From NPR News, this is ALL THINGS CONSIDERED. Im Audie Cornish.

In the Gulf of Mexico, scientists are monitoring the long-term environmental impact of the BP oil spill. At the same time, sociologists and psychologists are working to mitigate the spill's impact on the Gulf Coast psyche. Counselors say getting people to talk about mental health issues isnt easy, especially in Asian immigrant communities.

NPR's Debbie Elliott reports as part of our ongoing series, The Disappearing Coast.

Ms. LE HUONG CARTER (Crisis Counselor): Shoes off. Shoes off.

DEBBIE ELLIOTT: Crisis counselor Le Huong Carter is making a house call in Bayou La Batre, Alabama.

Ms. CARTER: Hey, Phuong.

ELLIOTT: The counselor is Vietnamese and works closely with the Southeast Asian refugees who've settled on this working coastline, south of Mobile.

(Soundbite of babies)

ELLIOTT: On this afternoon, she's visiting Phuong Khuu, a widowed mother of two who used to work picking crab in the seafood processing plants that line the bayou. But now...

Ms. PHUONG KHUU: Cooking, clean up house, take care of my kids, and waiting BP - they pay the money.

ELLIOTT: Since June, she has been living off money from the BP claims fund, and staying up nights thinking about the future.

Ms. KHUU: I can't sleep. I worry at nighttime. I'm scared.

ELLIOTT: Sleeplessness is just one of the symptoms that researchers say have spiked since the BP oil spill. Several studies have found that more than a third of Gulf Coast residents report higher levels of anxiety, stress, anger and depression.

Tanya Fistein is a therapist with AltaPointe Health Systems in Bayou La Batre. She says the uncertainty in the aftermath of the disaster has taken a toll on people who relied on the Gulf for their livelihood.

Ms. TANYA FISTEIN (Therapist, AltaPointe Health Systems): What are they going to do now when is, you know, when they do get back to work? Is it going to be safe? Are they going to be able to sell their product? I mean there's all of this: If, if, if and what if?

ELLIOTT: Most of the Gulf of Mexico is back open for fishing. But the market hasn't been there for the seafood, so the industry has yet to rebound.

For Vietnamese immigrant Phuong Khuu, finding other work is nearly impossible because of her limited English skills.

Ms. KHUU: In seafood, no talk. No read, not write...

(Soundbite of laughter)

KHUU: And it's a strong hand.

(Soundbite of laughter)

ELLIOTT: To process seafood, she says, you just need a strong hand.

Counselor Le Carter has enrolled Phuong Khuu in English classes, and is trying to help her in other ways. Carter is part of an oil spill crisis team, put in place this summer by AltaPointe Health Systems. They've set up group sessions and other programs to get people talking.

But Khuu resists structured therapy as a way to deal with her anxiety. Carter says there's a real cultural barrier when it comes to mental health in the Amer-Asian community.

Ms. CARTER: Depressed, anger or hurt are suppressed within the culture.

ELLIOTT: Carter says there's no middle ground where people can explore why they're struggling emotionally in the aftermath of the oil spill.

Ms. CARTER: There is no concept. Either people are healthy or they are very, very, very broken down. People would say that person is coo-coo, is the term. You say coo-coo or very crazy.

ELLIOTT: Counselors have also discovered a religious reluctance to seek help from those who practice Buddhism.

AltaPointe therapist Pam Maumenee.

Ms. PAM MAUMENEE (Therapist, AltaPointe Health Systems): If they are experiencing difficulties, a lot of them feel this is a necessary thing to experience. And if they don't walk through the path now, their next life will not be better. So they should actually pay this price.

ELLIOTT: Figuring out how to break through the cultural barriers has been a real challenge, Maumenee says. One way she tries is to start the conversation about physical, not behavioral needs.

Ms. MAUMENEE: Im having problems today in my life with housing, utilities. Then maybe they start talking about some other issues going on in the family. Maybe anger is increasing. It might be substance abuse going on. Domestic violence we've seen an increase in domestic violence.

ELLIOTT: The crisis team is also trying to connect through trusted community resources.

(Soundbite of conversations)

ELLIOTT: At the end of a dirt road in Irvington, Alabama, is a brightly colored gate that leads to a Buddhist temple complex. It's part religious hall, part Cambodian community center. Seafood workers chat on the front porch about happier times when work was more abundant.

Thirty-nine-year-old Thin Bo says he used to work six days a week cleaning crab. Now he says he's lucky to get two day's work.

Mr. THIN BO: When we work we are kind of happy to live with, you know. But now we just staying home, that's it - just a lot of depression and worry about what the situation in the future.

ELLIOTT: The father of four admits it's been a struggle, yet he's reluctant to seek counseling.

Mr. BO: No. No. No, we would not go to a counselor. We can solve one problem at a time. They just go day by day.

ELLIOTT: The AltaPointe crisis team has been working with Van Suon, an activist in the Cambodian American community here. He's been trying to help with claims and set up classes, so that more immigrants can learn English and a trade other than the seafood industry.

Right now, he says, people are surviving on payments from the BP compensation fund.

Mr. VAN SUON (Activist): It's going to run out one of these days. It's not going to last forever. They're not going to take care of you forever, so you need to go to Plan B.

ELLIOTT: He worries the depression and anxiety will only escalate.

Mr. SUON: I guarantee you. For those who say they don't need counseling, when they run out of money, they will need some sort of counseling; whether it's marriage counseling or individual counseling.

ELLIOTT: The experts agree. They say the mental health fallout from the oil spill has yet to peak.

Debbie Elliott, NPR News.

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