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Bainivalu Davetawalu, who grew up in American Samoa, was excited to be the first person in his family to move to the continental U.S. in 2023 to pursue a college degree. He moved in with relatives, slept on a couch, and woke up at 4 a.m. to catch the bus each day to City College of San Francisco. After class, he worked at a restaurant and returned home by 11 p.m. But soon loneliness dampened his enthusiasm. He struggled with the fast-paced culture and missed close relationships with extended family back home.
“I didn’t feel I could tell anyone that I was unhappy, because I was supposed to be living the dream,” said Davetawalu, 20. “Mental health was a taboo subject in my culture.” He started experiencing insomnia, migraines, and severe anxiety. Eager to connect with other Pacific Islanders, he attended a mental health workshop led by a community health worker from the San Francisco-based Samoan Community Development Center (SCDC). “I remember crying at that event as I shared what I was feeling for the first time in eight months,” he said. “I felt like a burden was lifted.”
Davetawalu is part of one of the fastest growing populations in California: Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPI). His experience reflects a broader opportunity to expand culturally responsive care. Recent data show Native Hawaiian and Pacific Islander adults were 60% less likely to have received mental health treatment, according to the 2024 National Survey on Drug Use and Health. That survey showed Asian Americans were 45% less likely overall to have received mental health treatment in the last year.
The Commonly Connected Workforce
Mental health paraprofessionals — also known as community health workers, wellness coordinators, or lay counselors — play a critical role in destigmatizing mental health and serving as a bridge to behavioral health services for AANHPI populations. The community connected workforce often shares the same culture and language as their clients, according to the Healthforce Center at UCSF. This cultural concordance is invaluable in a state where only 4% of licensed behavioral health clinicians speak Asian or Pacific Islander languages even though these groups represent 10% of California’s population. By forming relationships with AANHPI people in the community, these workers become trusted advisers who can refer individuals to therapy offered by their organizations that is often free of charge.
With newcomer communities, there is often still a desire to hide struggles with mental health, and we need community health workers who can bridge the gap to the services they need to help them thrive.
laura coelho, Center for Empowering Refugees and Immigrants
Even though AANHPI organizations rely on community health workers to provide mental health support, recent federal and state funding cuts have triggered layoffs in these organizations. SCDC previously employed two full-time wellness coordinators, but the center recently cut back to one part-time coordinator.
“I can’t do my job sustainably without the wellness coordinators,” said Tone Va’i, a licensed clinical social worker and clinical supervisor at SCDC. “There is more freedom that comes with being a nonlicensed worker because they can be out in the community showing people that someone loves and cares for them, and they can provide the referrals to therapy.”
Bridging the Cultural Gap
One way community health workers facilitate care is by framing mental health support in the context of culture. When Davetawalu participated in an eight-week Fēfē (meaning “fear” in Samoan) mental health education program at SCDC, the meetings reflected Pacific Islander values related to connection to self, others, and space, said Henrietta Fonua, the wellness coordinator who developed the program.
In one session, she invited participants to take an attachment style quiz to help them understand how they build emotional bonds. In Western culture, an individual’s attachment style is often rooted in early relationships with parents or caregivers, but Fonua knew that individuals from Pacific Islander cultures often live with and are raised by caregivers such as aunts, uncles, grandparents, and other relatives. She explained to the group that if their quiz result did not seem to fit Western culture, this could be related to their “collectivist” cultural background.
At the end of the program, participants also learned that free mental health therapy was available at SCDC for people who wanted more extensive support. This prompted Davetawalu to start meeting regularly with Va’i, who helped him recognize a pattern of isolating from people rather than asking for help. He discovered running as a healthy strategy for dealing with stress and started sharing more openly with others. He moved into his own apartment and plans to transfer after two years at City College to a four-year university to earn a bachelor’s degree in environmental science.
Meeting Youth Where They Are
Community health workers also facilitate access to care by speaking the same language as the people they serve. “It’s a lot easier to find bilingual community health workers than bilingual clinicians,” said Sarah Wan, executive director of the Community Youth Center in San Francisco. The center serves AANHPI youth. “I have also found community health workers to be much more versatile than the licensed clinicians because they can engage in programming in the community to build relationships with more people.”
These workers, who lead sports, after-school, leadership, and workforce development programs, identify students who may need additional mental health support at the youth center. The community health workers are trained in lay counseling, a program for nonlicensed clinicians that teaches them how to build a therapeutic alliance with clients, listen with empathy, and help people decide if they are ready to make behavioral changes.
“They have also learned to see red flags as they interact with students,” said Wan. “If they see signs of cutting, restricted eating, or crying, they can share what they are noticing and ask students if they are willing to seek help together.”
The community health workers frequently work with students who are navigating a new country and culture after immigrating to the Bay Area. One high school student from China was adapting to life in a new country and learning a new language. During this transition, he stopped attending school and rarely left his room. A worker from the youth center began visiting the student’s home to better understand the situation. Initially the young man made no eye contact and did not want to interact, but after a few visits he became open to trying therapy at the center. He started with short-term goals like attending one class at school and visiting the center once a week. Aware that the language barrier created difficulties with communication, the worker also introduced him to photography as a way to express himself. Now he visits the youth center regularly and is taking classes in community college.
Reducing Fear for Immigrants
As the current political climate amplifies fear and anxiety within immigrant communities, community health workers have become trusted confidants for many AANHPI people. The Center for Empowering Refugees and Immigrants (CERI) in Oakland serves many people who immigrated from Cambodia. The government crackdown on immigration and the cuts in public benefits have triggered symptoms of post-traumatic stress disorder for those who survived the Khmer Rouge genocide.
To address these fears, community health workers at CERI are leading groups to help people learn their rights related to immigration, Medi-Cal, housing, and other services. “This is a time of fear that impacts every area of mental health,” said laura coelho (who styles her name in lowercase), director of communications and evaluation at CERI. “We are seeing people who are afraid to sign up for government services because they are afraid to provide documentation that can be used against them.”
Over the past 20 years, the center has established connections and trust in the Cambodian community, and workers are doing the same with other AANHPI people, including the Vietnamese, Burmese, Nepalese, and Tibetan communities in the Bay Area. The relationships often start when community health workers help people navigate tasks such as opening a bank account, signing up for public benefits, finding childcare, or preparing to visit the Department of Motor Vehicles to apply for a REAL ID. The workers typically share their mobile numbers with people and offer to be a source of help. Often this connection gives workers an opportunity to invite individuals to meet with a clinician at the center or join a support group based on their specific needs.
As the AANHPI population in the Bay Area continues to grow while funding for critical support services shrinks, leaders in community organizations worry that people who have built trust with these workers will lose a vital connection. “It took years to reduce the stigma around mental health in the Cambodian community,” said coelho. “With newcomer communities, there is often still a desire to hide struggles with mental health, and we need community health workers who can bridge the gap to the services they need to help them thrive.”
The Asian Pacific Fund provided background support for the reporting of this story. You can read more about APF and CHCF’s funded research into the impact of paraprofessionals, conducted by Healthforce Center at UCSF, at the APF website.
