As a teenager, Paul Hoang used to have daily panic attacks. Every night, he’d suffer nightmares. He’d lie down in bed and become immobile.
“I thought I’d been sat on by a ghost,” he said, alluding to an old Vietnamese expression.
“I thought that was normal.”
He also thought his childhood as a refugee was normal. He fled Vietnam with his family in the late 1980s.
“We left Vietnam when I was 7,” he said. “I lived in a refugee camp for almost two years and came to the U.S. when I was 9.”
“Growing up, I was not aware of mental illness,” Hoang said. “Neither was my family. I was not aware that my dad suffered from PTSD. I was not aware that I, myself, was suffering from depression until I went into the seminary after high school.”
Only later, after taking his first psychology class, did Hoang say he realized that the trauma of displacement fueled his teenage anxiety.
“That’s when everything opened up,” he said.
Now, Hoang’s life mission is to help others in the Vietnamese American community understand and overcome any mental health challenges they may face.
A clinical social worker and former Orange County Health Care Agency service chief, Hoang is the founder and CEO of Moving Forward Psychological Institute, a mental health services provider in Fountain Valley.
His experiences with trauma have informed one of the few mental health clinics in Orange County focused on serving the Vietnamese community.
It’s a community that, compared to other ethnic groups, has limited access to mental healthcare, but has among the greatest needs for treatment due to generational trauma from war and refugee resettlement, data collected by the county has shown.
A 2010 county health needs assessment focused on the Vietnamese population said that Vietnamese adults in Orange County, while at greater risk for mental health issues relative to other ethnic groups, also reported higher rates of shame and embarrassment for requesting mental health care.
“This is largely due to a cultural artifact from the motherland, where those with mental health issues are still ridiculed,” the report’s authors said. “Mental illness is believed to be a punishment for some personal or familial transgression or a result of a curse.”
“This perception of mental health problems acts as a deterrent to seeking help for treatable problems,” they said.
An updated county study specific to the Vietnamese population has not been done, but Tricia Nguyen, CEO of Southland Integrated Services, a nonprofit dedicated to treating the medically underserved community in and around Little Saigon, said the trends remain consistent.
“In our community, the stigma is very heavy,” Nguyen said. “There’s this attitude that when someone has mental health issues, they’re just looked at like they’re crazy,” she added. “So, people rarely admit when they need help.”
In 2023, the county approved a three-year, $10 million contract for nonprofit organizations to provide mental health services for Vietnamese adults. Most of the funding came from the state. The rest came from federal Medi-Cal funds.
Hoang says it’s a step in the right direction, yet the number of culturally competent mental health clinicians around Little Saigon remains precariously low.
Brittany Morey, a UCI professor who studies how structural barriers shape ethnic health inequities, emphasized why it’s important for there to be culturally competent providers.
“I think there’s still almost a kind of mistrust of Western-style medicine, especially if the care provider themselves don’t speak Vietnamese or understand the culture,” she said.
Outside the Vietnamese community, Hoang said the mental health needs of refugees and their families at times have literally been lost in translation.
He recalls manning a health fair booth for the Orange County Health Care Agency.
Each time he’d chat with Vietnamese passersby about mental health, he’d watch them take a brochure translated into Vietnamese, then immediately throw it away and turn back to him in disgust.
Soon enough, he started asking people what was wrong.
“Turns out, the brochure was highly triggering,” Hoang said. “Because, even though it was using technically accurate translation from English to Vietnamese, the words and even the accents were associated with communist language. It was not written in the dialect of Vietnamese Americans.”
That was his aha moment.
“I realized I have to be very socially sensitive when I communicate with my community,” he said. “I have to understand which area of Vietnam they come from. Where did they arrive in the U.S. and when? Did they arrive as a refugee or did they immigrate by choice?”
The community has a lot of post-traumatic stress disorder, Nguyen said.
“There’s a lot of panic and anxiety that is the result of peoples’ experiences with war, rape, piracy and other horror stories,” she said. “We still need to do more with education to show that these conditions are normal responses. They’re not crazy.”
The first wave of refugees to the U.S. in 1975 tended to be more affluent and politically connected.
“Many already understood English and integrated into American life and business easier than others,” Hoang said.
“Those from the ‘80s, the second wave, tended to have more trauma,” he said. “By then, many had tried to escape Vietnam multiple times unsuccessfully, some getting caught in prison, witnessing atrocities or separating from their families before making it to the United States.”
“Those who came in the ‘90s tended to come through humanitarian family unification programs. So, they have unique needs about family separation,” he added.
To tackle the gap in mental health support, Hoang believes service providers should meet people where they’re at — whether that’s in a clinic or somewhere else like work or church.
“Mental health service providers can be the priest, they can be the community leader, the teacher,” he said. “We have to take on whatever role we can to serve our community.”
But the bottom line, he said, is that leaders need to continue directing resources to better serve the mental health care needs of the Vietnamese community in Orange County.
“Fifty years on, and our trauma is still very raw,” he said. “Elected officials, community leaders and spiritual leaders need to take this seriously and prioritize investment.”