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Ep. 3: Navigating Mental Health Challenges in Marginalized Communities · Wellness in Today's World

0:01
Hello, I'd like to welcome you to Wellness in Today's World with Dr.
0:05
Kawahara, a space where we discuss the latest insights in psychology, wellness trends, and everything in between.
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I'm Dr.
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Deborah Kawahara.
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Thank you for joining me today.
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April is National Minority Health Month.
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Focused on raising awareness about health disparities that continue to affect people from racial and ethnic minority groups.
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Today, our guest is Dr.
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Jan Estrellado, who is an assistant professor in the Clinical Psychology PsyD program at the California School of Professional Psychology, Alliant International University.
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Dr.
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Estrellado's expertise focuses on examining race, ethnicity, sexual orientation, and gender identity in trauma therapy.
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Welcome, Dr.
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Estrellado.
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Sounds great...
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Let's begin by talking about why is it important to raise awareness about minority health issues, particularly at this time.
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Yeah, it's a great question, I think that it's particularly important because people who experience oppression, people from different marginalized populations are being targeted
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in a really intense way right now.
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And, you know, we're still starting to understand how that's affecting people empirically in this current historical moment.
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And, you know, I think both for myself, the students I teach, the people I work with clinically, the people
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I supervise people around me in my communities.
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We know that we are being affected.
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And I think part of the point of the overwhelm that we're seeing in our political environment is to confuse people, to overwhelm people, and really to put us in a place
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where we feel helpless.
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And so I think it's really important for people to take care of their mental health in the midst of this really intentional overwhelm that many of us are experiencing.
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And I think it's important to acknowledge that even before this administration, many people were already experiencing different kinds of stressors, you know, related to access
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to care, related to feeling like they don't belong.
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And so this
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current administration is really just sort of intensifying, I think, an experience that many people have already been having.
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And so it feels particularly important for people to take care of their mental health now.
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So I think.
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you can?
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Okay.
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That's okay.
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No, that's all right.
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It'll be okay.
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the you can't hear I hear a little conversation outside.
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You can't hear that.
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Can you?
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Okay.
3:10
No, that's okay.
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Do we do that one over again?
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Do we need to-
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Okay.
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Okay.
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then Deb, my rank is associate.
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I don't know if you, if we can edit that or change it or.
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So did I say assistant, not associate professor?
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Okay.
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Can we...
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Let's just start over, Tony.
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And I'm sorry about that, Janet.
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I...
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I just feel bad that you have to say it again.
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I do have associates, so I don't know why I'm not an assistant.
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I'm trying not to look at it, but I do have to look at it at times.
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notes too, it's okay, I'm just trying to make it like, try not to do this.
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Okay, well Tony, you'll have two, you'll have two recordings of it.
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warmed up now.
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Should we just start recording, Tony, or is it gonna count down?
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I mean, so the most authentic pronunciation of my last name is with an L-yay.
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It's Estroliado.
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Yado?
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Yado?
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Estruyado.
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Okay, I'm gonna try and say it.
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If it sounds clunky, it'll just be...
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You got this.
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You know, I've been friends with Jan so this is like so formal, you know I don't usually say her last name while they're talking.
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It's like usually hey Jan, okay Okay, let me go.
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Okay.
5:05
So today we are so fortunate to have Dr.
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Jan Estrellado who is associate professor in the clinical psychology doctor of psychology program
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at the California School of Professional Psychology, Alliant International University.
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They expertise focuses on examining race, ethnicity, sexual orientation, and gender identity in trauma therapy.
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Welcome Dr.
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Estriado.
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I'm gonna call you Jan, because that's just not as hard to say.
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All right, let's begin by talking about why is it important to raise awareness about minority health, particularly at this time and particularly with mental health.
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I appreciate that question, Deb, because I think a lot of us in the field are thinking about that.
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And I want to normalize for therapists that we are thinking about this for ourselves as well.
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So not just for the clients that we serve, but also for ourselves, our families, and our communities.
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And I think it's important that we are really framing part of what we were experiencing as an intentional
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a strategy to overwhelm and shock and confuse us.
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And that the feelings that we're having as a result are appropriate.
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know, if people are feeling a sense of dread, if people are feeling a sense of overwhelm, if people are feeling helpless, I think these are emotional responses that are part of the
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strategy that is being used.
