Podcast: Addressing the Mental Health Needs of Latinx Teens

Scott talks to Dr. Fairlee Fabrett about how to identify and meet the unique mental health needs of Latinx adolescents. Fairlee discusses why Latinx teens may not seek mental health help, offers ways to help combat the stigma around mental health in the Latinx community, and answers audience questions about how we can help members of the community be seen, heard, and understood.

Fairlee C. Fabrett, PhD, is the director of training and staff development for McLean’s child and adolescent division and the director of McLean’s post-baccalaureate clinical fellowship. Dr. Fabrett has extensive experience in evidence-based assessment and treatment for depression, anxiety, and behavioral disorders, and in providing culturally sensitive treatments.

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Episode Transcript

Jenn: Welcome to Mindful Things.

The Mindful Things podcast is brought to you by the Deconstructing Stigma team at McLean Hospital. You can help us change attitudes about mental health by visiting deconstructingstigma.org. Now on to the show.

Scott: Thank you so much for joining us today. My name’s Scott O’Brien. I oversee McLean Hospital’s education outreach initiatives and our guest today is Dr. Fairlee Fabrett, who is here to talk to us about the child and adolescent wellness, particularly around Latinx teens.

Dr. Fabrett is a psychologist at McLean Hospital and she is the director of staff training and staff development in our child and adolescent program. Dr. Fabrett, over to you.

Fairlee: Hi, Scott, thank you for the intro. It’s nice to see you. Hi, everyone. So, yes, as soon as you start having any questions, let me know. I’m happy to answer them as I go along.

And I was thinking that we could start just by talking about adolescence in general, kind of like to get ourselves situated and then we’re going to go into Latinx youth. So, as some of you might remember and maybe some of you are going through it, adolescence is a really tough developmental stage.

The transition from childhood to adolescence is characterized by changes in behavior, in emotion, in personality. Teens are trying to figure out who they are, what they like, who they want to be.

And adolescence just happens to be very culturally bound. And what I mean by this is that different cultural groups expect different behaviors from their teens. So some cultures expect teenagers to be irritable and have a lot of conflict with their parents during adolescence.

And other cultures don’t. And you don’t have to have conflict with your parents to have a healthy or like normative adolescence. I think regardless of what group you’re a part of, when a child is going through adolescence, there’s a profound pressure of internal and external processes.

So, internally, hormones are at a high level, never experienced before, for the kid. And also the brain is growing and they’re parts of the brain that are growing faster than others. So, for example, the emotional areas of the brain, let’s say, they’re growing faster and almost adult-like.

But the areas of the brain that are more related to thinking and processing are slower. They’re trying to catch up. And that’s why a lot of the times we see that adolescents lack self-control.

A lot of the times they just tend to make impulsive decisions, especially when they have pressure from the environment. So, this is a phase where there’s a lot of vulnerability to influences from the outside.

They’re influenced by their friends, what their friends think of them, how they’re perceived by friends. They’re also influenced by what their friends like. They’re also trying to figure out their relationship with their parents ‘cause it starts changing.

Adolescents also are trying to figure out what they like, who they like, who they are, who they want to be. And this is when we start to see some of our adolescents start to struggle with issues that maybe were not an issue before.

So, for instance, maybe you had a kid that was a little bit anxious, there was a little bit of perfectionism when doing homework or a little bit of anxiety going to school.

Adolescence comes, hormones peak, and then you have a child or an adolescent, I guess, that is really struggling with anxiety about going to school, about going into social situations. And it’s just no surprise that we start to see an increased demand of mental health services during the adolescent period.

Now, this is for all of our groups. And I’m sure you’ve heard and I’ve heard, I’m sure you’ve read the news and you’ve heard in podcasts, yes, we have an adolescent mental health crisis, and child.

But this was happening before COVID hit. We already had really high rates of depression, anxiety, suicidal ideation, suicide attempts.

The issue is that now, after the pandemic, and we can’t even get to talk about this at length, but you all know that we struggled with the isolation, not being able to see friends, now imagine this for adolescents. It was really hard.

So I’m going to share with you a couple of statistics just so that you have an idea of where we’re at right now with our adolescent group. So since 2020, there’s been a 5% increase in alcohol use and 10 in drug use among kids 12 and older.

One in six adolescents have experienced a major depressive disorder. There’s been an increase of 31% in emergency room visits. And right now, suicide is the third cause of death for individuals 10 to 34. A lot of our teens are included in that rate. So this is very serious.

Of the ones that committed suicide, 46% had a condition, but 90% had symptoms. And this is important to keep in mind. 90% of them had symptoms that maybe went unnoticed, maybe they were noticed but not addressed.

And we’ll talk about why. I’m just asking you to hold onto this little fact in your minds as we continue. So, Scott, that was the state of all of our adolescents in general. Now, COVID, I think it just highlighted many different aspects in our lives.

We learned a lot about businesses, about schools, about our relationships, and also about our minority groups. So COVID disproportionately impacted the health and economic stability of our Latinx families.

