Advocacy and Community Building to Address Filipino Behavioral Health

Introduction

In Filipino culture, the social value of bayanihan (spirit of civic unity and cooperation) is often depicted by a community coming together to physically lift and move a bahay kubo, a traditional Filipino home, from one place to another. This Filipino cultural value is seen throughout history, such as through community action to address the impacts of natural disasters, Filipino migrant labor strikes in Hawai‘i and California to improve work conditions, and in the 1986 People Power Revolution against a Philippine dictatorial regime. The bayanihan spirit is a way for Filipinos to share their individual strengths, abilities, and knowledge for the betterment of the collective, a necessary approach in harrowing times.

The present time could be defined as such, as Filipinos in general—and Filipino frontline health workers in particular—have been disproportionately impacted by the COVID-19 pandemic. Moreover, the ongoing acts of anti-Asian violence across the United States (US) have spotlighted the discrimination targeting the community. These events have led some to share their experiences with stress and anxiety, elucidating the lack of attention paid to Filipino mental health and substance use conditions, also commonly known as behavioral health.

Filipinos constitute the second largest ethnic group in Hawai‘i and the third largest Asian ethnic group in the US.^1-2 Within the formal behavioral health system, their needs often go unmet for a variety of reasons including social stigma related to mental illness, cultural mistrust of health systems, and lack of resources for culturally and linguistically appropriate care, among other factors.^3-4 This column calls attention to the Filipino community in Hawai‘i and the US by highlighting research and community-based efforts to destigmatize behavioral health and address community need.

What Is Known

Filipinos experience mental health and substance use conditions at rates similar to other Asians in the US.^5-6 However, they seek assistance for mental health and substance use disorders less frequently than other racial/ethnic groups.^7-8 Most Filipinos (75%) have never received behavioral health care while those who have sought help (25%) have relied on supports (whether singularly or in combination) from family and friends (16.5%), general medical providers (7.1%), behavioral health providers (2.7%%), and traditional Filipino folk healers (3.8%).7 And, when Filipinos do receive mental health and substance use services, they often present with more severe and chronic diagnoses than other Asians.⁹

Filipinos are less likely than other Asians to utilize behavioral health services potentially due to the cultural stigma surrounding mental illness.¹⁰ Filipino values such as hiya (shame, or fear of loss of face),¹¹ pakikisama (the necessity of getting along with others), and kapwa (shared identity, togetherness), among others, hold significance to how Filipinos conceptualize themselves and their relationships, and in turn, how they might choose to address problems. Furthermore, legacies of Spanish colonialism, US imperialism, and labor migration have shaped the experiences of the Filipino diaspora in unique ways that scholars are still trying to understand with respect to the community’s behavioral health needs, including the confrontation of colonial mentality and internalized racial oppression.

What’s Being Done?

Given what is known about Filipino behavioral health and the importance of Filipino social values and culture, this column describes recent efforts to address these issues through research and community action. A throughline of these efforts is the connections these initiatives make among community members, reflecting the importance of bayanihan.

Research

Recently, scholars and students at the Thompson School of Social Work & Public Health have initiated research to understand the Filipino diaspora and its relationship with mental health and substance use issues and help-seeking, and to understand the community’s vulnerability and resiliency within the context of a challenging pandemic. Highlighted below are 3 recent or ongoing studies that have either been led or supported by social work students.

Page, Bersamira, and Burrage¹² conducted a qualitative study to examine the barriers and facilitators to the Filipino diaspora accessing mental health supports, and to identify cultural beliefs associated with mental health. This study’s findings are being prepared for publication and have been disseminated through community presentations which have initiated conversations about whether and how Filipinos discuss mental health. Participants have noted these conversations as being one of the few, if not the only time, they have discussed Filipino mental health.

Second, Macaraeg and Bersamira recently conducted a qualitative study to understand how the Filipino community in Hawai‘i overcame personal, family, and community struggles within the context of the COVID-19 pandemic (Jethro Macaraeg, M.S.W., email communication, November 9, 2022). This study aimed to identify the contexts, resources, and reflections that construct the community’s resilience and empowerment processes. Given growing research COVID-19 pandemic’s negative impact on the Filipino community locally,¹³ nationally,¹⁴ and abroad,¹⁵ this study contributes strength-based, culturally-informed knowledge that supports Filipino behavioral health initiatives.

