The California Health Report is an independent, non-profit journalism project supported with initial funding from the California Endowment. The site’s mission is to inform Californians about public health and community health issues, to engage readers in an ongoing conversation about matters ranging from health care policy to land-use, transportation, environment, criminal justice and economic policy, and to show how all of these things are connected.
By Hannah Guzik
When Irene Gomez emigrated from Mexico at 14, she immediately began working in the strawberry fields in the Oxnard Plain.
The work was exhausting, poorly paid and unreliable — but that was the least of her problems. She was also helping a friend escape from a violent relationship and was worried about living in the U.S. without legal papers.
She was overwhelmed, but felt she had nowhere to turn.
Gomez speaks Mixteco, an indigenous language that existed before the Spanish Conquest of Mexico. She’s among the estimated 165,000 indigenous farmworkers who have immigrated to California in the last two decades. About 60 percent of them do not speak English or Spanish.
Although many counties have programs that provide at least some medical care to this population, access to mental health services is extremely limited in most parts of the state.
This is despite the fact that indigenous farmworkers are believed to face higher amounts of anxiety, depression and post-traumatic stress disorder than the general population, said Sandra Barrientos, a therapist with the Ventura County Health Care Agency.
“They face acculturation issues from immigrating to the United States and stress related to leaving their families, as well as being undocumented and feeling like outsiders,” said Barrientos, who has learned basic phrases in Mixteco and is trying to push the county to do more to help the population. Ventura County is home to about 20,000 Mixtec immigrants, driven from rural southern Mexico by drought and poverty.
“I just presented a couple weeks ago to my clinic here to bring awareness of the languages of how region also matters” in terms of dialect, Barrientos said. “Even here, I feel like there’s not much awareness unfortunately in the community about the indigenous population.”
‘There’s an urgency’
The Oxnard Plain, which produces about 30 percent of the state’s strawberries, draws migrant workers and recent immigrants who oftentimes live in cramped, substandard housing conditions.
After watching a number of farmworkers experience psychiatric issues and interpersonal violence over a decade of living in Oxnard, Gomez wanted to start a program to help them.
She had worked in the fields for 12 years, learning to speak Spanish there and attending night school to learn English. In 2001 she began volunteering at the Mixteco/Indigena Community Organizing Project, a nonprofit based in downtown Oxnard, a working-class city that is one of California’s agricultural hubs.
Six years later she was hired full-time and is now the manager of a domestic violence and mental health outreach program run through the nonprofit.
“There’s an urgency to this, because if no one is helping them, the situation is only going to get worse,” said Gomez, 33.
The program, called Living With Love, offers a support group for women, referrals to mental health appointments and interpreters. It also teaches therapists about indigenous culture. This month the nonprofit will start classes for men on how to have healthy relationships and improve mental health.
But Gomez’s group, which started in 2008, is one of the few places in California where indigenous immigrants find mental health services. There are a handful of similar groups in places with large farmworker populations, such as Salinas and Santa Maria, but access remains limited even in those areas.
Even in Ventura County, a number of therapists refuse to allow translators in the room, effectively banning Mixtec speakers from getting treatment there, Gomez said. There are no therapists who speak the indigenous language, she said.
Language barriers, despite laws
The problem isn’t just limited to indigenous immigrants. Anyone who doesn’t speak English may have trouble accessing mental health services in California, said Claudia Menjivar, an attorney at the Western Center on Law & Poverty who works on language-access cases.
“There’s a lack of professionals in these areas that are adequately bilingual to provide mental health services,” she said.
Any mental health programs that receive state or federal funding must comply with laws that require services to be provided “in a culturally and linguistically appropriate manner,” Menjivar said. But budget cuts in recent years — some due to implementation of the federal Affordable Care Act — have resulted in language-access issues being pushed aside, she said.
Statewide, few mental health professionals speak a second language, according to the Board of Behavioral Sciences, the state licensing agency for marriage and family therapists, clinical social workers, educational psychologists and clinical counselors. The agency’s most recent data, taken from 2006 survey, shows that only 12 percent of licensees are fluent in Spanish, and about 1 percent speak Chinese. Fewer than 1 percent speak the other languages surveyed: Korean, Tagalog or Vietnamese.
The California Board of Psychology, which licenses psychologists in the state, said it does not know how many psychologists speak a language other than English, because it does not track that information.
More than 21 percent of California residents speak a language other than English at home, according to the U.S. Census Bureau’s 2012 American Community Survey.
Will a mall clinic help?
Ventura County’s behavioral health department, which does work with translators, has had a hard time reaching farmworkers due to language and cultural barriers, as well as stigmas about mental illness, said Meloney Roy, chief deputy director and behavioral health director for the county’s health agency.
“We are not seeing large numbers of indigenous people coming and seeking specialty services, and I think that needs further explanation,” she said.
This month the county is launching an effort aimed at reducing mental health disparities for Latinos in South Oxnard, where many indigenous farmworkers live. The plan includes relocating part of a mental health clinic to the Centerpoint Mall, a shopping center in the low-income neighborhood.
But advocates question whether the county is doing enough to help those living in the shadows.
“I think we have a long way to go to make it more equitable and I’d like to see the county do more to make that happen,” said Oxnard City Councilwoman Carmen Ramirez. “When people don’t get treatment, there’s major consequences for all of us.”
Meanwhile, Gomez continues with her work, trying to expand services despite a constricting budget. The nonprofit received a $90,000 grant from the county, spread out over the last three years, to help run its Living With Love program, but this year the funding was reduced to $10,000.
Gomez, who now works full-time at the Mixteco nonprofit, estimates that the group has helped more than 200 people access therapy since the program began.
Irene Flores is one of them. A mother of three and a strawberry picker, Flores sees therapist on Monday evenings, after her shift in the fields. She talks to the counselor about surviving domestic violence, parenting and the stress of making ends meet.
“After I go, I feel lighter,” Flores said, tearing up as she told her story in the nonprofit’s office last week. “I feel like with each step, I can surpass another obstacle and life will get easier.”
This story was reported with support from a grant from the nonprofit Entertainment Industries Council.
This article was published on the California Health Report website on June 15, 2014.
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