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San Diego’s Somalis Worried About Mental Health Needs

Four members of San Diego's Somali community who lost relatives to suicide sit in a row at a Somali Family Services of San Diego conference room (from left: Abdinur Jama, Liban Ali, Munisa Ali and Munira Ali), Feb. 21, 2018.
Roland Lizarondo
Four members of San Diego's Somali community who lost relatives to suicide sit in a row at a Somali Family Services of San Diego conference room (from left: Abdinur Jama, Liban Ali, Munisa Ali and Munira Ali), Feb. 21, 2018.
San Diego’s Somalis Worried About Mental Health Needs
San Diego’s Somalis Worried About Mental Health Needs GUEST: Dr. Wael Al-Delaimy, chief, UC San Diego Global Health Division

Mental Health Resources

Phone: 888-724-7240 (Crisis Hotline) or 211

Web: Up2SD.org

Map: Outpatient services

Research shows refugees are at a high risk for mental disorders, and some may inadvertently pass those symptoms on to their kids. But because of cultural stigmas and language challenges, they may not be fully addressed. This can delay engagement in the local economy, or worse, result in suicide. Some among San Diego’s Somali population — one of the largest in the country — say it’s that worst-case scenario that’s giving them concern.

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Four members of the East African community who have lost loved ones to suicide discussed the topic to combat the culture’s stigma against psychological disorders and raise awareness about behavioral health needs.

Munira Ali lost her older brother to suicide in 2009. She said part of the problem is staying silent.

“We don’t really talk about it when the suicide occurs in the community — of course we grieve, of course we go to the graves, but I feel like there’s no larger discussion at the end of the day,” said Ali, a common surname in the community.

Munisa Ali — no relation — said the community’s negative perception of mental illness is also part of the challenge. She said her husband, a refugee and father to her seven children, denied his diagnosis before he died by suicide in 2011.

“When we say, ‘This person has mental illness,’ in Somali, we interpret that: ‘This person is extremely crazy,’” she said.

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Liban Ali, also no relation, lost his younger brother to suicide in 2016. He said his family had approached the 20-year-old about behavioral changes they had noticed, but he resisted the discussion. They didn’t suspect that he’d die by suicide that night.

“If the families have that training, we could help those kids. We could understand what they’re going through, what the sign is,” he said.

Last year, Abdinur Jama said he lost his oldest son to suicide. He said his son had actually received a mental health assessment and was placed on medication, but it wasn’t enough.

“We have to find the root of the problem,” he said in Somali through a translator. “Once we know what the root of the problem is then we can start a discussion and involve the wider community to have that discussion.”

RELATED: San Diego’s Somali Population Explained

San Diego’s Somalis Worried About Mental Health Needs

Word of self-inflicted deaths travels fast through the tight-knit community. The group counted eight suicides, mostly young men, in eight years plus some attempts, but cite only anecdotal evidence. Another death occurred late last year in Orange County, they said. The figure is significantly smaller than the county's annual suicide rate, which is 13 per 100,000, while San Diego’s Somali population is estimated at 20,000 to 30,000. However, UC San Diego Global Health Division Chief Wael Al-Delaimy said the number points to a larger problem.

“If it’s that severe, then there’s a lot under that that is hidden of mental illnesses,” said Al-Delaimy.

His past research on nearly 200 Somali women found some who experienced trauma and suffered from mental illness transferred coping challenges on to their children. The epidemiologist, originally a physician from Iraq, is seeking funding to further examine the mental health challenges in San Diego’s East African community and identify intervention strategies.

“Whatever we learn from this community could be applied to other communities,” said Al-Delaimy, who is also working with primary care doctors in Jordan to help treat refugees.

San Diego has resettled refugees for decades, including those from other conflict areas, such as Iraq and Syria. A UC San Diego study flagged mental health needs as a top concern among the region’s refugee population in 2007. Nearly 10 years later, the issue of unmet mental health needs was raised again in a report by nonprofit Nile Sisters Development Initiative.

RELATED: Helping San Diego-Resettled Refugees Overcome Trauma

Alfredo Aguirre, San Diego County Behavioral Health Services director, said he is aware of the mental health needs among the region's diverse refugee population, but that the agency doesn’t have the staff to provide culturally and linguistically adequate care.

“We struggle with our more significant other languages, like Spanish for example, and so when we talk about even more specific — and there’s so many languages as you know that’s represented through all of the African countries,” he said.

He said bipartisan legislation introduced in the California State Senate would help address this. The bill, authored by State Senators Joel Anderson, R-Santee, and Jim Beall, D-San Jose, would establish certification for peer specialists — community members who have experience with mental illness and can serve as a liaison with refugee populations. Under the bill, the service could also be covered by Medi-Cal. SB 906 is expected to go before the health committee on March 14.

At the local level, Aguirre said the county is working to expand an existing artistic therapy program to also serve East African youth.

“Over the next couple of years we’ll be able to enhance it for this population, and we’re hoping at the end of the day to be able to sustain it,” he said.