So now we’re going to start to get into our topic of the day. 50% of our families had job loss income. That’s a substantial amount. That led to a 60% of our Latinx teens having to provide childcare. That’s a lot to ask of a teenager.

But yet our families needed to rely on them to do this childcare, because some of these families lost their job, they had to go look for another one. So the kids had to take care of the younger kids.

And this led to a very significant increase in anxiety rates, in depression rates and also school dropout. Right now, 22% of our Latinx youth are experiencing depressive symptoms. And here’s what’s interesting here. 8% seek treatment. Only 8%.

And right now, one in three students say that they feel depressed and hopeless. 17.2% of students report bullying. But this is another statistics that is really striking to me, is that 15.1 of our students who identify as female, 15.1% have attempted suicide in a year.

So, in 2018, it was very similar to 2019, and their rate continues to increase. Compared to our white community, they have a 9.8%. And our Black community of individuals who identify as female is also pretty high at a 10.2%.

I want to make sure that you all just think about the implications of this. This means that we probably know one of them who has attempted suicide. 15.1% rate is pretty high. So COVID just was hard for all of us.

But I think the numbers are starting to show that our underrepresented groups have suffered substantially more. I’m going to stop there, Scott. I don’t know if there’s questions already.

Scott: Yeah, there are, thank you so much for that. So you get into, the statistics are alarming.

And obviously stresses the need that we all need to be watching out for the young people in our lives, especially people that are in positions where, especially educators, things like that, where they’ve got a lot of young people in their care.

What are some of the things that parents and educators should be watching out for in terms of signs and symptoms that a young person may be struggling to the point that they need additional help?

Fairlee: Okay, so I think it’s slightly different if we’re thinking about parents and educators.

Scott: Talking about both of them, that would be fantastic. Thank you.

Fairlee: Okay. So, parents, I think nobody knows your kid better than you.

So if you start to sense a shift in their behavior, maybe they’re more withdrawn, maybe they’re isolating in their room, maybe they’re more irritable, maybe they’re complaining of stomach pains, maybe they’re talking about being very nervous, very shy.

In my opinion, that’s when you start to need to get curious and start to ask questions. Because obviously your kid, and especially in our Latino community, they’re not going to come out and say, “I’m feeling anxious.”

They’re probably going to say something more like, “I’m afraid of going to school today. My stomach really hurts.” So parents need to pay attention to those signs. Also, any change on eating habits, sleeping habits, anything that’s out of the ordinary.

At school, I think because of how sometimes issues or difficulties are expressed, a lot of educators end up putting our kids, teens, in the problem category. This is a problem child because they’re being very disrespectful in school.

They’re calling me names, they’re not following rules and they’re just more disruptive. I think this is when educators need to pay attention and have a conversation with a kid.

Now, this is where then having the context of working with a Latinx teen is important because as educator, when you go in and want to talk about the teen, about how they’re struggling, they’re not going to come out and say things directly.

One, because of shame, two, because they don’t want to get their parents in trouble. In our Latinx community, there’s a lot of fear of getting in trouble with the school. What if they call child protective services? What if I get in trouble with the law?

So there’s a lot of hesitation to talk about, if things are going on at home, if their parents, if there’s a lot of conflict in the family. So there’s going to be a lot of hesitation to openly discuss difficulties.

An educator that has this in mind I think has to get a little creative and figure out a way to ask these questions in a way that is not as intrusive.

And almost like normalizing for the teen the conversation about conflict at home or being angry and it being okay to be angry at school and trying to figure out how to talk to their parents about it, and then involving the parents in these conversations.

I mean, school can do a lot, if you think about it. We’re hoping that every kid goes to school. So when educators get on board and they’re looking at a kid, thinking about the context, thinking about the Latin culture as a framework, then you can start the conversation with the teen, but also involve the family. It’s very important.

Treating or talking just to the kid, it doesn’t go anywhere. I think family is a really important value. Family is a really important value in our community. So bringing them in and working with them together is crucial.

And of course here is when we would need to think about how a lot of our parents have more than one job, some of them have two jobs. And getting them into the school is really hard. And that’s why having the flexibility and the creativity is important.

And also not trying to tackle each case in the same way. ‘Cause every family is different and their values are different and even their culture is different. I dunno if I answered that, Scott.

Scott: No, I think you did a great job. This is fantastic.

You mentioned before the statistics around the number of students or young people that are exhibiting symptoms, especially around depression and other disorders.

But it seems like a very low rate of the students who are exhibiting those symptoms are actually seeking care. Would you speak to that, please?

Fairlee: Yes. Yeah. This is one of my goals in the future as I grow older, is going to be to figure out ways to make care more accessible to our Latinx community. So what gets in the way? For our Latinx community, I think stigma is something that gets in the way.

What is stigma? Stigma is any negative way that you have or discriminatory way that you have of seeing someone who’s struggling. So there’s people who see themselves negatively because they’re struggling.

