Dental visits to dance classes: How Chinese American seniors are connecting to mental wellbeing

Two million Asian Americans and Pacific Islanders live in the San Francisco Bay Area. Roughly a thirdof them are Chinese Americans.

During the COVID-19 lockdown, Chinese Americans had an especially hard time. On top of health issues due to COVID, concern grew about older Chinese Americans’ mental health. Already isolated physically, or because of language barriers, Chinese American seniors experienced increased hate crimes, and even gun violence.

Oakland and San Francisco are home to two of California’s largest Chinese American communities. And it’s here that a focus on early intervention is helping Chinese American seniors and their families to recognize and address mental health issues. From dance classes to dental programs, nonprofits in these cities are finding ways to deliver mental health messages and support to seniors through familiar settings and languages.

This is part two of a series on mental health in Asian American communities you can listen to part one here.

A Personal Journey

Elaine Peng emigrated from China to California in 2005 with her husband and young daughter. She got a job as a Chinese teacher in Castro Valley. And then, seven years later, her world was turned upside down.

She says: “My husband… he’s my high sweetheart… and we get married and we had a pretty daughter. But I didn’t know what was going on in my family.”

Elaine found out he was abusing alcohol. And then, in 2012, he died by suicide. She was devastated. And frustrated that she hadn’t known how to help her husband or where to look for support.

“Because we didn’t know, we didn’t know how to get some treatment for him… some help for him. If you, your family have that issues… people don’t know how to talk about, communicate with you, keep the relationship with you.”

And Elaine’s experience isn’t uncommon. A 2019 survey found thatonly a little more than 20% of Asian Americans with mental illness received the care they needed.

The reasons are complicated. The National Alliance on Mental Illness outlines a number of barriers to quality care: high cost, language barriers, a lack of culturally-competent staff. And the stigma attached to mental illness in these communities.

One year after her husband’s suicide, Elaine’s teenage daughter Irene began to experience sleepless nights. She took Irene to the hospital, where she was treated for bipolar disorder. And when Elaine started experiencing panic attacks, she also went to hospital, where she was diagnosed with panic disorder and depression.

“I had the counseling. Also I had the medication,” she says.

And she says that completely changed how she was feeling: “And suddenly one day, I think ‘Wow, the sunshine’s so pretty. And the flowers… so colorful’.”

Practical Steps

In 2013, Elaine started an organization – Mental Health Association for Chinese Communities. It now helps hundreds of individuals and families each year. It does this through the free, multilingual mental health helpline, and in-person or online support groups across the Bay Area, run in Mandarin and Cantonese.

Chinese American seniors are a big focus of the non-profit’s programs, from support groups to singing classes. They’ve also just launched two bi-lingual mobile apps for mental health survivors and their caregivers. One offers survivors easy access to mental health information and services, a therapist directory, and breathing exercises for relaxation.

The other appoffers tools to support caregivers' mental well-being, help manage medications, and keep notes for multiple individuals.

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Oakland's Asian Cultural Center acts as a hub for senior support.

Liza Ramrayka

To get started, Elaine took a family counseling course via NAMI, the national alliance on mental illness. This gave her the tools to recognize and deal with mental illness, and also connect patients to local support groups.

Next, in her new role as a mental health family volunteer, she secured a room at the Kaiser Permanente-run Washington Hospital in Fremont. There, she could talk to others affected by mental health issues.

At the start, she hand-wrote hundreds of flyers and distributed them across senior centers and public libraries. Only a couple of people would turn up each week but Elaine grew the group with her honest approach: “I had the panic disorder. I had depression. I just say it.”

On the long nights visiting her daughter in the hospital, Elaine’s father’s singing helped her cope. She would come home to hear this familiar and powerful sound which comforted her and gave her strength.

Three years ago, Elaine introduced a regular MHACC singing class for mental wellness. The weekly Sing-A-Song Zoom class is led by tenor Zhao Xia Yang. Participants learn a new song or practice familiar standards. This year, MHACC launched a national singing contest with a strongly-contested seniors category.

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The Oakland center combines dental and wellness services.

Liza Ramrayka

A ‘Dental-Mental’ Approach

For the past 50 years, Oakland’s Asian Health Services (AHS) has provided federally-funded primary health care in 15 languages. And more recently, it has offered mental health services.

President, Dr. Thu Quach says supporting AAPI mental health requires cultural sensitivity. “Often for our Asian American communities, especially when you look at seniors, they're limited English-proficient, so a lot of social isolation, but many of them are immigrants and refugees. So you have, you know, past trauma… oftentimes unaddressed for decades.”

