Closing a gap in mental health care for migrant workers in Minnesota
Closing a gap in mental health care for migrant workers in Minnesota

Growing up in south Texas as a third-generation Mexican-American, Gilberto Perez Jr. was familiar with some of the challenges facing immigrants.

This fueled his efforts as a social worker in Indiana, where he worked with community mental health centers to fill the gap in services for people who needed mental health help. In the early 2000s, through a community health assessment, he found that many people (86% of those surveyed) felt lethargic and depressed several times a week. It also became clear that people did not know where to find help.

“The conversations in the community have been stimulating and exciting with people saying, ‘Oh, I think I might need some help.’ Where do I get it from?” he said.

In 2007, he created the Bienvenido curriculum and program, originally designed around this original health assessment. Perez Jr. said the state recognizes that the program — Bienvendio means “welcome” in Spanish — encourages people to seek help at health centers.

His program first received a contract to train others in Indiana. Then, in 2008, the National Network to Eliminate Behavioral Health Disparities (NNED) and the National Hispanic Association for Behavioral Health nominated the program as one of 16 “community-defined evidence-based projects”—efforts that use cultural and/or community-based guidelines to improve the availability, quality, and outcomes of behavioral health care.

The Substance Abuse and Mental Health Services Administration and NNED then worked together to train 20 people to run the program from 10 states, Perez Jr. said.

Since the program began, Perez Jr. said about 450 people have gone through the training and are now able to facilitate the program in their communities. Minnesota is also part of the effort.

Some people in Minnesota have already been trained through a USDA grant to the University of Nebraska-Omaha designed to train leaders in Midwestern states, particularly those with migrant farm workers.

Each state has unique needs among its migrant workers, and the program gives facilitators the flexibility to make it their own based on community needs, Perez. said junior.

“We offer venting opportunities to share stories about migration, and then we offer training on things related to anger management, family dynamics, mental health, their strengths and weaknesses,” he said.

The program gives a place for people to talk about their migration experience and adjustment to a new life. It also allows people to build relationships with each other and become more involved in their local communities, which helps foster a sense of belonging, Perez Jr. said.

The Minnesota iteration of Bienvenido aims to reach Latino migrant workers who work in high-stress jobs with minimal support structures.

There was one full part of the program. About 15 to 20 people attended, said Silvia Alvarez de Dávila, a professor at the University of Minnesota’s Department of Family, Health and Well-Being. Each part includes about nine sessions and allows participants to build community connections and learn coping skills for stress, among other emotions.

Temporary farm workers

Alvarez de Dávila said the participants are usually workers in agricultural settings, such as meat processing and packing plants. Many of the participants came to Minnesota through the H-2B visa program, which allows companies to hire foreign workers on a temporary basis.

In 2023, 245 of the state’s 388 H-2B workers in manufacturing operations (specifically manufacturing) were employed by the HyLife meat processing company, which is located in Windom, according to U.S. Department of Labor data.

However, some of the participants are undocumented – unwilling to seek care during this time staying off the radar of federal programs out of fear, Alvarez de Dávila said.

With the help of facilitators in these communities who are familiar with Latino customs and culture, organizations like the University of Minnesota Extension can connect with these workers who might otherwise distrust such programs.

“We know that mental health is one of the main issues for immigrant families, especially those who are uninsured and undocumented,” Alvarez de Dávila said. “The idea is to support them with resources and activities to stay well when they’re away from their families while they’re working hard.”

She added: “They have really hard jobs and also schedules so they don’t connect with the community. They have no time to relax.”

Such situations can trigger strong emotions that can be challenging, especially for people who don’t have support systems, said Aubrey Derksen, who works with the University of Minnesota Extension and is a trained facilitator for the program.

“In preschool or in a classroom, you label body parts and emotions, but then we get to adults and forget that. And there is some cultural stigma associated with mental health in the Latino community,” Derksen said. “Just to be able to say, ‘Man, I’m mad. Now what do I do with this and how do I do it in a healthy way?’

Not an easy sell

Alvarez de Dávila said many migrant workers don’t talk about their emotions because they don’t have safe places to do so. They also tend not to have medical insurance, so there’s no formal way to talk about their mental health — and their supervisors and employers typically don’t offer insurance either, she said.

The first round of the program was held in Worthington, a city of about 14,000 in southwestern Minnesota. Many of the participants were employees of the JBS pork processing plant, and Alvarez de Dávila said everyone who started in the program stayed in it.

“They’re in a really tough environment,” she said. “It’s really hard for them because they’re tired at the end of the day. But they really wanted to come.

Not an easy sell. Alvarez de Dávila has noticed that it takes time for people to feel comfortable talking about their feelings and the difficulties they have faced.

“There was one lady who was actually very pessimistic on the first day and didn’t participate at all. She didn’t want to talk,” Alvarez de Dávila said. “But at the end she said after that lesson she was able to share and open up about her feelings and talk about what she feels and how now she has ways to share her emotions.”

Welcome Workbook
In 2007, Gilberto Perez Jr. creates the Bienvenido curriculum and program. credit: Courtesy of Gilberto Perez Jr.

Although the program is not focused on the migration experience, Alvarez de Dávila said it certainly comes up for many participants. “Most of them share how they feel different or how they ended up here,” she said. “It’s a safe place where they share stories. When you share, you must feel that you are not alone.”

Others sometimes share the stress of sending money to their families back home.

“Most of them, if not all of them, that’s why they’re here,” Alvarez de Dávila said. “That’s why you see families that are separated. That’s the main motivator, to get the money back because of the lack of opportunities.”

She said one of the challenges facilitators have faced so far is convincing employers to work with them on such a program. It is therefore important that facilitators have connections with their communities and migrant workers.

“Employers don’t like it because they think these workers will complain, talk about the harsh environment they work (in),” she said. “When we’re trying to offer the program, it’s difficult. Then we had to somehow explain the … benefit because ultimately the employers benefit because their workforce is fit and not absent or sick.”

Because of the difficulties in convincing employers, it is important that facilitators have connections with their communities and migrant workers. Derksen is at the University of Minnesota Rochester Extension office learning how nearby communities can benefit from Bienvenido.

Perez Jr. said the program has helped open doors to more mental health services for communities in many states besides Indiana and Minnesota, including New Mexico, Oregon, Kansas, Illinois, Michigan, Pennsylvania and New Hampshire.

“They can have immigrants who are better informed about where resources are, know how to access services and when they need help, know where to go,” Perez Jr. said.

Program expansion

The University of Minnesota Extension, one of two organizations that operate Bienvenido programs in the state, is in talks with companies in both Waseca and Owatonna about the program to be made available to their employees.

One of the Waseca companies hires workers from Guatemala who come for six months and then return together. The next batch of workers for the Waseca company will arrive in April, she said.

Derksen said the program could potentially be rolled out to farm workers. She has spoken with people from the Minnesota Farmers Union and the Minnesota Farm Bureau and said their initial reactions to the idea seem promising.

Ava Kia

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