‘They come in with their silence’: How stigma and limited access to mental healthcare affect L.A.’s Thai community – Los Angeles Times

Report on Systemic Barriers to Sustainable Development Goals for Thai Immigrants in Los Angeles

The case of Pranom, a Thai immigrant and survivor of human trafficking in Los Angeles, exemplifies the significant systemic barriers that prevent vulnerable populations from achieving fundamental Sustainable Development Goals (SDGs). Her experience highlights critical challenges in accessing healthcare, justice, and economic stability, directly impacting the fulfillment of SDG 3 (Good Health and Well-being), SDG 5 (Gender Equality), SDG 8 (Decent Work and Economic Growth), SDG 10 (Reduced Inequalities), and SDG 16 (Peace, Justice and Strong Institutions).

Case Study: A Survivor’s Intersection with Human Trafficking and Healthcare Inequities

Background and Exploitation: Violations of SDG 5 and SDG 8

Pranom’s journey began in 1991 when she was deceptively trafficked from Thailand and forced into sex work in the United States. This experience constitutes a severe violation of fundamental human rights and specific international development targets.

• SDG 5.2 (End Violence Against Women): Pranom was subjected to sexual exploitation, a primary form of violence targeted by this goal.
• SDG 8.7 (End Modern Slavery and Human Trafficking): Her situation of forced labor is a direct example of modern slavery, which this goal aims to eradicate.

Even after escaping her traffickers, a lack of legal status and economic opportunities forced her into precarious work, including sex work, to support herself and her son. This “choiceless choice” underscores the failure to provide survivors with pathways to decent work, a core component of SDG 8, perpetuating a cycle of exploitation.

Barriers to Good Health and Well-being: A Failure to Uphold SDG 3 and SDG 10

Pranom developed a substance dependency on methamphetamine to cope with depression and the trauma of her experiences, a critical health issue addressed by SDG 3.5 (Strengthen prevention and treatment of substance abuse). However, her attempt to seek help was thwarted by systemic failures that reflect deep-seated inequalities, undermining SDG 10.

When Pranom was ready for rehabilitation, she was denied entry into a treatment center because no staff could speak Thai. The two-month delay in finding a suitable program nearly extinguished her hope for recovery. This incident demonstrates a critical failure in providing equitable and accessible healthcare, a cornerstone of SDG 3, and highlights the inequalities (SDG 10) faced by non-English speaking minority groups.

Analysis of Systemic Failures in Achieving SDG Targets

Institutional and Policy Gaps Undermining Equality and Justice

The challenges faced by Pranom and the broader Thai community in Los Angeles stem from specific institutional and policy gaps that prevent the realization of key SDGs.

1. Language Access Policies (SDG 10): The Thai language does not meet the required 3,000 Medi-Cal beneficiary threshold in Los Angeles County to be designated a “threshold language.” This policy results in a lack of mandated, publicly funded interpretation services, creating a significant barrier to healthcare and social services and directly contributing to the inequalities SDG 10 seeks to eliminate.
2. Data Invisibility (SDG 10 & 16): Thai populations are often aggregated under broader categories like “Other Asian/Pacific Islander” in census and public health data. This practice renders their specific needs invisible, making it difficult to advocate for targeted resources and build the strong, inclusive institutions envisioned in SDG 16.
3. Cultural Barriers and Stigma (SDG 3): Cultural concepts emphasizing endurance (*ot thon*) and fear of bringing shame (*khwam ai*) discourage Thai individuals from seeking mental health support. Healthcare systems that are not culturally competent fail to address these nuances, hindering progress on SDG 3.4 (Promote mental health and well-being).
4. Scarcity of Culturally Competent Resources (SDG 3): The limited number of Thai-speaking social workers and therapists creates a bottleneck, forcing community organizations to refer clients within a small, overburdened loop. This lack of capacity prevents the delivery of effective and equitable health services.

The Role of Community-Based Interventions in Advancing SDGs

Successful Intervention and Recovery Pathway

Pranom’s eventual success was facilitated by targeted, community-based interventions that align with the principles of the SDGs. The persistence of her social worker, Wanda Pathomrit, and the support of the Asian American Drug Abuse Program (AADAP), which had a Thai-speaking staff member, were crucial. This demonstrates that achieving SDG 3 for marginalized populations requires culturally and linguistically appropriate services provided by strong community partners.

Organizations such as the Thai Community Development Center (Thai CDC) and Asian Pacific Counseling and Treatment Centers provide essential support, helping individuals navigate complex systems and access justice, such as applying for special visas for trafficking survivors (a key element of SDG 16).

From Survivor to Advocate: Promoting Health and Justice

Now in recovery, Pranom has become a public advocate, using her story to combat the stigma associated with substance use and human trafficking. Her participation in the Unshame California campaign and other advocacy efforts directly contributes to several SDG targets:

• SDG 3: By sharing her story, she helps reduce the stigma surrounding substance use disorders, encouraging others to seek help.
• SDG 16: Her advocacy for trafficking survivors promotes justice and encourages others to reclaim their dignity and rights.