Third, Bersamira and colleagues have developed an ongoing study to understand how Filipinos in the US perceive drug use and to identify best practices among addiction treatment providers working successfully with Filipino clients (Clifford S. Bersamira, Ph.D., email communication, November 9, 2022). This study, supported through a NIH funding through the Center for Pacific Innovations, Knowledge, and Opportunities (PIKO) pilot study grant, is notable given its involvement of Filipino scholar-mentors and community members in its implementation.

A commonality among these studies is that they are conducted with social work-oriented scholars with close attention to Filipino cultural values, practices, and beliefs. Furthermore, planning, implementation, and dissemination have connected and continue to connect community members to discuss behavioral health in ways seldom seen before.

Community Action

There have also been several community-based efforts eliciting conversations about behavioral health and wellbeing. These actions exist nationally and locally, but just a few examples are highlighted below related to social media, artistic expression, grassroots conferences, and community education.

Social media offers a broad platform for behavioral health topics to be discussed. Licensed Filipino mental health practitioners, for example, have utilized social media spaces to share information on psychoeducation, career development, and topic awareness. Social media has democratized our ability to share our lived experiences and Filipino creators have developed platforms aimed to build awareness, community, and social action. For example, the Kasamahan Collective¹⁶ website documents the diverse narratives of the Filipino community in Hawai‘i. Through podcast episodes, blog posts, and other media, featured community members explore the intersections of identity, historical contexts, and social environment. Kasamahan Collective also engages the community in discourse around cultural mental health experiences including internalized oppression, acculturative stress, and intergenerational trauma. In addition, perhaps one of the most popularly-known examples of the Filipino community leveraging social media to normalize help-seeking is from Hawai.i-based Filipino social media influencer Bretman Rock, who documented his experiences processing family dynamics and trauma through mental health counseling in the popular YouTube series MTV’s Following: Bretman Rock.¹⁷

Behavioral health awareness can also come from artistic expression and the sharing of lived experiences. For example, Hawai‘i-based artist Zachary Angeles uses mixed media forms to express emotional comprehension and processing.¹⁸ In her recent album Circa91, rapper and spoken word artist Ruby Ibarra lyricizes her intersectional experiences as a female, Filipina, immigrant of color in the US.19 Most recently, director Cole Bacani’s short film Everything Stays documents the story of a Filipino high school student in the US navigating a choice between career and family. These artistic forms provide opportunities for storytelling of Filipino community lived experiences otherwise kept private given the stigma around behavioral health.

During the COVID-19 pandemic, behavioral health issues have been discussed in shared community spaces, including grassroots conferences and community education. For example, the Hawai‘i-based 2020 Baliktanaw Conference offered reflections of Filipino historical roots to guide cultural identity development and community empowerment initiatives. The Pilipinx American Public Health Conferences in 2020 and 2022 provided opportunities for current and emerging public health leaders to discuss systemic barriers to mental health care. And, LAING Hawai‘i, a non-profit organization promoting and sustaining Filipino language, culture and artistic traditions²⁰ has used its education spaces to facilitate conversation about the community’s mental health.

These initiatives share the value of bayanihan by addressing behavioral health challenges from a multifaceted, holistic approach that, most importantly, connect community members with one another. These actions also showcase the integration of Indigenous Filipino wisdom and Westernized modalities to inform accessible, culturally relevant, and beneficial opportunities to advance conversations about Filipino behavioral health.

Conclusion

To move the bahay kubo, a community must come together, aggregate its strengths, and move in the same direction. Highlighted above are a range of actions to destigmatize conversations about Filipino behavioral health and to bring awareness to scholars, practitioners, and the community about these often-ignored issues. The community’s bayanihan spirit is needed to ensure that scholarly and community efforts are aligned. However, the question remains, how can this be done?

More efforts must take place to connect researchers, service providers, and Filipino community members to close the knowledge gap regarding culturally inclusive, community-based care. Behavioral health scholarly literature would benefit from knowledge and wisdom from Filipino community-based initiatives to inform paradigms of “evidence.” More must be done to understand Filipino pre-colonial and Indigenous ways of being and how Filipino communities have been able to sustain their behavioral health and wellbeing despite confronting generational oppression, trauma, and social injustice. The Filipino community must be involved with and benefit from the research being done on their communities; and researchers must move towards a community-based participatory approach driven by community inquiry and informed by Indigenous Filipino ways of understanding.

Social workers are well positioned to support the Filipino community in its efforts to address its behavioral health, as the profession recognizes the importance of an evidence-based approach and the interaction between the individual, community, and environment as central to resolving social injustices and addressing health disparities. Social workers also emphasize a strengths-based approach to individual change and collective community action, aligning well with the Filipino bayanihan spirit.