In the meantime, the four Somali community members whose brothers, son and husband died by suicide say they want their interviews to help start a community-wide discussion about the issue and shed the stigma associated with mental health care.

“We hope that this is the beginning,” Liban Ali said.

Some organizations have already taken steps to help, but they say more resources are needed. Somali Family Service of San Diego holds community workshops that include discussions on mental health. Nile Sisters coordinated stakeholder meetings and launched a public toolkit on behavioral health resources.

San Diego’s Somalis Worried About Mental Health Needs
Members of San Diego's Somali community share their stories about losing loved ones to suicide in an effort to shed the taboo on psychological disorders.

>>> With San Diego as a refugee hub, it comes to providing healthcare with patients with a range of languages and cultures. That could be challenging for providers especially when it comes to addressing behavior health. Research shows refugees are at a high risk of mental disorders. Some may inadvertently pass the symptoms onto their kids. Mental health needs can delay a person's engagement in the local economy or worse result in suicide. San Diego's Somali population says it is that worst-case scenario that is giving them concern. KPBS reporter Karen Minto introduces us the four members of the East African community who lost their relatives to suicide. >> Reporter: To manure Ali, her older brother was someone to be admired. He introduced her to reading, took her to 7-Eleven runs, and was not annoyed by her little sister antics like the time she shipped the car to neutral at the stoplight. She thought the letters PR in DL formed the word parental. >> I was like what does that mean. As he was at the red light, I took it to in. >> Reporter: Not surprisingly, her brother notice. >> He was like was going on. And I was like I moved the parental thing and looks at me and laughs. >> Reporter: That brother that you knew and laughed would later died by suicide in 2009. She and three others from the Somali community who lost family to suicide shared their stories to raise awareness about mental health needs. In 2011, when he saw ollie no relation lost her husband to suicide. She says her partner of 19 years and father to her seven kids was in denial about his mental health needs . >> when you say this person has mental illness in Somali we integrate that person is extremely crazy. >> Reporter: In 2017 it was me to Ali's younger brother again no relation. >> No one knew was coming. We knew he had some change before it happened, but nobody knew that it would be suicide. >> Reporter: Last year it was a do much am her son, John says in Somali her son was on medication but it was not enough. >> But he believes that we have to understand what the root of the problem is. Once we know, then we can start discussion. >> Reporter: Word of self-inflicted deaths travels fast to the tight knit community. The Somali community Council eight suicides in many years plus --. The Somali population one of the nation's largest is estimated at 20 to 30,000. The suicide rate is smaller compared to the County's annual rate which is 13 per 100,000. But UC San Diego global health division chief while I'll Delaney says the situation does there is a deeper look. >> The suicide is almost the tip of the iceberg. If it is that severe, then there is a lot under that that is hidden of mental illnesses. Whatever we learn from this community could be applied to other communities. >> Reporter: Epidemiologist is seeking funding to study the underlying problem and identifying intervention strategies. His past research found Somali women who experienced trauma and suffered from mental illness can pass the coping challenges onto their US-born kids. The County's behavior health services director says he is a layer of the mental health needs of the Somali community and the wider refugee population. He says the division lacks a diverse workforce to provide linguistic and cultural competent care. The county is working to better support the East African community by expanding a music therapy program. In the meantime, the four Somali community members whose lives were altered by suicide say they want their stories to start a communitywide discussion about the issue. >> We hope that this is a beginning. >> Reporter: They help the loss can help warn others of warning signs . >> and I figure we can talk about it more, you can see how that person is feeling you can see more signs. I feel like we can get in front of it. >> Reporter: Some organizations are taking help with workshops and roundtable discussions. They say more resources are needed. >>> And KPBS reporter Karen Minto's focus with global health division chief IL why Dini about mental illness in the Somali community here is that interview. >> Reporter: How would you characterize the mental health needs among the Somali community in San Diego right now? >> I think the main issue is to try and train and educate the community to overcome the stigma. That is the major obstacle. The stigma about it is what is leading to complications because neither the patient nor the family want to deal with it. They might ignore it and neglected. The second step is for healthcare providers to be more understanding of the cultural barriers, language barriers, and presentation of these conditions. These are the needs. But is also driven by evidence. We have to have evidence to guide all of these. Just throwing something and think it will work in one community might not work in another. That is what I think is the need for >> Reporter: How common is mental in this among refugees. >> It is higher than the average American within a population. The main reason and it is logical because they have been exposed to higher frequency of trauma, loss, and resettlement, loss of community, loss of loved ones and so on and so forth. They have that higher risk. >> Reporter: I want to get to the study you did. How common is it for the children of refugees to also struggle with mental illness? >> In the first study we did, we took mother's and their children who are between seven and 13 years old, most of those children were born in the U.S. We wanted to see if there was a relationship between the mother's history who almost all of them, all of them came as refugees in the 90s and afterwards. Initially we found there was no association. There was no link between her mother having depression or anxiety and the child having that. So we were surprised. Without there was maybe some protective factor. When we look further in the analysis, we found out actually the