Pranom’s message to “reclaim your dignity, reclaim your stability for your future” embodies the spirit of empowerment that is central to the 2030 Agenda for Sustainable Development, proving that with adequate and equitable support, recovery and progress are possible.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article highlights several interconnected issues that are relevant to multiple Sustainable Development Goals (SDGs). The analysis identifies the following SDGs as being directly addressed:

• SDG 3: Good Health and Well-being: The central theme of the article is Pranom’s struggle with mental health (depression), substance abuse (meth use), and the significant barriers she faces in accessing healthcare. The lack of culturally and linguistically appropriate mental health services for the Thai community in Los Angeles is a primary focus.
• SDG 5: Gender Equality: Pranom’s story is a clear example of the vulnerabilities faced by women, particularly immigrant women. She is a survivor of human trafficking and was forced into sex work, which are extreme forms of gender-based violence and exploitation.
• SDG 8: Decent Work and Economic Growth: The article details Pranom’s experience with forced labor and human trafficking, which are direct violations of principles of decent work. Her subsequent struggle to find legitimate work without a permit, leading her back into exploitative situations, also connects to this goal.
• SDG 10: Reduced Inequalities: The entire narrative is framed around the inequalities faced by a specific ethnic minority. The Thai community in Los Angeles experiences systemic barriers, including language access, cultural stigma, and a lack of data that makes their needs invisible to public agencies. The article explicitly states, “The system is not equitable.”
• SDG 16: Peace, Justice and Strong Institutions: This goal is relevant through the lens of combating human trafficking and ensuring access to justice. Pranom’s journey involves legal assistance to secure a special visa for trafficking survivors. The article also points to institutional weaknesses, such as healthcare systems that are not equipped to serve non-English speaking populations, thus failing to provide equal access to services.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the issues discussed, several specific SDG targets can be identified:

1. SDG 3: Good Health and Well-being

   • Target 3.4: Promote mental health and well-being. Pranom’s story of depression, despair, and the need for mental healthcare directly relates to this target. The article emphasizes the cultural stigma and lack of resources that prevent Thai immigrants from seeking and receiving mental health support.
   • Target 3.5: Strengthen the prevention and treatment of substance abuse. Pranom’s use of meth to cope with her trauma and the difficulty she experienced getting into a rehabilitation program (“waited more than two months”) are central to the article, making this target highly relevant.
   • Target 3.8: Achieve universal health coverage, including access to quality essential health-care services. The article demonstrates a failure to provide universal access, as Pranom was initially turned away from a treatment center because “no one on staff could speak Thai,” highlighting a significant barrier to quality and accessible care for her community.

2. SDG 5: Gender Equality

   • Target 5.2: Eliminate all forms of violence against all women and girls, including trafficking and sexual exploitation. Pranom’s history as a survivor of human trafficking, where she was “forced into sex work,” is a direct example of the issues this target aims to eliminate.

3. SDG 8: Decent Work and Economic Growth

   • Target 8.7: Take immediate and effective measures to eradicate forced labour, end modern slavery and human trafficking. The article details Pranom’s experience of being trafficked to the U.S. and forced to work to pay off debts, which is a textbook case of modern slavery and human trafficking.

4. SDG 10: Reduced Inequalities

   • Target 10.2: Empower and promote the social, economic and political inclusion of all, irrespective of origin. The article shows how Thai immigrants are socially excluded from essential services due to language barriers and cultural misunderstandings, hindering their well-being and inclusion.
   • Target 10.3: Ensure equal opportunity and reduce inequalities of outcome. The policy mentioned in the article, where Thai is not considered a “threshold language” for mandatory public service access because it doesn’t meet a minimum number of Medi-Cal speakers, is a practice that creates unequal outcomes for the Thai community.

5. SDG 16: Peace, Justice and Strong Institutions

   • Target 16.3: Promote the rule of law and ensure equal access to justice for all. Pranom’s ability to get legal help from the Thai CDC to apply for a “special visa that allows trafficking survivors to stay in the country” is an example of accessing justice. However, her initial struggles highlight the broader challenge of ensuring this access is equal for all vulnerable individuals.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

The article implies several qualitative and quantitative indicators that could measure progress:

1. For SDG 3 (Good Health and Well-being)

   • Indicator: Availability of substance abuse treatment services for non-English speakers. The article implies this can be measured by tracking wait times for linguistically appropriate programs. Pranom’s “more than two months” wait is a negative indicator, while her eventual admission to a program with a Thai staff member is a positive one.
   • Indicator: Density of mental health workers who are proficient in minority languages. The article explicitly states there are “few Thai-speaking mental healthcare workers,” which serves as a direct, measurable indicator of a service gap.

2. For SDG 5 (Gender Equality) & SDG 8 (Decent Work)

   • Indicator: Number of victims of human trafficking who receive comprehensive support (e.g., legal, health, housing). Pranom’s case is an example. The article mentions she received legal aid, was admitted to a residential treatment program, and then transitioned to a temporary housing program. Tracking the number of individuals who successfully navigate this support system would be an indicator of progress.

3. For SDG 10 (Reduced Inequalities)

   • Indicator: Policies on language access in public services. The article points to a specific policy indicator: the “threshold language” requirement of 3,000 Medi-Cal beneficiary speakers. Progress could be measured by whether this threshold is lowered or if alternative policies are implemented to include smaller linguistic communities.
   • Indicator: Data disaggregation for ethnic minorities in official statistics. The article notes that Thai people are often coded under broader categories like “Other Asian/Pacific Islander” in data systems, which “makes it harder to see Thai-specific needs.” An indicator of progress would be the collection and reporting of disaggregated data for the Thai community specifically.

4. Summary Table of SDGs, Targets, and Indicators

Source: latimes.com