Pranom was losing hope.
She had been waiting more than two months to be accepted into a substance abuse program. A survivor of human trafficking, she was using meth to numb her depression, doing sex work to pay off her debts and caring for her adult son with special needs. The Times is not using her last name.
Her psychiatric social worker, Wanda Pathomrit, called a treatment center to start the intake process. But when Pranom arrived, they could not accept her because no one on staff could speak Thai.
“But you can hire an interpreter,” Pathomrit told them. “She is ready. Do you know how hard it is to get someone who’s ready to quit?”
Despite Southern California having the world’s largest Thai population outside Thailand, those here face stigma, language barriers and limited resources when accessing mental health care. Thai Town’s temples and resource centers aim to support the community, but having few Thai-speaking mental health care workers can mean long waits to access treatment centers, housing support and social work resources.
While waiting for a Thai interpreter, Pranom fell deeper into despair. Pathomrit said she recalls Pranom sharing how she wanted to be a good mother and make ends meet, but felt ashamed for needing drugs.
Pathomrit tried encouraging her to follow up with the treatment center, but Pranom stopped picking up the phone.
“The idea of treatment provided a sense of hope,” Pathomrit said. “When she got rejected and had to wait, I was worried she might think this type of help was not meant for her.”
Eventually Pathomrit contacted the Asian American Drug Abuse Program, which had a Thai staff member. In August 2023, Pranom was admitted into its residential treatment program. She stayed for eight months, then transitioned to a temporary housing program to begin securing a permanent home.
Working at Asian Pacific Counseling and Treatment Centers, Pathomrit primarily serves first-generation Thai immigrants — prioritizing those with limited English proficiency — and helps clients navigate Los Angeles’ complex mental health care system.
“The system is not equitable,” Pathomrit said. “You have to do more, because there are more … barriers in the way.”
Navigating mental health as a Thai immigrant and sex trafficking survivor
Before arriving in the U.S., Pranom worked in a factory in Bangkok. In a docuseries by Myx TV following her journey fighting human trafficking, Pranom said a friend had told her about an opportunity in Hong Kong to make money cleaning apartments. She immigrated to Hong Kong in 1991, not realizing she instead would be forced into sex work. Her traffickers later brought her to the U.S., where she lived in an apartment with seven other women and was told she needed to continue working to pay off the cost of bringing her to America.
When Pranom escaped, she eventually made her way to Los Angeles and found the Thai Community Development Center, or Thai CDC, a nonprofit providing health and social services and staffed with people from the Thai community.
In an interview with The Times, Panida Rzonca, directing attorney at Thai CDC and one of Pranom’s lawyers, said Pranom initially came to the organization seeking parenting and housing services. . It wasn’t until 2014, when Rzonca asked Pranom about her immigration history, that Pranom opened up about her experience with forced sex labor. Rzonca helped Pranom apply for a special visa that allows trafficking survivors to stay in the country if they assist law enforcement in prosecuting their trafficker.
Because Pranom did not have a work permit, she was providing massages as an unlicensed practitioner and doing sex work. She didn’t know how else to support herself and her son.
“It was a choiceless choice,” Pranom said through an interpreter. “If I don’t do it, I don’t have a means of survival.”
That type of desperation, Rzonca said, is often another form of exploitation for human trafficking survivors.
“She wasn’t victimized just once when she entered the country,” Rzonca said. “Because of the circumstances, she became a victim again because she didn’t have whatever magic potion it would take for her to find a fresh start.”
Pranom described enduring physical and emotional exhaustion from long workdays serving clients. Frequently she relied on meth to push herself to work and dull her senses. Without it, she was afraid she would fall into despair and hopelessness.
A friend who previously worked alongside Pranom pushed her to seek help. Pranom’s friend spoke to The Times on the condition of anonymity because of privacy concerns around their own human trafficking history.
Pathomrit, the social worker, had helped the friend get substance-abuse counseling. Now, after getting support and landing a new job, the friend wanted the same for Pranom. It had been about 15 years since Pranom escaped her traffickers.
The friend called Pranom every day asking her to consider treatment. They told Pranom about their new job helping people in situations like theirs understand their labor rights and how to access social services and mental health care. Like them, Pranom could have a better life.
“I made her dream,” Pranom’s friend said.
Pranom thought about her son, who lived in a group home for adults with disabilities. When she used meth, she didn’t feel safe being near him.
“I wanted to become more stable in order to have a home together,” Pranom said. “I want to reunite with my son and get him help.”
