The added challenges of getting mental health care as a farmworker – KUOW News and Information

Getting care can already be difficult when you live in a rural area — but there’s also a stigma surrounding discussions of mental health and self care in the agricultural industry.
And getting proper care for your mental needs depends on what work you do, and who you are.
Last week we talked about the mental health needs of farmers — the people that own and run our agricultural businesses across the state.
Recommended reading: The unique mental health challenges facing farmers and farmworkers
Today, we’re focusing on farmworkers, the folks who keep those businesses running.
Because, while some of the challenges they face may look similar, there are a lot of differences between these communities.
Esmeralda Mandujano is a community health program manager with the Western Regional Agricultural Stress Assistance Program, also known as WRASAP, as well as the University of California, Davis.
She grew up in a farmworker family and has done farm work herself. She says that from an early age she was taught to keep a lock on her emotions.
“Since we’re kids, we’re taught to control ourselves,” Mandujano says. “That this is something that we have control of. And oftentimes, with mental illness, especially as it advances, it’s not something that you can control.”
Mandujano notes that farmworkers experience physical injuries on a daily basis while at work, and are often pushed to work at a faster pace in order to get paid more.
“Farmworkers work through musculoskeletal discomfort, injury and illness on a daily basis,” Mandujano says.
Working through discomfort can lead to added stress, anxiety, or depression. And there’s a lot of barriers to seeking care, including language, work hours, and a lack of clinics in the area. At any given time in the U.S., there’s a shortage of mental health care providers, Mandujano says.
“And at any given time, also, there’s more than 10 million adults in the United States that have an unmet need for mental health treatment,” she says.
One place farmworkers can receive low cost mental or behavioral health care in Washington is the Yakima Valley Farm Workers Clinic.
Yakima Valley Farm Workers Clinic offers two different branches of mental and behavioral health care — there are the more traditional therapy clinics where you meet a counselor to talk specifically about mental health. And they have the branch run by Dr. Philip Hawley, director of Primary Care Behavioral Health, which places counselors in primary care clinics.
Dr. Hawley says that by putting his team into primary care clinics, they’re fighting stigma around talking about mental health.
They ask every person that comes into the clinic about how they’re feeling, about substance abuse, about their mood.
“We want that to be something that is very normal at lots of different doctor’s appointments,” Hawley says. “And then if something comes up, and we need a more in-depth conversation, that’s why our team is in the clinic.”
The Yakima Valley Farm Workers Clinic is a nonprofit clinic, with sliding scale prices available. It’s been around since 1978.
Hawley says that through those long-term connections, the clinic has created trust between farmworkers and providers. And continuing to build that trust comes from understanding, and actively engaging with the communities it serves.
American Indian and Alaska Native veterans can now see local Indian Health Service providers for care that is covered by the Department of Veterans Affairs. Under the agreement the VA will now reimburse local Indian Health Service doctors for providing things like mental health care, pharmacy services, and diagnostic testing.Roughly 6,200 Native American veterans live in Washington. Many live in rural areas, so getting health care at VA facilities meant hours of travel time on the road. The new agreement will lift that burden.It could also improve the relationship between health provider and patient, according to Terry Bentley from the VA office of tribal-government relations for its western region.  "Veterans who get their care at those IHS facilities probably feel that the care is more culturally competent and they're more comfortable [than at VA clinics and hospitals]," Bentley says.Bentley says local access to care for Native Americans and Alaska Natives will also help shorten wait times, which can be significant at VA facilities. Many are hopeful the agreement will serve as a first step for more agreements between the VA and tribal health programs.
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