Stigma, every group, every group, I believe, has stigma regarding mental health. So I’m not saying that this is just for the Latinx community, but that’s a community that we’re focusing on now. So we’re going to get a little bit more specific.

With the Latino community, there’s this tendency to keep quiet when things are going wrong and there’s a family narrative of explaining things.

So, sometimes, you’re older and you start asking questions about your uncle and your aunt, and everybody’s very secretive because they don’t want to talk about the difficulties that they faced growing up.

So the narratives about family’s own mental health issues get from generation, they get transmitted to the younger generation, and the younger generation learns that they cannot ask or cannot even try to understand why their family member had a really hard time.

There’s also some terms that are culturally appropriate. So the Latinx community is more likely and more willing to talk about nervousness or talk about, like I got so nervous that I couldn’t do this thing.

Or talk about stomach pain, like I said before, or back pain, lower back pain. Latinx community have no issues talking about that. But when you suggest that maybe that’s anxiety, the walls come up.

There’s also this sense that as Latinos, you are going to figure it out no matter what, chin up, and you are not going to need additional services. There’s like this sense of pride in figuring it out on your own.

So asking for help hurts even more the dignity of the person wanting to ask for help. Obviously there’s research that males or individuals that identify as male are more likely to feel this way than those that identify as female, but this also gets in the way.

Another thing that I was thinking is that, we kind of perpetuate stigma when families go look for support or help for their difficulties with the priests or the pediatrician, which is really common.

In fact, I’m thinking about a particular case where a woman I knew had a daughter who was experiencing stomachache, vomiting, and really nervous when at school. I suggested, hey, it sounds like anxiety, let’s look for help for her. Maybe she needs to talk to a therapist.

And the mother just took her many, many, many times to the pediatrician. And I think sometimes medical providers struggle a little bit talking to the Latino parents about, hey, maybe you should take him to see a therapist, because they also feel worried about bringing this up and presenting this as an option because of the stigma that Latino community has.

So you suggesting, oh, maybe you need to go to therapy, is almost like calling them crazy. So the pediatricians continue to do test after test after test and eventually, they end up in the psychiatry department.

But if we empowered our medical providers to be able to have these conversations with the family earlier on, we would save a lot of medical trips and unnecessary tests and evaluations. So the way that traditionally Latinx community sees mental health is thinking that they’re crazy.

And that is a very huge obstacle. Same thing for medication. Actually, it might be a little worse. Suggesting to someone to maybe you need medication to help you with anxiety is almost like you’re invalidating their feelings, is almost like you don’t really understand them. How dare you suggest medication?

So it’s really embedded in the culture. The stigma is there and is heavy and, unfortunately, is preventing people from accessing care. Now that is just the way they’re thinking about this.

We can add to that all the other factors that get in the way for our Latino families to take their kids and access care. One of them is, they don’t really, parents, really don’t understand the mental health system.

I mean, even I, in the position that I am, when I’m trying to help some of the parents that call me, find providers, it’s really confusing. Navigating insurance companies and who’s approved, who’s in network, who’s out of network is almost like a different language.

Our Latino parents, some of them, don’t have the time, don’t have the internet skills to go into the website and figure all of this out. Some of them don’t have insurance that provides a lot of access to different providers who speak Spanish, for example, or that give mental health services at all.

Cost is really high, so a lot of our Latinx parents don’t want to be paying out of pocket, which makes sense.

There’s also, it is just a reluctancy to show that you’re struggling in general as a family ‘cause you don’t want to draw attention, you don’t want to get other authority people looking at you and trying to figure out, why are they having a hard time?

You also have to take into consideration that a lot of our providers are not culturally competent or culturally sensitive. So it’s hard, it’s hard. It’s hard to go and open up your, especially with teenagers, a lot of the teenage work is with the families as well.

If you don’t have a provider that speaks Spanish or can understand your culture, it’s going to be really hard for the teenager to even ask about this or talk about how they’re having a hard time or bring their parents into session.

It’s just going to be really hard. So I think all of that impacts why these adolescents are not asking for help. That’s why the percentage is so low. But I think the stigma is the first step.

‘Cause if you’re thinking, if you’re at a point where you’re thinking, “Alright, I need help, I need to see a therapist, I need to figure this out,” I think there’s more likely there’s, the likelihood is higher that you’re going to end up doing what you need to do to look for these services.

Scott: You mentioned people going to faith leaders.

Do you think that faith or religion has played a role, especially in these communities around people not seeking treatment and relying solely on their faith in terms of their children’s health?

Fairlee: I hate to say this, but I think so.

I hate to say this because I think priests mean really well and I really love that Latinx families are connected to faith and they do, some parents really go talk to the priest and they seek advice and they follow through.

But I don’t think the priests’ messages or not all of them is for, they’re not encouraging the parent to go and look for external help. I think if we were able to work with, I think there’s a great way to incorporate therapy and faith and other aspects of the Latinx community.