Asian Health Services’ wellness center opened in 2017 – the first in the country to combine an integrated ‘dental-mental’ approach. The idea is simple: a senior visits a dental clinic for an annual check up or treatment. As part of the check-in process, they’re given a nine-question survey in their patient intake packet to assess their mental health. Questions like: How often do you feel little to no interest in things? Do you have trouble sleeping? Any thoughts about hurting yourself? 

If a high score is recorded, the patient is referred - with their consent - to a behavioral health team member. Says Quach: “Our communities are more open to medical or dental appointments, and we can integrate it in because we see it as a whole person care approach.”

There’s a clinical social worker on site three days a week, otherwise the dental team can refer patients for a follow-up visit. Medi-Cal allows insurance to bill for a dental and mental health visit on the same day.

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Inviting decor at the wellness center helps to put patients at ease.

Liza Ramrayka

The room’s a lot more inviting than your average dental surgery. There are comfy couches and colorful pictures on the wall. Quach explains: “You want them to feel comfortable and to feel relaxed rather than anxious… the colors and schemes and such are picked out very intentionally, to really convey that feeling of, you know, just talking to someone in community with each other.”

The dental clinic sees more than 600 geriatric patients a year. From the survey, about 5% of those show signs or symptoms of mental illness. Almost all have agreed to speak to a counselor. Thanks to a government-backed learning collaborative, the program has been replicated nationwide in an estimated 50 sites, from California to Idaho and Virginia.

Response To Hate Crime

All of these efforts began before the recent rise in anti-Asian hate crime, which made organizations like Asian Health Services even more worried about Asian seniors’ mental health. In the wake of a dramatic rise in hate crime from 2020, AHS also set up a unit of community workers to visit or call victims, whether or not they were AHS patients.

Says Quach: “We actually established a community healing unit, where we can just be able to receive victims and their families, and start with what they needed, whether it's like, Hey, can I help you fill out that police report? Can we give you a little financial assistance, since you just got robbed, or you've got targeted here, or you're afraid to go out and get food? Can we deliver food to you? And then, through that, be able to develop that relationship to then move them to our mental health care.”

The community healing unit offered vital support to seniors, too. It offered yoga, meditation and other classes to support older members of the community.

Supporting Mental Wellness

AHS is among the growing number of organizations in the Bay Area finding creative ways to support AAPI seniors’ mental health.

Over at San Francisco’s South Sunset Senior Center, the all-purpose rec room is set up for ballroom dancing. But tables are covered with flyers about mental health services, nutrition and wellness. The twice-weekly classes attract dozens of seniors from the neighborhood and beyond.

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Class participants pair up to learn new steps each week.

Liza Ramrayka

Kin Chung Poon, the octogenarian who leads the ballroom dance classes, taught himself to dance with DVDs and YouTube videos. Now, he teaches students new steps like rumba or foxtrot. He says: “We dance not too good. We are no professional. But the old people like moving… Dancing is good for old people.

“The people all friends. First time – I don't know you, you don't know me. Second time, third time and then we be good friends.”

That was the goal of San Francisco non-profit Self-Help For The Elderly, to get seniors out of their homes and connect with others. They run classes for seniors at community centers across the city, from ballroom dance to karaoke. And, while the seniors are there, they can also learn about wellness and mental health programs.

Shirley Chan, who’s in her late 60s, left Hong Kong for the U.S. in 1973. She worked at AT&T in San Francisco as a legal secretary for over 20 years but quit her job when her husband passed away. She says she felt depressed so she joined the senior center classes.

Shirley visits the South Sunset center – a 20 minute bus ride from her home – every Thursday and Friday for the ballroom dance classes. Her grandson is at school and her son and daughter-in-law at work. She loves learning new dances and making new friends. She even comes early some days so she can have lunch at the center and chat with her fellow dancers.

“I like it here – I meet a lot of friends, it’s good for me, make me happy too! So besides physically, and then mentally because I have to study, I have to memorize other steps,” she says.

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Shirley (4th from left) and teacher Kin (to her right) with dance class regulars.

Liza Ramrayka

Preventative programs like dance classes and dental mental screenings are helping Bay Area non-profits reach Chinese American seniors where they’re at. Thu Quach at Asian Health Services hopes these early interventions and creative approaches to supporting senior mental health will weather funding cuts as California refocuses its mental health spending on housing services, education and employment.

“When we take away prevention approaches, then all you're dealing with is when people are in the hospitals or at the end. We really need a public health approach that also starts upstream as well. And so I think, for philanthropic organizations, for donors, and for the government, to see that long term investment and that savings that happen.”

Early intervention – she says – is the lifeline that could turn these outcomes around: “I just worry so much that if you cut the prevention types of programmes, you're gonna see a lot more people in the psychiatric wards.”