Vietnam, and other Southeast Asian countries, experienced war and other trauma,” said Yoon Joo Han, the program director of ACRS’ mental health services. “But everybody has mental health to improve and maintain, so when you need help or cry, seek out other people and talk about it, which is the best way to destroy stigma, and the treatment and services are out there.”
Nearly 60 million Americans experience a mental health condition needing treatment every year, regardless of ethnicity, age, or economic status, she said. Clients needing less comprehensive care take part in a program of counseling and medication management, if needed, known as “Therapy Associates.”
But about 90% of those needing mental health treatment are enrolled in ACRS’ outpatient mental health clinic. It provides a spectrum of services that encompass nearly every aspect of life—housing assistance, support finding and keeping a job, mental health counseling, and medication management if needed.
The clinic employs 80 staff members including six psychiatrists and six psychiatric nurses, and sees about 2,000 clients per year.
“We can cover over 20 languages in our mental health program, or we will have someone call back to interpret, if we don’t have the language,” said Han.
Perhaps more importantly, many counselors at ACRS have the cultural background to help their clients navigate conflicting or confusing belief systems.
One young man with schizophrenia, for instance, refused to take the medication to treat his condition.
“He thought it was a curse,” said Han, who started out as a counselor and has since led the mental health program for 20 years. But the client was a devout Buddhist and trusted the monks in his Vietnamese temple.
“So the case manager talked to one of the monks and the monk held a ceremony and blessed the medicine in front of the client and said, ‘This is not poison,’” said Han. “After that, he took the medicine.”
In Asian culture, the stigma attached to mental illness is particularly strong, so caseworkers take an indirect approach.
“We start by asking, ‘What is bothering you the most?’” said Han. “We build a rapport with the client and that helps us assess if the causes are biological, psychological, or social.”
For Lim, the peer counselor, they seemed all tangled together. After escaping from Cambodia and arriving in Seattle at the age of 12, he lived with an uncle who regularly beat him. Still, he managed to complete high school and found work in an electronics assembly factory. But he fell in with a woman who drank heavily. He began to drink as well, and gambled recklessly and was soon pursued by gangsters.
“One day, I decided to give up on my life. I overdosed on Nyquil and 24 sleeping pills. But I did not die,” he said. “When I woke up, I felt like there was a ghost inside of me. I started to hear voices. Some force and voice took over my body and mind.”
Eventually, the voices told him to harm his sister.
“I told the voices that she’s my sister, and I didn’t want to. I fought hard against the voice. I had to be very strong. I couldn’t sleep that night. In the morning, the voices told me to hurt myself, so I stabbed myself in my stomach,” he said.
His sister called the police. And this is how the ACRS caseworker found him in jail.
Later, he reasoned that all the bad memories from his childhood had triggered his attack.
After meeting his case manager, who spoke to him in Cambodian, Lim received counseling and medication management and was released from jail. He began to attend peer support groups at ACRS, taking three buses a day to reach the clinic.
For the time being, he lived with his sister, but eventually he would take advantage of the housing program at the nonprofit.
Since clients are often refugees or immigrants, specialists guide them through all aspects of finding and living in low-income housing, including how to pay rent and utility bills, acquire furniture, and live peaceably with neighbors.
Housing is critical for those struggling with mental illness, said Han.
“For people with a low income, bringing in more money is essential to their recovery, and housing is essential for finding and holding a job,” she said.
ACRS employs two job placement and support specialists. They find employers, match clients with openings, and coach them through all phases of the application process as well as how to retain a job.
“Even though it may feel hard or unmanageable, sometimes doing things, especially things that may lead to a sense of mastery or accomplishment, and that can provide structure, can provide meaning, and can help improve depression,” said Debra Kaysen, a professor in the Department of Psychiatry and Behavioral Sciences at Stanford University who has conducted critical studies on treatment of PTSD and substance abuse across a variety of marginalized populations.
ACRS’ mental health program serves anyone looking for a job, said Munzie Man Peng, a supported employment specialist at the outpatient clinic.
In one case, a young woman in her 20s, who had been adopted from China, had a major depressive disorder. She had experienced two nervous breakdowns, sitting in the corner crying uncontrollably, as the result of a job that, on the surface, might have seemed to be low stakes.
“While doing her janitorial job, she was under huge pressure. The boss had such high standards, that if someone dropped a piece of paper somewhere else, he would be all over her to go pick it up immediately,” said Peng.
Peng and her colleague, Jane Ng, talked with her and discussed her strengths. Eventually, she found a job as a kindergarten teacher, where she is still working.
“People with that diagnosis have a very limited impression of themselves,” said Peng. “This job helped her to gain confidence and be financially independent.”
Sometimes, however, cultural differences complicate the job search.One client, in his 30s, wanted to find a job based on his interests. But he was living at home with his parents who insisted he find something permanent with benefits.
“That made it more difficult to find a job,” said Peng.
Eventually, he was hired in a restaurant. But once the manager observed his symptoms of schizophrenia, such as having difficulty making conversation or holding eye contact, although they did not affect his ability on the job, he was let go, after one day.
“Even though discrimination is written about in the law, people with obvious symptoms will sometimes be rejected,” she said.
In most years, however, Peng is able to place 25-30 clients in jobs. The number dropped to nine, however, since the pandemic broke out. Still, the entire team at the clinic has adapted, said Han.
Since many clients do not even have cell phones, ACRS procured hundreds to give out and trained clients how to use them. Case managers worked extra hours reaching out and updating documentation, provided thousands of bags of groceries and hot meals for those who could not cook, and kept a skeleton staff at the clinic for injections and crisis management.
Lim now comes in three days a week and greets clients in the lobby. On his other days, he makes phone calls to his clients, sometimes talking for an hour.
“I am happy to come to ACRS every day to help people like me. I am happy that people thank me for my help. I want to reach out to people when they are down and need help, just like my counselor did to me when I needed help,” he said.
ACRS is located at 3639 Martin Luther King Jr. Way South. Anyone (of any ethnicity) is welcome at the intake desk. Or call the intake number: 206-695-7511.
“Call our agency. If you’re willing, you can say, ‘I want to get mental health help,’ or just say, ‘I want help.’ We can figure it out,” said Han.
Mahlon can be reached at email@example.com.
ACRS will be honored at a virtual event on Feb. 9 from 4-5 p.m., http://bit.ly/3qwXfqy