But talking to priests and saying, hey, you can support all of the community and be there for these parents who come in and talk to you and give your own advice.

And in that advice, please also help us break down the stigma that there is about mental health services and encourage the person that is coming to ask you for support to go and seek some services as well.

It doesn’t have to be one or the other, it’s not the church or therapy. It can coexist and I think that’s a lot of the work that I wish we could do in our Latinx community. There’s a little bit of reluctance in wanting to have both, in wanting to have science and faith coexist. But I think there’s a way to do it.

And if we got our faith, our priests along with our pediatricians and other doctors involved and we said, we need help breaking down the stigma in our Latinx community, I think we could do much better.

But, yes, I think it has impacted how much help is asked for and how much mental health treatment is sought by these families.

Scott: Thank you. So some of the folks who have reached out today with questions are either providers or they’re folks that are working with people, I imagine educators.

Questions around, how do you advise starting a conversation with parents about a child’s mental health when you’re afraid they may not have the same view about mental health as you do?

Fairlee: That is a great question. I think it would pull on a lot of different contexts in my first meeting with the parents.

First of all, I would say from the get-go, “It’s very likely that I see mental health needs and approach very differently from you. And I want to understand your view and I want to help you understand mine, but I think the most important thing here is to help you with your adolescent.”

So I would name that at the beginning so that they know that maybe we’re not going to agree and I know, and it’s okay. Then I’m going to try to understand their values, where they’re coming from.

And one thing that I think is very important to keep in mind when we treat our Latinx families is the level of acculturation that our parents have and our teens. And you know acculturation is this concept that has been researched endlessly.

I mean, we still need more, but there’s a lot out there. And acculturation basically means, is the process through which you adopt traits or values or routines of another culture that is not yours.

And a lot of Latinx parents have teenagers that have acculturated to the American environment or the American culture very quickly. So they have teenagers that are seeking a lot more independence and autonomy and they’re trying to do things on their own.

And the parents who typically are more aligned with their culture of origin struggle with this because they think back and they say, I wasn’t like this when I was a kid. I wasn’t raising my voice at my mother when I was a kid. I wasn’t trying to do all of this when I was a kid.

So I would try to get a sense of where are they in this process of acculturation. Are they still very much in their own culture, in their own heritage and maybe adopting some traits of the new culture? Are they rejecting the new traits of the new culture or are they open to it?

‘Cause that’s going to help my dialogue. And then, let’s say, maybe they’ve been reluctant to become Americanized ‘cause there’s a lot of fear too.

There’s a lot of fear about letting your culture go and then getting more American because then your own people give you a really hard time if that happens. So parents might be reluctant to do that, but since they’re here asking for help for their kid, maybe they’re more open to consider other ways of being.

So then I would say, and I would point out that, yes, yes, you have a way that you’ve thought about child rearing practices for all of your life and you have a parenting style that maybe your mother used when you were living in another country. That’s all good.

And you’re raising your child in the new culture, in a new environment and there has to be some flexibility and this flexibility is going to allow you to have a better communication and a better relationship with your kid.

So then I would start to work on, where are the areas where these parents are willing to be more flexible in? What are they willing to, or what areas are they willing to compromise with their child on? And that’s what I would do. But that’s how it would start.

And then I would point out that the goal here is not for the parents to let go of their culture of origin and to Americanize their kid. That is not the goal and that is not recommended actually.

There’s a lot of research supporting that biculturalism is a way to go with our Latinx adolescents and community.

What I mean by this is, there’s better health outcomes, better academic outcomes, better job, just having a job down the line, when you’re able to have values from your culture of origin, traditions that you continue to pass onto your kids.

Maybe using certain, if you don’t speak the language, maybe just relying on certain words that help you feel connected to your kids. So protecting some of your culture of origin and also adapting to the new culture.

So maybe working on giving them a little bit of autonomy and independence and also fomenting, I’m not sure if that’s a word, but like really working on creating, making your sense of family stronger. Familismo, is what we call this.

So you want to have a kid who cares about their family, who wants to make their parents proud and who also gets some leeway from their parents to figure out who they want to be to be a little bit more independent, to make their own choices.

Scott, I feel like I just went on a huge tangent, but I think that’s how I would start the conversation with these parents.

Scott: No, that was fantastic and I want to point something out that I actually had a question about and you more or less got into it, was talking about your culture of origin and then moving to a new country, here we’re talking about the United States, and having to try and accept certain parts of it but also maintain your culture of origin.

And I imagine that it’s very difficult on a child to feel like you are not 100%, how do I say this? If you’re making new friends, if you’re meeting new people that were maybe born here that are first generation or beyond, you want to be more like them to be accepted.

But then also going home, if your parents are also rejecting a new culture, and wanting you to remain tied to your culture of origin, I can imagine it being very isolating for a young person to be in the middle if they don’t feel like they’re being fully accepted by either side, by the family or by their new friends and classmates.

Fairlee: Yes, it actually, sadly, I mean, what you’re pointing out is a very difficult process because this is what we call acculturative stress.