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to target a lot of people who experience different kinds of marginalization in our country.
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And because of that, it's really important for people to be thinking about how do I maintain my mental health during this time?
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And it's also important to note that previous to this, it's not like a lot of this is really new for people.
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If you are a non-citizen of undocumented status,
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it's not new that you are thinking about, how do I keep my family together?
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How do I keep my family safe?
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Now it's just intensified with the targeting that is happening in the current federal administration.
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So I want people to be thinking that the feelings that we're feeling are valid, they're appropriate, and that the feelings that are preceding, the situation that's preceding
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these feelings,
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is meant to do to initiate these feelings.
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So I want to reiterate, people should be taking care of their mental health and probably need to do a little bit extra now because of what's happening in the socio-political
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environment.
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You know, you talked about the chaos and the confusion and the uncertainty that the current situation is happening and, you know, part of this month's awareness.
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Debs are mine.
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Okay, let me see if...
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How...
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Let's see.
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I'm trying to see...
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My microphone's on 100.
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Can you hear me or you can't hear me, Tony?
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Huh.
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Okay.
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Do you want me, does that, is that better?
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I put the microphone closer to me.
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Yeah, a little bit better.
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Okay.
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Okay.
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Should we just continue or do you?
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Okay.
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Right.
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No, no, So, Jan, you talked about the chaos, the confusion, the uncertainty, the fear, and anxiety that is being created right now.
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you know, we know that there was already a mental health crisis even before all of this took place.
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And part of this month's awareness is around the disparities that ethnic
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Okay.
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I guess I'm wondering as this gets exacerbated, what will be continuing factors for us as therapists, us as just citizens, as people living in this society right now?
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What are some of those factors that we have to be thinking about?
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I want our field to be thinking at a few different levels.
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One of them, I think the one that a lot of us do have some control over, are some of the systemic issues that affect people's access to mental health care.
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So thinking about is the mental health care that we provide, is it linguistically accessible to the people that we want to serve?
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Is it culturally relevant to the communities that we serve?
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And I want to get into that just a little bit more.
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Our field has taught us in a framework that is mostly westernized.
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It's mostly individually focused.
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It's mostly internally focused.
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And those are not inherently unhelpful approaches.
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And they're not the approaches that might be the most relevant to the communities that we serve.
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So culturally responsive care is going to look like for a lot of people, including their families and communities in care, providing therapeutic care that might be outside of the
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office.
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Sometimes it's going to be in a community hall.
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Sometimes it's going to be in churches.
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Sometimes it's going to be in schools.
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And so
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thinking flexibly and expansively about how we can provide care at a systemic level for people for whom our traditional frameworks might not apply as directly as they might do
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for some communities.
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So I want us to be thinking about it on that level.
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unfortunately, our mental health care system has not always treated people from marginalized communities adequately.
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Mm-hmm.
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we have some understandable mistrust that happens for some of our communities.
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You know, I'm thinking about queer and trans communities, that mental health providers have been gatekeepers for our care for decades, and even currently so, specifically for
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trans and non-binary people.
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So it also makes sense that we probably have continual rebuilding that has to be done with communities that...
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might be a little bit hesitant to engage with us as people are more and more needing mental health care again, as we talked about previously with this current environment that
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people might need it more and might feel hesitant about that.
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And I think it's important for us to normalize that and continue to think more expansively about how to address that.
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Although the last thing I want to say about this, Deb, is
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One of my favorite mentors, Dr.
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Tom Lee, he used to supervise in the behavioral health hospital setting.
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And he said, Jan, one of the most important things that we're gonna treat in this hospital is the disease of hopelessness.
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And I love that because it really puts into perspective what our job is in a very succinct way.
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Again, we're not at extremes with everyone in terms of everyone being in a psychiatric crisis and we know that people are really deeply affected.
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And so how can we as providers treat the experience of hopelessness and helplessness that a lot of people are having right now?
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Yeah, that hopelessness, helplessness, um, apathy, numbness, all of those things kind of going on.
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And, you know, I think it is not just for our, you know, the people we serve, but also for our own well-being and health and right.
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Yes.
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And I guess, know, as you talk about that, Jan, I think about how do we, you know, what are some ways that we cultivate hope?
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We cultivate coping in these kind of stressful and challenging times that we find ourselves in.
