Dr. Luis Garcia glanced at his watch, sighed and tapped the mic.
It was 10:20 a.m., 20 minutes past the scheduled start, and it was clear that this Saturday’s workshop — talking about the psychological risks of being an immigrant — would not be well attended. Garcia looked up from the podium, scanned the approximately 200-seat auditorium at MemorialCare Long Beach Medical Center, and saw just seven people, most of whom were sitting in the back.
“Buenos dias… Good morning!,” Garcia said. “We’re going to start in about five minutes.
“I apologize for taking so much of your time,” he added.
“I don’t know why there aren’t more people here.”
Actually, he did.
The same political and cultural trends that are creating an epidemic of stress-related health woes in the Latino communities of Southern California — everything from rising pre-term birth rates to widespread depression to little kids diagnosed with PTSD — also are making many people wary of venturing out in public.
Cowed by the threat of Immigration and Customs Enforcement (ICE) raids, harsh changes in immigration policies, and racially motivated violence (such as the recent mass shooting at a Wal-Mart in El Paso), some Latinos are avoiding contact with anybody who might be deemed an authority, according to Garcia and other leaders of public mental health programs.
That wariness extends to seminars, health fairs and other gatherings that might improve their health.
Garcia, vice president of quality care for the nonprofit health network Pacific Clinics, said attendance has fallen by half at some of the workshops he holds.
But the need for those classes — which offer information about mental health problems and how to seek appropriate treatment — is real and growing. Garcia said those who do come to his events include a growing number of adults suffering from serious mental health disorders and substance abuse, and parents who say their kids are depressed, anxious or suicidal. But when he gives out contact information to get some help, Garcia said, many are too scared to follow up.
“The first thing they’ll ask is: ‘Will I be safe if I go to you for services? I don’t want any problems.’ They ask a lot of legal questions,” Garcia said.
“And you can see the main issue is they are so afraid.”
Latinos have long been reluctant to seek care for mental health problems, and that reluctance has soared since the 2016 election of President Donald Trump, several health providers said.
People who are undocumented, and others who are citizens but have family members without legal status, worry that contact with a public health clinic means their information soon will be shared with immigration authorities, even though providers say such information is protected. And the Trump administration’s “public charge” rule — a proposal that’s currently on hold but, if implemented, would penalize Green Card applicants for using certain public benefits — is scaring off many legal citizens from seeking mental health care for themselves or their U.S. citizen children, providers said.
This mistrust couldn’t come at a worse time. Numerous studies have tracked a spike in stress-related health problems in the Latino community since the 2016 election.
A study in JAMA Pediatrics, which looked at nearly 400 U.S.-born Latino teens with immigrant parents, found they had higher-than-normal levels of anxiety, higher blood pressure and more trouble sleeping. Another study found an unexpected surge in preterm birth rates among Latina mothers. Other surveys by The Children’s Partnership and California Immigrant Policy Center detected greater anxiety and fearfulness among Latino parents and their children.
These fears are pushing immigrants to isolate themselves and their children, further undermining their mental well being, experts said.
“It’s a double bind,” said Gloria Montiel, a strategic consultant with the Santa Ana-based nonprofit Latino Health Access. “There is an increased need for mental health services, and real preoccupation (within) the community.”
Montiel’s organization works to provide mental health treatment to people in Orange County, offering help that ranges from an on-site, Spanish-speaking therapist to assistance in navigating the healthcare and legal systems.
Part of the agency’s work involves face-to-face outreach, she said, but even that is hampered by fear.
“People are really hesitant to even open the door,” Montiel said.
“It’s becoming harder to convince them… that we’re not reporting their information (to immigration authorities),” she added.
A similar phenomenon played out last year at an event in Bell Gardens put on by the Los Angeles County Department of Mental Health. The event, aimed at the area’s Spanish-speaking community, promised a Zumba class, free haircuts and more than 100 vendors.
But when the day came, and turnout was shockingly low, organizers asked the few people who did attend why other Latinos in the area didn’t come.
“People said they don’t want to come out of their house,” said Ana Suarez, a health program director with L.A. County Dept. of Mental Health.
“We had more vendors than we had attendees,” Suarez added. “It was really sad. It was like having a big birthday party and nobody shows up.”
Some elements of this dilemma pre-date current politics.
Among older Latinos, for example, mental health issues carry a stigma, prompting many who suffer to deny the problem. And some people, particularly first-generation immigrants, simply don’t have the vocabulary to describe mental distress, said Sergio Aguilar-Gaxiola, director of the UC Davis Center for Reducing Health Disparities. The Mexican indigenous language Mixteco, for example, doesn’t have a word for “depression,” he noted.
Those factors, combined with a severe shortage of bilingual and multicultural mental health providers, can make it harder to get proper treatment. Patients sometimes show up at a doctor’s office complaining of physical symptoms, such as body ache or fatigue, when in fact they’re suffering from depression or PTSD.
“If the providers are not well trained on psychiatric issues, it will take them some time to diagnose what the problem is,” Aguilar-Gaxiola said
Without treatment, mental health conditions intensify over time, he added, leading to
problems that can ripple through their lives.
“It interferes with their work, with their relationships with family and friends and co-workers,” he said. “It limits people’s ability to reach their potential.”
Spreading the word
Despite the challenges, Latino outreach is ramping up.
Sometimes, the message is simply telling people that mental health treatment isn’t connected to immigration enforcement, and that seeking treatment isn’t a threat to staying in the United States.
Suarez, with Los Angeles County, said her agency has been asked by community groups to send in promotoras — Spanish-speaking health workers — to teach a class about the connection between trauma and immigration issues. The broader goal, she said, is to help handle the growing crisis in the Latino community.
Suarez and others who work in the field also said the health promoter, or “promotora” model, which is common in many Latin American countries, remains an effective way to reach some Latino communities. Promotoras are not mental health providers. But, because they speak Spanish and tend to be well-known within the community, they can be effective health messengers.
Laura Olvera Arechiga, a promotora with the non-profit Vision y Compromiso, said she and three other outreach workers in Riverside County will hold public workshops to address stress, depression, anxiety, trauma, violence and suicide prevention. Arechiga, who is originally from Mexico, has worked as a promotora for asthma prevention but said many of the people she helps also struggle with mental health problems.
Montiel, with Latino Health Services in Santa Ana, said her group is trying to partner up with trusted institutions, such as schools and churches, to spread the word about the help they can provide. The organization, she added, also has contracted an on-site therapist so that community members who are fearful of going to a mental health clinic can get counseling at their offices.
In the Boyle Heights neighborhood of Los Angeles, the county recently launched a range of services — knitting, Zumba, hiking — to help get out the word about mental health to the Latino community.
Diego Rodrigues, chief operating officer with Alma Family Services, which runs the program, said the idea is to create a non-threatening space where people can talk about mental health and also have fun.
“The whole purpose is to destigmatize mental health, and think of mental health as just wellness, which the whole community can benefit from.”
Meanwhile, Dr. Garcia with Pacific Clinics continues to speak at mental health outreach events, even when the audience is small.
“For me, it’s very clear… I have to go and talk with people,” he said. “I want to avoid any tragedy, keep these kids and their families safe, and encourage them to do the prevention that they need to do.”
Claudia Boyd-Barrett writes for the Center for Health Reporting at the USC Schaeffer Center for Health Policy & Economics. Reporting was supported by a grant from the California Mental Health Services Oversight and Accountability Commission.