So you have a kid that is trying to make friends, you have a kid that is trying to adjust to a new culture. And I think this even fits in when the child was born here but has foreign-born parents.

So they’re trying to adjust, they’re maybe speaking English more, they’re trying to fit in with their friends, they come home, and if they have parents that are very aligned with their culture of origin, that is going to create conflict.

This different styles of being or the different levels of acculturation cause acculturative stress. And there is a huge link between suicidality and family conflict. So the more conflict there is in the family, and a lot of the conflict in our Latinx community is because of this acculturative stress.

So the more conflict you have, the more likely a kid is going to think about suicide and then maybe attempt. The same goes for family cohesion. How can you feel close to your parents? How can you have family cohesion if you are in constant conflict with them?

Because they don’t get you, because they don’t understand that you want to do things with your friends, because they’re just really hard to get on the same page. So that’s going to lower cohesion and this is going to increase the conflict as well, but then low cohesion.

And this is related to high suicidality in our Latinx teens. So this is really stressful. And honestly, I don’t think there’s an easy way of avoiding this. I don’t think you can avoid this. This is going to be a process that our families are going to go through.

I think what’s important is to encourage these parents to ask for help. It could even be in the form of a teacher. If a parent approaches a teacher and they’re like, I don’t know what to do, they can get a different perspective.

The teacher can hopefully then ask them to go and get additional outside help. But just acknowledging that this is a process that a lot of our families go through makes you feel more normal. You’re normalizing the experience and they’re saying, hey, you can get help with this.

And if you reduce a level of conflict, you’re going to improve your communication with your teen. You’re going to be able to figure out how to compromise what, where to give in, where to stay strict. And it’s just going to be, it’s going to be better all around.

But we do need other providers. We do need other, we need allies, basically. We need allies in the school, in community centers, in PCP offices. We need allies who are going to encourage our families to ask for help. But the process is hard and there’s just no way, no way to avoid it.

I mean, Scott, I was reading statistics on Massachusetts. Here in Massachusetts, in 2021, and of course you have to keep in mind it is not okay to lump all of our subgroups together into the concept of Latinx. We’re all different.

Mexicans are different from Puerto Ricans, from Dominicans. And there’s only enough resources to do research. So researchers have focused on lumping all of these subgroups together to be able to at least learn something about the processes of the Latinx culture.

But that being said, in Massachusetts, there are right now, 90% of our kids are born in the U.S., and keep in mind, this is also whoever decided to report. There’s a lot of under reporting because of fear.

So take all of this with a grain of salt, but 90% of our kids are born in the U.S. And that doesn’t mean that immigration practices or the news that they hear on the radio don’t impact them because 48% of those kids have at least one parent that is foreign-born. Which means that this is a constant stress.

Maybe one of these parents is undocumented, maybe one of those parents is still here documented but very aligned to their culture of origin and very stressed about these immigration practices that we’re seeing.

Anyway, so, of all of our kids here, even though they’re foreign-born, and maybe a lot of them are speaking English on the regular, they also tend to be living in very poor neighborhoods, especially in Massachusetts, where there’s just not a lot of resources, there’s just less access to mental healthcare.

And even the schools, the schools are struggling because they also tend to be in poor neighborhoods. So it just is difficult and the stressors impacting our community just go above and beyond the stress of acculturation, the stigma, discrimination, prejudice, poverty. It’s just like a bunch of different factors impacting our families at the same time.

Scott: You brought up two really great things that I was hoping that you would touch on, and I’m going to pick the second one and we’ll come back to the first one.

So one of the things, you brought up a really good point and it’s something I think you and I have actually talked about before. It’s about, when you start talking about race, lumping groups together, even though their cultural experiences are very different.

And I think that’s potentially dangerous when we’re having conversations like this because, I’m so happy you brought this up, saying that, “Oh, people from Mexico and people from Argentina are the same culturally,” when they could be very different.

Would you speak briefly to that in terms of, even when providers are culturally competent, it might not be with an entire race of people. It could be with a subset of that. Would you speak to that for just a moment?

Fairlee: Yeah, yeah, yeah. Yeah, I remember our conversation. It is something that we, there’s just not a good way to go about this. First of all, a lot of Latinos are asked to choose their race. And there’s just not enough options there.

So already you’re categorizing in a way that doesn’t really fit. I remember when I moved to the United States, actually it was after that, it was when I started grad school, I was talking to one of my classmates and we were filling out these forms and it said, what’s your ethnic background?

And I think I had the option of Hispanic, so I chose that. And then it said, what’s your race? White, Black, and I forget what the other one was. There was three options. Of course this was like 20 years ago. So I hope things are different now.

But I was like, okay, I’m going to choose Black because I’m not white. And my friend was like, oh my gosh, you’re white, you’re not Black. And I could not understand why I was put in a position of choosing between, in races that just didn’t fit me.

The same goes for when you have to choose ethnicity. You’re almost pushed to choose Hispanic, and sometimes you have Latinos, sometimes you have subgroups, which is awesome.