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Mm-hmm.
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Yeah, the most immediate way that I think about this is, uh, intrapersonally.
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So how do I really connect with myself?
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How do I check in with myself about what it is that I might need?
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And knowing that we are going to have to work a little bit harder because we're responding to this overwhelming and chaotic environment.
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One of the things I encourage people to do is to think about what's worth fighting for.
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You know, what in your life is important to you that sort of drives you every day?
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Why do you get up every morning and do the things that you do?
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For a lot of us, it's gonna be about family.
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For a lot of us, it's gonna be about our community.
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For a lot of us, it's going to be about justice.
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So there are different values that people have that I would encourage them to try to connect with.
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as they decide, okay, what are the things that I might have to do that are hard, that might be painful, that might be uncomfortable, but could be worth it in the service of
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those important drivers of my life, important things in my life.
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The next thing I would encourage people to think about is interpersonally, right?
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Because so many of us, I think, probably feel more isolated.
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We could feel more alone.
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as we're responding to all of these different waves of news and continually shocking, even if not surprising, they're still shocking, if that makes sense.
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so having people think about, how do I maintain the relationships with people, specifically with people with whom I do not have to explain why I'm upset or why I feel
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afraid?
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or why I might feel anxious about some of these things.
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So I think nurturing the relationships that really fill our cup is important.
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And then the last thing that I would encourage people to do in terms of coping is to think about what helps me feel more hopeful and like I feel like I can have more influence on
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changing the environment around me.
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And I want to share something that happened actually yesterday for me.
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A friend of mine, Yvonne Zander, who's an alum of our CID program, invited me to meet with some folks in our local community.
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live in the same area, to talk about how we might want to create change.
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And Yvonne pointed me to the research of Erica Chenoweth.
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And Erica Chenoweth has research on
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civil disobedience and how this is effective for creating collective change.
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And there's one specific statistic that Dr.
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Chenoweth talks about that I want to share.
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It's that historically in the 20th century with different movements, movements that are fighting anti-democracy, so these are movements that are working towards democracy, that
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if three and a half percent of the population engaged in
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non-violent civil disobedience, different forms, not just protests, but boycotts, strikes, et cetera, that the government had to respond.
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The government had to adapt or change in more extreme way towards democracy.
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And I love that statistic, Deb, because it made me feel hopeful that if 3.5 % of our population, approximately 11 million people, felt
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that they could engage even in local efforts that we could collectively create change.
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So that for me, attending that meeting increased my sense of hopefulness about what I could do to help initiate change in our environment.
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Interestingly, you know, I just went to a conference and this political scientist kind of went over the last 10 years of how we got to this point.
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But part of what they are doing is trying to look at interventions that will, that are not bipartisan, but will get people to think about actions that they're taking at this time.
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And so part of the intervention that they're trying to see, does it kind of move people to action?
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So like a call to action, which is what I'm hearing you talk about, like this collective action plan, is trying to get them to think about, for women, it worked better for
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females, to think about a favorite teacher.
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Mm-hmm.
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And for them to then think about the behaviors and actions that they're engaging in.
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And really trying to get them to think how would that favorite teacher respond.
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And so they're trying to, it didn't work as well with males.
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And so they're trying to think about who would be someone that a male, and there was, she only talked about the
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the two genders, know, binary.
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But it's really an interesting concept in terms of trying to intervene in a way so that it addresses, even at this time, that the policies may seem more societal.
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What could I do in my own kind of local community that may make a difference at this time?
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You know, and so...
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almost that that you can do something.
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You can make a difference.
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And that when you I mean, I'm thinking of that Margaret Mead quote, and I'm not going to get it right.
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But when a group of thoughtful, intelligent citizens come together, they can make change.
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And that that is the way that you do it.
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You know?
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Yeah.
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I feel grateful that you and I are part of a field that is focused on what motivates people to do or not do things.
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And, you know, typically we think about this sort of in the traditional reasons a person might go to therapy, know, if they're depressed or anxious, et cetera.
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But thinking about this relative to the topic that we're discussing now, I love the idea that we could be
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we are thinking about what does motivate people to engage in collective actions that are congruent with their worldviews and their values.
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So, and I watched Erica Chenoweth's TED Talk on this, the idea that if I see a group of, know, a thousand people that believe the same thing that I believe about change,
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then it's much more likely that I'll want to join that if I see a sea of people who are engaging in that versus six or seven.
