Mental health treatment is a difficult subject for many Hmong Americans. A new podcast wants to make it easier to get help.

The topic for the day is trauma, but the mood is convivial as four therapists sit down to record the latest episode of “The Hmong Mental Health Podcast.” It’s a Friday afternoon, and the group is in a new space: The offices of Vanguard Mental Health and Wellness Clinic in Woodbury are expanding to accommodate new hires. Two of the four therapists have had babies recently, so the cheerful chatter gravitates toward diapers and infant photos. 

This is the third episode of the podcast, which began in March and is already garnering attention in the mental health treatment community. Psychologist Alyssa Kaying Vang, who opened Vanguard 15 years ago, hopes that the podcast will reduce barriers to therapy for Hmong Americans.

“While we’ve seen an increasing openness to mental-health services, it’s still a stigma in the Hmong community,” she said. “There’s a lot of shame, lack of support from family members, and a limited understanding of mental-health services.” 

Traditional Hmong culture emphasizes the physical and spiritual; the concept of mental health doesn’t have a place in that model, Vang said. Hmong therapists who have trained in the United States practice with Western methods. This system relies on the fifth edition of The Diagnostic and Statistical Manual of Mental Disorders to diagnose conditions across five categories: anxiety disorders, bipolar and related disorders, depressive disorders, feeding and eating disorders, obsessive-compulsive and related disorders, and personality disorders.

The explosion in social-media consumption has been both a boon and challenge to mental health practitioners, Vang said. People have more access to information, but also a greater likelihood of finding misinformation. 

“It compelled us to say, ‘Hey, if we want to meet the needs of mental-health struggles today, we must do something differently to reach those communities and make an impact,’” she said. “At Vanguard Clinic we believe in meeting people where they are, and what better way to do this than a podcast?”

The show comes at a time when many Hmong people seem to want a better understanding of mental health. “The community is ready for this,” said therapist and podcaster Mosi Thao. 

The four podcasters sit in new white office chairs in the conference room, and the gray walls are still unadorned. Four microphones and a six-pack of bottled water sit on the table. The podcasters are still dressed professionally from their day of traditional work. They’re the only ones left in the building at 3:30 p.m. on a Friday.

Vang’s team is clear: A podcast cannot take the place of professional therapists. But for people who don’t have a referral for therapy, or who are more comfortable listening to a podcast than seeking out a therapist, the show can give them access to quality information on mental health. And for Hmong people, the podcast is a way to easily access information pertinent to their community. 

“It’s a way we can give people the information, enough that maybe they can take something away without necessarily seeking out therapy,” Thao said. 

For others, it could be a bridge to treatment.

A podcast also has the potential to reach more people than any one clinic, Vang said. So far, about 475 people have downloaded the show, without anyone on the team doing any major advertising. And the therapists can reach Hmong communities across the country from Minnesota and Wisconsin to California and North Carolina.

The Hmong concept of mental health

Until recently, most of the Hmong community has been operating in survival mode, said Sheng Elizabeth Lor, executive producer of The Social X Change Project, a Hmong activist platform, and a fan of the podcast.

“My parents went through a war,” Lor said. “They don’t have time to think about mental health; they’re surviving. Now that we’re in this place where we’re not in pure survival mode, we start thinking about opportunities for advancement … that’s when things like activism and mental health and self-development come in.”

The line between physical and mental health in the Hmong community has traditionally been blurrier than it is in Western medicine. Hmong communities emphasize the physical and spiritual, Vang said. 

“Mental health doesn’t have a place in that model,” she said.

Things that appear to be symptoms of mental health issues in the U.S.—such as a loss of appetite, hearing voices, or poor concentration—would be attributed to spiritual or physical suffering in Hmong culture, she said. 

“Our people defer to skill sets that have been based on traditional ways of moving through the world and navigating,” Vang said. Traditionally, she said, Hmong communities value interdependence, which is very different from the American value of independence. “Reconciling the two has resulted in significant difficulties,” she added.

Even if there is a known mental-health issue, it’s often hard for Hmong people to share that experience with an outsider, Lor said. 

“If we have issues, we barely tell our cousins,” she said. Historically, “we deal with it in-house.”

A younger generation may be more willing to seek outside professional help, she said. But it can still seem intimidating and scary. 

“Mental health is often affiliated with weakness and shame and vulnerabilities we don’t want to show to the community,” Lor said. “So there are a lot of layers we need to explore.” 

Need for mental-health services

Back in 2010, a report by Wilder Research confirmed the lack of resources for culturally competent mental health care for the Hmong community. At the time, Vang was one of just a handful of Hmong therapists in Minnesota. She and her colleagues were over capacity; they were often asked to extend patient hours into the weekends.

Since then, the field has grown: Now, there are at least 30 mental-health providers who speak Hmong in Minnesota. But it’s still far from enough to fulfill the need. Vang hired four new therapists in 2020, she said, but the clinic continues to get new referrals every day and maintains a waiting list for patients.