And I think that the research community is moving towards there and I’ve seen some questionnaires that have Mexican American, Argentinian, Salvadorian, and all of that, but it’s just not that common anymore or not that common yet.

So I think I can see why they lump it together when they need to do like a big study. But when you are treating a kid in private practice or at school, you have to stay curious. You cannot assume that one subgroup is the same as another. We all behave differently.

There’s different values, there’s different things that you believe in. Some people are more religious than other even within the same culture. So there’s people who believe in God in a way that is all encompassing and some others have a different view.

Others believe in what, the responsibility to take care of their elders, even to their own detriment, let’s say. And others have a more balanced view.

So, as a provider, as an educator, it is your responsibility to be curious and to ask questions and not assume that you know your student or your patient because they’re Latino.

It’s just like, that’s the biggest mistake you can do. And you know what? If you ask questions, they will answer. They’re happy to answer. It’s better to know that your teacher, your provider is trying to get to know you than to be lumped together.

There’s nothing worse than to say, “Oh, you’re Mexican. Oh, I thought you were Puerto Rican. It’s the same anyway, you guys are all the same.” Which is something that I’ve heard multiple times, and it’s just not true. So I think the best way to go about that is to remain curious, honestly.

Scott: No, that’s a fantastic answer, thank you.

And I’m going to come back to the first point I wanted to touch on, that you touched on that I wanted to get into, is that we unfortunately know that many Latinx families in the United States are living around or below the poverty line.

Will you talk briefly about the mental health impact on young people who may be struggling to have their basic needs met?

Fairlee: Well, this is very complicated and I think there’s parts of it that we’ve touched on, but let’s put it all in context. So, just in Massachusetts, one third of our Latinx families are living below poverty line. And that’s striking.

So you already have parents who are exhausted, having more than one or two jobs, they probably don’t have the time to think about other things, to take their kids to therapy. So that already is an obstacle.

Then you have, these kids often are, like I said before, in neighborhoods that don’t have access to care. They just don’t have the way of providing these kids with the additional support they need.

So, for instance, a lot of our Latinx kids are in schools that tend to have less qualified teachers, less strict curricula, less funding, less resources. So there’s less to give these kids. If the teachers are themselves overwhelmed, then they’re going to have less capacity to be mentors to these Latinx kids that are there.

A lot of these kids also maybe are in charge of taking care of their own siblings after school. So how are they going to access care? And now that telehealth is everywhere, a lot of our Latinx families don’t have computers, they don’t have internet.

I mean, with a pandemic, some of the schools, I actually live in a district that is very heavy in their Latino population. The schools had to go out to the different houses and provide the parents with a computer and with a hotspot to be able to connect to the internet.

‘Cause you cannot assume that our parents have that opportunity. So there’s even less opportunity for access to mental healthcare.

And with poverty, also comes the fact that a lot of these parents are not or don’t have the education that would allow them to access the information or to understand mental health care.

A lot of our families, unfortunately, are just a single mom kind of household and they rely on other family members to help with their kids. But these mothers are also spent and they are unable to provide the care.

So, in a lot of these cases, what you see is a kid who is either being labeled at school as a problem child ‘cause they’re really having a hard time in school because they’re not being taken care of at home, or a kid that is just really withdrawn and they’re quiet and they’re giving up and they’re not asking for care or for help.

And, unfortunately, this is why we see a lot of just increased rate of high school or school dropout in our Latino community. I think it’s all related. And this is how it impacts not having their needs met.

Scott: We know that young people in general are incredibly resilient, but something like moving to a different country as a child, I imagine, can be incredibly stressful. What kind of mental health impact does moving to a new country have on a young person?

Fairlee: This is going to be related, again, on how the parents are dealing with the move as well as how the child is dealing with the move.

So if this is a new child coming to the U.S., age depends, I mean, this is a huge question, Scott, very difficult to answer. Because if you have a young child, the difficulties are going to be different than if you have a teenager.

But, regardless, moving to a country that speaks a language that is not yours is going to create absurd stress and impact on your own stability and eventually in your mental health. I mean, maybe at the beginning you’re going to be struggling.

Kids are resilient. So they’re more likely to grasp on the English language and start talking and start doing better in school because they’re learning it quickly.

But you are not going to get the same from the parents, who are probably working really hard because they just immigrated here, and they don’t even have the opportunity to check in with the kid about how school is going.

They’re not involved in school, so they don’t know how their kid is doing during school either. They don’t have communication with teachers. So you have all of that. And then here’s when you would get to see the conflict that is most related to acculturation.

The kid is going to be around other children. And depending on the district, maybe this child is surrounded by kids that are the part of the majority culture.

The rate of acculturation for that kid is going to look very different than if the kid goes to a district where there’s more kids like them, maybe other recent immigrants or kids that identify or maybe they’re part of an underrepresented group.

But when the acculturation process starts to look different between the kid and the parents, you start to see issues and then you start to see mental health difficulties.

