While lawmakers across the U.S. fiercely debate the implementation of mental health programs, a group of African immigrants in Los Angeles has created culturally relevant mental and public health assistance for their own communities.

The African Communities Public Health Coalition non-profit was started in 2011 to serve African and Caribbean immigrant communities struggling with emotional, cultural and mental health needs. In 2017 there were 56,300 immigrants from African countries and 31,500 from Caribbean countries in Los Angeles County according to the Migration Policy Institute.

“There [were] a lot of suicides back in 2008 to 2009,” Executive Director of the African Communities Public Health Coalition Senait Admassu said.

Admassu said the Los Angeles County Department of Mental Health attempted to help the community and prevent these suicides but didn’t know how to reach Caribbean and African communities due to cultural communication barriers.

“We are trying to be complementary to the western system of treatment along with holistic culturally sensitive healing,” Admassu said. “This is community-driven from the bottom up, a more holistic than only one method under state and county structure.”

The non-profit, which receives a combination of funding from the department and private grants and fundraising, sees itself as a bridge between community initiatives and government health services.

In 2017 the organization began providing direct mental health services by state-certified employees. All staff and volunteers, however, are not required to have an educational background or work experience in mental health to work in the coalition’s outreach and education efforts.

According to Admassu, education is vital, especially when dealing with a contentious subject like female genital mutilation practiced in certain African societies. The ACPHS also engages in efforts to educate the Department of Homeland Security and other law enforcement on why this practice exists, why it is accepted and the social stigma associated with it. The coalition also hopes to educate migrant families that may engage in female genital mutilation that the practice is illegal and not accepted in the United States.

However, outreach and understanding can be challenging. Admassu said she often hears the term “hard to reach communities” used by county health officials in reference to African immigrants and Caribbean communities of African descent. Admassu said this term is isolating because it sends the message that these communities are difficult to work with and are somehow an insular population.

There are multiple methods that the ACPHC uses to inform African and Caribbean communities about their services. Outreach to Nigerian social gatherings in Carson and attending community events in Little Ethiopia are good at increasing the coalition’s presence. However, Admassu said it is not as effective as word of mouth from trusted sources said Admassu.

“For mental health back home in Africa and even here, the first resource is a faith-based organization,” Admassu said. “A pastor, or an imam a spiritual person in general, is whom we go to for any resource and because of that, we are mainly partners with community faith-based leaders. It’s an easy way to reach out.”

People of all backgrounds can experience similar mental health problems, but Admassu said immigrant populations can experience more severe versions of anxiety and depression. In some cases, a pre-existing condition could become worse.

Isabela Shawel, who is currently an intern for the ACPHC, is a second-generation Ethiopian earning her master’s in social work at California State University Dominguez Hills. She hopes to help heal these conditions through therapy and case management.

“Case management is primarily serving people on Medi-Cal, California’s version of Medicaid,” Shawel said. “The people we serve in this program are traditionally low income and immigrants who may need help understanding the legal process.”

According to Shawel, most agencies do not have staffers that reflect the African and Caribbean populations they serve. For the ACPHC, there are two different models used depending on a person’s goals and the issues they are presented with.

“Primarily we do talk therapy ... there are a lot of social factors at play like immigration issues, how to find services, isolation from not knowing how to find their community,” Shawel said. “These impact stress and their mental health.”

Another method is support group sessions. Creating networks of people from regions that share aspects of history and culture, such as West Africa and East Africa. Shawel became one of those advocates and underwent 40-hour training sessions to learn about the stigma within the mental health discussions for Ethiopian communities.

Admassu said trauma can be a factor before and after migration. Understanding a person based on country of origin, generation, and cultural and ethnic identity is necessary to understand their trauma.

“Black immigrant, undocumented and refugee communities that are not being represented in examining factors like racism and incarceration and what people have to navigate in getting here,” Shawel said. “There is a large population from African and the Caribbean along the [Mexican] border for example.”

Admassu said the center is also a valuable asset to other non-profits and county service provides by bringing together translators under one roof.