Even among Hmong people born in the U.S., there’s a desire for culturally specific care, she said. 

“There’s such a need for providers who look like you sound like you,” Thao said. 

Although there hasn’t been much research on Hmong mental health since the Wilder report, practitioners have begun to prioritize culturally competent care. That can include therapists working with communities other than their own, he said. In order to do that, the provider needs to honor the way the patient’s community approaches mental health and acknowledge that it may be different from the Western way.

On air: What an episode sounds like

With so much hurt in the community, Vang decided that the first season of the podcast should focus on healing the self. Episodes so far have focused on attachment and trauma, with a closer look at how Hmong people experience them. 

“Whenever we talk about mental health in the Hmong community, we cannot not talk about trauma,” Vang says in her introduction to the third episode. “Because the Hmong story is filled with an oppressive history and displaced experiences, we have internalized this narrative, historically speaking, that says that we’re a people without a country.”

When Hmong people sought asylum in the United States, starting in the 1970s, they started seeing themselves as refugees, she says. 

“With that comes a lot of trauma and of course the adjustment to the U.S. And so whenever we talk about the Hmong people with mental-health experiences, of course trauma is one thing that comes up. So that’s what we’re going to address today.”

Before the taping, the four podcasters huddled around the table and shared feedback from the first two episodes. So far, most reactions have been overwhelmingly positive. 

Lor, the activist, said she found herself so transfixed while listening that she started talking out loud in response. 

Although the podcasters speak mostly in English, they dip in and out of Hmong “when the concept is better understood within that language,” Vang said. 

Some concepts work better in English, such as the understanding of certain disorders like schizophrenia. “But some things in our language make more sense and are more accurate,” Lor said. “So to have both dialogues helps me connect with them; it’s more accurate, and there’s no translation lost. It’s empowering for me that I connect with them on that level. Language is communication, understanding, comprehension, connection.”

In the second episode, for example, Vang uses Hmong phrases to describe parent/infant relationships. “We really don’t like allowing a child to cry for long periods, because we believe if they do, lawv tus ntsuj tus plig tu tu siab [their soul might become too sad], and then they’re very vulnerable to some of these spirits that reside among us. And menyuam quaj kiag xwb [at the slightest sound of an infant’s cry], ‘OK, what’s wrong with you?’ and we want to coddle them.”

Vang further expanded on this concept in an email: “This is based on the belief that infants’ souls are still not well connected to their physical form yet due to new life. And, as a result, infants can easily become vulnerable to being taken by evil spirits. So if they cry too long, their souls will become sad and even less connected to their physical body and thus more vulnerable to being taken by evil spirits—which, when this happens, will lead to illness and even death.” 

Listeners have told Thao that they love the shift between languages, even when it’s just a phrase or a few words in Hmong.

“People from the younger generation say, ‘Oh, I’m really going to learn Hmong through these podcasts,” Thao said.

Language can help bridge the generational gap in the Hmong culture, Vang said. Take the concept of self-love. “Hlub kws hlub tij, hlub neej hlub tsav, hlub zej hlub zos” translates to “love your relatives, love your community,” a value in traditional Hmong culture. 

Now, the phrase “hlub yus tus kheej“, meaning  “love yourself,” is becoming more popular. 

“When we think about it from the Western lens and the American language, self-love makes so much sense,” Vang said. “It’s so core to the individualistic way of thinking.”

Younger, first-generation Hmong Minnesotans understand the concept of prioritizing themselves,” she said. But when a call comes in from relatives to help with the community, it’s hard to say no. 

For a younger Hmong person who has heard plenty about self-love, that request can feel conflicting.  Their parents likely advised them to love others first, Vang said. “Then you start to feel guilty and shame and bad,” she said. 

It’s exactly the type of information that Lor feels the community needs. “It’s nice to have four professionals having a conversation in a way that’s light-hearted, conversational, not super clinical, but still has a lot of educational components,” she said. 

That’s the vibe the podcasters are going for, although a few listeners suggested the debut episodes sounded a little over-edited. (Indeed, the first episode took half a day to record and Vang spent about 20 hours editing it.)

So for the newest episode, Vang decided to toss the scripts, replacing them with a simple list of questions. The group agreed that they could have a more natural, back-and-forth conversation without a script.

“It gives me more freedom to talk,” therapist and podcaster Chue Her says.

The lack of a script allows the therapists to engage more casually, Thao says. “I like it; it seems like there’s a narrative and a flow. It’s like we’re color-commentating.”

Each question on the list for Episode 3 could be its own podcast, therapist and podcaster Houa Vang adds.

“Let’s get into it!” Vang says. 

The podcasters check their mics, and Vang presses record:

“Welcome back to ‘The Hmong Mental Health Podcast.’” 

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