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So that helps me feel more motivated to engage in collective action in the service of things that I think are where I would like our country to go.
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So I'm grateful that we're in the business of behavior change in this way.
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Yeah, and I think a lot of people are trying to address that collective action, hopefulness, and that you can make a difference.
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I I also have been trying to watch more about active citizenship, like how do you hold on to democracy?
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You know, and I think for a lot of racial and ethnic minority communities,
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That is the hope.
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That is kind of what to fight for.
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And I guess I would say in terms of our ethical code, we do have a responsibility for the environments and contexts that all of our clients are living in.
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And so this becomes part of, this is part of the work.
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that we do.
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Mm-hmm.
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Yeah, I was having a conversation with my daughter yesterday about why it would be important for us to to be more active, you know, to be productive, contributing citizens
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to collective change.
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And I told her, you know, that a lot of the privileges that she and I have are because other people stood up for us because other people
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named injustices even when there was pushback.
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And the idea that we would also be contributing to the betterment, not just for ourselves, but for other people and future generations is a real motivator to me and I hope to her to
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be able to engage.
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And so I appreciate that we're sort of thinking about this.
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I'm even feeling energized as you and I are talking about.
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like, yes, I want to keep doing things.
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I think the first, closer to January of this year, I wasn't feeling so much of that.
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I think it's taken me a while to feel like I can pivot into action that feels sustainable for me.
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And I also want to note.
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that because people, certain people from marginalized communities are disproportionately targeted right now, that it doesn't mean that every person has to be doing the same thing
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or every person has to be on the front lines.
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And in fact, it probably doesn't make sense for some people to be on the front lines because they're being targeted.
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So I also want to encourage people to think about the ways that they might be able to engage without...
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putting themselves in an unnecessarily unsafe position.
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So whether it's working kind of in the background with different kinds of community care, I think that's perfectly fine.
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I think if it's sort of thinking about how do I keep myself and my family safe, I want people to be doing that.
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And it's a greater call for our allies, those of us who have different
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privileges around being able to be in the front lines that we do that.
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Interestingly, you know, I just recently met with a group of graduate students and this very issue came up and other kind of more, more seasoned professionals kind of told them,
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you know, right now it's about survival and that to really be thoughtful in terms of, yeah, maybe you don't put yourself.
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out there to then get kind of wiped out right now.
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This is temporary, it will pass and we need you to be around for the future.
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And so let the ones like your mentor, your advisors who are more farther along in their careers take kind of the risk because you may not be in a place in your career where
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you're at.
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you know, that you have those privileges or you have that power to withstand any threats or attacks to your career or your credibility.
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And so really telling them, let us take it because we have kind of the capital to take it right now.
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What we need you to do is to finish so that we have you when times are hopefully, you know, better.
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But that you survived this and that we can do that together and so it is being talked about like if You you need to be really thoughtful right now It is a time to take a huge
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risk And there's a lot of us and I remember dr.
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Gail Wyatt kind of said, you know this this is this is this is gonna be a long game and that
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We may have to, you know, some of us go to the front line for a while and then have to retreat and do respite.
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But if there's like you're talking about, if there's a large number of us, we can do that for each other so that we don't wear out, we don't get burnt out, we don't get sick along
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the way.
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And that to me is a part of taking care of ourselves that you talked about earlier, you know?
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Yeah, I think seeing ourselves as part of a larger movement that takes into account the sort of shifting responsibilities and roles that you're talking about and also taking into
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account the reality that people will need to step back for various reasons, whether it's to take care of their health or to let other people move to the front or
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that they might be targeted in a way.
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I think that's really important for us to be thinking about.
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And I think when we view it from that perspective, it feels a lot more manageable.
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It feels more sustainable.
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It feels less overwhelming that I have a part to play, but I'm certainly not the only one, and that there are other people who are aligned with that perspective.
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The thought of that alone...
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initiates positive feelings for me.
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So I'm glad that you talked about that.
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Yeah.
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The other thing that I just want to raise or amplify that you talked about is that we're all going to do this in different ways.
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And I want people to hear that just because someone's not doing it the way that you are doing it doesn't mean that they're not as committed as you are.