mother who have trauma severe trauma history, and still have mental illnesses, their children had mental problems whether depression, adjustment problems in school and so on and so forth, which then we found that there was actually a transmission of the trauma from the mother to the child. Even though it has been years, and even though most of the children were born here, they are still significantly more likely to suffer from these conditions if their mother currently has a mental problem, and this problem was caused by a trauma compared to other mothers. >> Reporter: What are barriers to getting patients to treatment. Treatment is out there. the county has services they provide. What is the hurdle? >> I think the main hurdle is that the patient and the family recognize this is a mental illness that requires medical treatment. >> Reporter: Nativeborn populations have the issue as well. But it seems acutely affecting immigrant and refugee populations like the Somali population. Why is it difficult to get the message across to that immigrant group? >> This is a first generation immigrant group. They were raised and born on values and culture and other aspects. You cannot just make it disappear. In that culture, and in most of these cultures, saying to someone that they have a mental illness means you are mad, you are crazy. That's an offense. That is a stigma. This cannot go just by simple education. It means much more effort and intervention. In some cases, unfortunately, until after problems happen, people realize that this is something they can prevent. >> Reporter: Refugees have been coming to the U.S. for decades including San Diego. Why does it feel like just now we are beginning to recognize that maybe there are some unmet health needs in this community? >> I think mental health is an unmet need in all of the U.S. nationally we know there's a problem. We are only beginning to recognize this. There is some serious effort to try to deal with it at multiple levels, federal, state, and local. But I think we are now realizing that this is an area that is not addressed in public health as it should have been. We have been focused on smoking, risk factors for cardiovascular disease and so on. That mental illness is linked to all of these. I think this is the field being developed further. I think what we are working on globally, we are working with refugees who are still in Jordan, Syria and refugees, Iraqi previously, and we are working and their transition countries. One of the things that we are seeking funding for is doing some community health worker training. So we developed the training and the capability of all mental illness detection among community workers. That is a model that could help. There are not enough psychiatrist in many of these countries. So we are relying on people who are specialized that won't work. The alternative also is to retrain primary care providers. That is what we are doing in Jordan. We are retraining their primary care provider so that they can deal with it when they are coming to the clinic for other conditions and then they detect that and treat it. >>> That was UC San Diego stucco IL other wheelie. If you or someone you know is in need of assistance, you can call the crisis hotline at 888-724-7240 or 211. A map of Clinics is at KPBS.org. >>> We now turn to the Central Valley were some agribusinesses believe California's role with the federal government over immigration is drawing more federal scrutiny to their workforce. The California reports Alex Hall says some growers are caught in the middle. >> Reporter: At Poindexter nut company in Selma outside of Fresno, staff walk around wearing green hairnets. There is a bowl of walnuts in the waiting room for visitors. The CEO at this family owned business Mike Poindexter shows me a letter that he recently received from the department of homeland security. This is what it looks like? >> This is it. The notice of inspection. U.S. immigration custom enforcement January 31, 2018. >> Reporter: The letter informs him that his business is getting what is called an I-9 audit. A process for agents from immigrations and customs enforcement examine employee records to determine if they are legally able to work in the U.S. >> Requires employers to only hire United States citizens and aliens authorize work in the United States. >> Reporter: After he got the letter, he hung up on notice to employees saying ICE will soon be looking at the documents. In 18 days a lot of people quit. Because he's frustrated with the federal government in their sanctuary policies. >> You have a bear and a person throwing rocks at the bear. When the bear gets mad and lashes out, you get slashed by it, how can you be mad at the bear? And this is the second audit for Poindexter. Nine days ago ICE came and took a lot of paperwork. He was told when he finally got his paperwork back to sit fire 70% of his workers today . >> we had to replace so many people that we can do it ourselves would hire people to hire people. >> Reporter: He says even though he's now using E-Verify the website that verifies if a person can work, he still feels like a sword is hanging over his head. >> You can't help but react and think oh my God what will happen now. Because you have been hurt bad. And you don't want it to happen again. >> Reporter: That notice Poindexter posted informing workers of the audit as required by law in California. It is one of the rules recently put in place to protect immigrant workers. Last week the U.S. Justice Department sued California saying it sanctuary policies are unconstitutional and blocked ICE from doing its job. Poindexter says businesses like his are confused. Who is the boss. >> That makes it difficult for us when we are being threatened with punishment I two different government agencies who want us to behave in opposite ways. >> All of our farmers the largest % of our farmers and businesses do not support the sanctuary state. At all. >> Reporter: That's manual [NULL] yeah president of -- based in Fresno. He says business owners are paying the price for sanctuary policies not sacramental lawmakers. >> You are saying you're protecting the people from being hauled off. You may stop that part of it but you won't stop the business audits. You have done more damage than anything ever now because now I have to let go of all of these people. >> Reporter: Ice will not say the agency is connecting more audits this year. A spokeswoman says ICE is stepping up efforts to enforce laws to inhibit businesses from hiring unauthorized workers. As for Poindexter, he gives the agency the documents they asked for. Now he waits.

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