What I think we need to be careful here is that, if the parents are aware of how stressful this is for the kid, I think they’re going to be able to keep an eye out just more closely on their kids.

So checking in more, making sure, if they’re quiet, how come they’re quiet? How’s it going in school? Are they getting bad comments from other kids? Are they connecting with the teacher?

Because without this, how are the parents going to know that their kid is having a hard time? The parent is going to like, it’s going to be more likely to justify the kid being quiet by saying, “Oh, we just moved to a new culture. That’s why they’re quiet.”

And this is a little dangerous because this is how anxiety starts to present itself, for example. So I think the impact of moving is huge. And they wouldn’t necessarily start to deal with a real or formal diagnosis, but going years with a little difficulty unnoticed could lead to more mental health difficulties in the future.

Scott: Any suggestions around preventing issues between children and parents around that gap between the acculturation.

Fairlee: Information, and how? How, if we’re getting parents from another country, they just moved here. And this is why I was saying before like, schools can help us out so much.

If you bring this information to the parents and explain the process, open up conversations. So let’s say school had a workshop, workshop about, you recently moved to the United States, you have a kid that you’re struggling to connect with, what can you do?

And in those workshops, that hopefully are free for the parents going to the school, if you start to explain what acculturation is, why the conflict starts, I think just having that is going to help a lot.

You cannot push a parent, especially when you’re an older parent, to let go of your own ways. That is not the goal. The goal would be to create a bridge of communication between the kid and the parent and to work with it.

So it’s not that you’re going to prevent the stress. The stress will likely happen because they’re going at different rates of acculturation. What you’re trying to do is improve communication.

So having a parent understand this and then allowing them, giving them the tools to have a conversation with their kid and saying, “I know that you’re trying to have a cell phone at 11 years old, that’s not where I grew up.

Let’s figure out a way to compromise. I want to understand what makes you want to have a cell phone. Is it to stay connected with your friends? What’s going on?”

Being curious and, also, the parent just knowing that this is okay, that this is part of the process. And to let them know, hey, you kind of have to work too on your parenting style.

Inflexible family systems and a harsh parenting, which some of you parents out there will agree with me, harsh parenting is a thing in the Latino culture. So that combined with inflexibility leads to poor outcomes in the mental health of our kids.

So I think giving the parents information, allowing them to understand that this is going to happen, this is a process and this is what you can do differently would go a long way. I would encourage schools to do this, to bring in the parents if you can, if they can, even if it’s on a weekend.

I mean, I know there’s so many factors that get in the way of this, but if we don’t start trying, we’re never going to get anywhere. So workshops late at night or weekend, where you bring the parents in and you say, hey, how’s it going? Where are the struggles? How are you feeling?

Do you feel like your kid is letting go of your Latino values? How does this make you feel? And how can we help you have this conversation with your teen? I think we would be going in a better path than we are right now.

Scott: I love it, I think that’s a fantastic suggestion. I think sometimes it’s very difficult to get parents to engage, especially parents that are working more than one job, if parents are single parents, things like that.

But I think it’s a fantastic suggestion to ask the schools to become more engaged, to do everything they can. Not forgetting you’re here to support the students more than anything.

And I know there’s probably a lot of frustrations around trying to engage the parents and whatnot, but a lot of people have a lot of stressors and a lot of things going on in their own lives that make engagement difficult. So I thank you for putting that out there.

Fairlee: Yeah, yeah.

Scott: One of the things I wanted to bring up kind of early on in the conversation, and I failed to do so.

But I did want to touch on it before we close out for today is that, when we talk to people that have different cultural backgrounds, certain groups will think that mental health does not impact their community or that certain conditions like depression or anxiety don’t exist in their community.

And they may call it something else, or they’re convinced that, oh, our people are, my own, are unaffected by certain things. Would you speak to this briefly about the fact that every community is impacted by mental health conditions?

It’s not a particular one community or another, and that they identify it as something else.

Fairlee: Yes. Scott, I feel that is, speaks to this, this pride that the Latinx community carries. This pride, we can figure everything out. We’re hard workers. We keep our chin up.

I mean, just look at, I don’t know if you’ve seen all the videos that have come out about Puerto Rico right now. They just had another hurricane that really impacted and you see everyone rallying, everyone getting back up on their feet and working so hard and together. And that is admirable.

And I would never want the Latinx community to lose that sense of pride and dignidad that they come and they just live their life with. I would just say, “Hey, you can have all of this and be struggling.”

And that constant headache that you have might be stress or might be anxiety. And that, times when you all of a sudden start crying and you don’t understand why, because you have a few beautiful family, beautiful home, great job. That might be depression.

And that back pain that you are having all the time, that can also be depression. So all of that can exist, it can coexist. And I think just bringing this information to our communities and talking about it openly is the way to go.