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that we actually need all the different ways and strategies to address kind of all the things that are going on right now.
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And so I wanted to ask you specifically, I mean, we talked about kind of advocacy and collective action, but can you see any other steps that can be taken to raise awareness,
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to address?
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health and mental health for those in minoritized communities.
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Mm-hmm.
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I think it's important for people to name that there's a need.
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You know, if one of the tendencies that people have during this time is to withdraw, then I think it's important to say withdrawing is actually a symptom of feeling hopeless and
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sometimes feeling helpless and feeling overwhelmed or responding to uncertainty.
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And I think
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That alone is helpful to people, just to name it.
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There are different needs that people have, and the way that people might respond happens on a spectrum.
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It can happen from the sort of internalizing way where people might start to feel some of these feelings that we're talking about, feeling discouraged or feeling more fearful, to
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the other extreme, which I think is people...
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lashing out in unhelpful ways, right?
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And so I think for people to know that many of the responses that we are already having are important, just to normalize that we're all trying to figure out, one, how we're
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responding to these different attacks on our communities, before, two, we figure out what to do about it how to respond.
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And so I think my hope for our field is that we're not
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just doing this in the setting of our therapy offices.
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I'm hoping that we're doing this in different ways.
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So one of the things that I talk about with my students is think about how you want your practice of psychology to impact people.
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And it might be beyond the clinical practice you provide.
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It can be writing a blog for Psychology Today.
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could be...
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in the kinds of presentations that you give to people or when you are giving presentations to the public about mental health and being able to really name some of the realities that
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people are facing so that people know that it's not, they're not alone in having those responses.
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And as you mentioned before, that we also as providers are having these responses ourselves.
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And so we're all in this together in terms of figuring out how to sustain ourselves, particularly during this next few years of this administration.
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Yeah, so what I'm hearing you say is naming it, voicing it, identifying it, and putting it out there.
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I mean, I know one of the things that in doing advocacy that legislators are saying they need stories.
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They need stories and narratives of how these things are actually impacting real lives.
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And so getting it out there and we know as minoritized
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individuals and communities that having those stories out there also makes others not feel so alone in their experience.
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Yes, absolutely.
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Yeah, I think it's so helpful to name this because I have an example.
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was getting ready to go to work the other day and I was feeling a sense of dread, but there wasn't really anything that I could point my finger at and say, this is why I'm
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dreading this.
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And it wasn't a...
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Discrete sort of thing.
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I think it was more that I was responding to news that I had read that morning that affects how we're going to work with DEI in our organizations and institutions and it was
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like this sort of low-lying feeling that was present but didn't feel like it was directly related to anything in particular that feels more and more common and
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you're right that i i that that's just sort of a small way i think there's a there are also more concrete ways as we've talked about that this is happening that i'm i'm hoping
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that we're able to make more visible uh...
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especially to our our government representatives because i'm hearing that also that hearing people stories uh...
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is really is going to be more and more important
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So I know we're getting close to the end and really wanting to end with, what would you want the people that are listening to this to take away today, at least?
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Take away from this.
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Sure.
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One of the takeaways for me is to people who experience oppression.
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Really, I can think about this on so many different levels and with different marginalized communities.
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We have existed in the midst of really daunting circumstances before this administration.
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And so that reminds me.
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that we will persist.
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We might be worn by the end of it and we will persist through it.
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And many of our communities have survived with or without different kinds of legal recognition.
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And I think that's also an important source of strength for me is that I come from multiple communities where that's been true.
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And so a legal recognition, of course, provides many different kinds of benefits to people.
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And we have lived without it for X amount of time, depending on which community we're talking about and which issues.
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So that's one thing is just to remember that we have a history that hopefully inspires us to continue persisting.
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And it's more important than ever for us to be able to take care of our mental health and that what's happening with us right now is intentional.
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There's a wish to have an intended negative impact that we can figure out together.
36:48
We can figure out how to overcome together if we continue to live in the service of our values and continue to live in community care.
36:59
I think those are probably the three takeaways that I'd have for folks.
37:03
You know, thank you so much, Jan, for being with us.
37:07
I mean, what I take away from what you just said is we have and will survive.
37:14
We are strong and we are resilient.
37:19
So thank you again for joining us as I sign off.
37:23
Remember, wellness is a journey, not a destination.
37:27
Take care and see you next time.