After a month of her friend’s insistence, Pranom agreed to meet with Pathomrit.
Stigma, language barriers and lack of data can present challenges for Thai people seeking care
Persistence through hardship is an important concept in Thai culture, said Thai CDC program associate Kittima Chambers. Common phrases such as phayayam (“try hard”) and ot thon (“to endure”) often are used when discussing adversities and challenges. This can encourage perseverance but it also may prevent Thai people from seeking help because of fears that their community will believe they did not try hard enough.
Chambers added that the need to demonstrate to others how well one is thriving also can heighten the stigma against finding care. Those facing mental health struggles fear losing face or bringing shame (khwam ai) to their family and community.
Compounding the issue is the fact that there is no legal requirement for public agencies to provide Thai-language access services to limited-English-proficient individuals. According to Sandra Chang, Cultural Competency Unit Program Manager at the Los Angeles County Department of Mental Health, a language needs at least 3,000 Medi-Cal beneficiary speakers in a given area for it to be considered a threshold language, which triggers the requirement.
“For Los Angeles, Thai has not made it to that point yet,” Chang said, adding that the department mandates services to be rendered in a client’s preferred language regardless of threshold status.
Chayanin “Teddy” Rattana-anun, a family advocate and case manager at the Center for the Pacific Asian Family, or CPAF, worries about overwhelming his community whenever he makes referrals to other local organizations, because there are so few therapists and social workers who speak Thai.
“We keep spinning around in a circle: refer to CPAF, refer to [Asian Pacific Counseling and Treatment Centers], etc. It’s always this loop,” Rattana-anun said.
In addition, many Thai Americans struggle to find therapists who can understand their immigrant experiences and the stress of adjusting to a new culture while maintaining traditional values and practices.
L.A. County has the world’s only officially designated Thai Town. But the needs of its people are not as visible as those of other Southeast Asian communities.
In the ‘80s and ‘90s, the federal government resettled tens of thousands of Hmong, Lao, Cambodian and Vietnamese refugees in California after the Vietnam War, the Cambodian genocide and the Laotian civil war . Because these groups were concentrated in specific counties and eligible for benefits through refugee programs, their trauma, resettlement stress and needs could be documented.
But Thai migration patterns are different. Instead of the refugee resettlement pipeline, most came as students, workers or to reunite with family.
The L.A. diaspora is relatively small compared with other Asian American and Pacific Islander communities in the county. Thai people are coded under broader categories like “Other Asian/Pacific Islander” in census surveys and are harder to track in county and state data systems.
“This makes it harder to see Thai-specific needs… even though the community exists,” Pathomrit said.
How Pranom’s community helped her find hope
Community was key in keeping Pranom engaged with her journey to recovery.
Because Pathomrit grew up witnessing her Thai immigrant parents’ struggles with cultural adaptation and language barriers, she understood that Pranom’s expressions of distress, as with many of her other Thai clients, may look different than the symptoms described in training for mental health clinicians.
“A lot of times they come in with their silence, and they don’t know how to describe it,” Pathomrit said.
Because talk therapy is a process of verbalizing symptoms to help process emotions, Pathomrit often spends extra time educating her clients and modeling what that looks like.
When Pranom entered rehab, her friend kept watch over her son and often asked Pathomrit to check up on her. The Asian American Drug Abuse Program also allowed Pathomrit to help Pranom navigate resources in a language she understood, particularly when AADAP’s Thai staffer left.
“There’s a lot of pressure” in receiving treatment for drug abuse, Pranom said. “But I am very lucky I have a support system.”
Today, Pranom, 53, speaks out against human trafficking and tells others who feel trapped in forced labor or substance abuse that healing and recovery are possible.
Last year she was featured on billboards on the 57 and 210 freeways by Unshame California, a campaign aiming to reduce substance-use disorder stigma by sharing stories of those impacted.
And this past March she shared her story of breaking free from labor exploitation for a campaign spotlighting Asian immigrant women. There is tremendous stigma in seeking help, Pranom said, but she wants to pay it forward with gam-rang-jai — inner strength — to encourage others to reclaim their lives.
“Reclaim your dignity, reclaim your stability for your future, reclaim your time,” Pranom said. “Believe that you have a future.”
Interpreter Lena Deesomlert contributed to this report.
The post ‘They come in with their silence’: How stigma and limited access to mental healthcare affect L.A.’s Thai community appeared first on Los Angeles Times.