Because I think there’s room, there’s room to say, “Hey, we’re Latinos and we don’t give up and we’re so stubborn and we make things happen and we keep our chin up and we also have anxiety because there’s things that are really heavy that we need to deal with, and sometimes we need medication for that.”

Or maybe you, you’re thinking something like, I don’t know, I mean, I’m in this job that is really hard and I’m neglecting my kids and I feel like I can never be enough but I’m trying so hard. And maybe you’re also a little depressed and you can get help by talking to someone about it.

And maybe you’re going to continue to work really hard and be really stubborn and acknowledge that you’re struggling. I wanted to say something, Scott, that I forgot earlier.

The stigma is so strong that there’s even Latinx families out there who have gotten therapy, who are probably individuals that are on medication, but they’re quiet about it. They don’t want to share, they keep it to themselves.

And this is a disservice to the community, because this is why the stigma continues to be so strong. So if you went to therapy as a Latinx person and you found it helpful, talk about it with your peers, talk about it with other parents.

If you’re a parent who went to get some parent coaching sessions because you didn’t know what to do with your teenager, talk about it with your friends, destigmatize this, please. Because we are all impacted by mental health issues.

Same as we all have foot pain when we run, blisters when we are working really hard in the yard, we suffer from poison ivy when we touch it, we all have mental health difficulties, because mental health is health and it’s part of us. It’s part of our composition.

And it’s just a matter of calling it openly like it is and being less afraid of the shame or how are other people going to see me.

I even feel like it’s going to help you feel closer to your teens who are more acculturated if you have the ability to talk openly about feeling depressed, feeling anxious, or other kids in, friends of your teens having these difficulties, is really going to even better your communication with them.

Scott: Thank you, that’s great. Any specific resources that you recommend for parents or for educators working with teens, just around mental health in general? Things that would be really great if everyone, at least research, if not read.

Fairlee: I have a list of places in Massachusetts that people can access care through. So I can send you that, Scott, and maybe we can put it in the links later.

But just day to day, very, very easy ways to support our teens, I would say, for families, work on your communication. It’s better to talk about things than to stay quiet. If you’re feeling sad, talk about it, show it.

Model sadness and how you go about it. Model making decisions and the difficulty of making them. If you’re having a hard day, talk about it. Don’t stay quiet, why? Because you’re teaching your teens that, one, it’s okay to have a difficult day or to be struggling one day or not.

And, two, you’re also showing how you go about solving your own problem to them. So talking about things, talking about things out loud with your teen. Number two, spend time with your teens if you can.

Family cohesion is protective, is protective against depression, against anxiety and against suicidality. So spend time together, even if it’s just half an hour in the week. Just having a moment to connect with your teen is very important.

Number three, I would say, do bring them into your culture. So don’t let your own culture as parents go. Bring them in. Do some of the family traditions that you love. Explain to your kids why is Dia de los Muertos a thing and why do we care, why do we pray for them?

And also be open to their way of thinking through things, of praying, for example. It doesn’t have to be one way, but having them be part of your values and you also taking on a little bit of their values is important.

For schools, I would say, be open and be curious before you think, “Oh, this Dominican child is such a... I’m going to write them up.” Be curious, sit down with them and say, hey, what’s going on? Know that they’re probably going to stay quiet and stay put.

Schools, provide resources for parents, provide the opportunity for these parents to talk about how difficult it is to raise a kid in the U.S., especially when you want them to also identify as your own country, as your own country of origin.

So I would say, working on family ties, cohesion, communication, and also schools respecting these family ties. So there’s a lot of the times when providers or teachers, they give advice that is inappropriate to these kids.

They’re saying things like, “Well, what do you care about what your parents say? They don’t know what’s better for you. You’re here for you.” And they try to just make these kids more independent.

You have to give advice and to treat these kids thinking about the whole cultural context that they’re coming from. So giving a lot of advice on staying independent or being independent is just also not a good idea because it leads to conflict.

So paying attention to the context of the kid before you give advice is also really important.

Scott: It’s a perfect way to end this session. I just want to give a quick thank you to the audience, everyone for joining us today and asking such great questions. I always genuinely appreciate when people show up.

I think it’s really important that all of you have been here with us for the last hour and share. And really making an investment into the lives and the wellness of young people that are in your community.

So thank you so much for that. And, Dr. Fabrett, of course, thank you so much for all of your insight and expertise today. I think this has been a great session. I hope everyone enjoyed it as much as I did. Alright.

Fairlee: Thank you.

Scott: Thank you so much everyone.

Fairlee: Bye.

Jenn: Thanks for tuning in to Mindful Things! Please subscribe to us and rate us on iTunes, Spotify, or wherever you listen to podcasts.

Don’t forget, mental health is everyone’s responsibility. If you or a loved one are in crisis, the Samaritans are available 24 hours a day at 877.870.4673. Again, that’s 877.870.4673.

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The McLean Hospital podcast Mindful Things is intended to provide general information and to help listeners learn about mental health, educational opportunities, and research initiatives. This podcast is not an attempt to practice medicine or to provide specific medical advice.

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