The Health Resources and Services Administration defines Migrant and Seasonal Agricultural Workers (MSAW) that qualify for the Health Center Program as Migratory agricultural workers whose principal employment is in agriculture, have been employed within the last 24 months, and have established a temporary home for the purposes of employment. Seasonal agricultural workers, on the other hand, are individuals whose principal employment is in agriculture, on a seasonal basis, and do not meet the definition of a migratory agricultural worker. The MSAW population also includes individuals who are no longer employed in migratory or seasonal agriculture because of age or disability, are within a work-related region, and/or are family members of MSAWs.¹
Mental health among MSAWs may be better understood through a holistic approach that provides support that focuses on the whole person, not only on their mental health needs. A holistic approach to mental health considers physical, emotional, social, and spiritual wellbeing. MSAWs are subject to structural and situational influences that may impact their mental health.
Examples of structural and situational influences include migration, which may result in mourning and grief. These are common responses to migration that impact behavioral health among MSAWs. Migration involves the loss of the familiar, including language, attitudes, values, social structures, and support networks.
- Acculturation is the process in which an immigrant person blends the culture of their home country with the culture of the host country or environment. This blending of culture is part of the acculturation process and immigration, which impacts a person’s mental health. In this process, the person is often pressured to adopt the language, values, and norms of the host culture, while those of their culture of origin, take on a lesser role.
- Familism refers to the value and importance of family over the individual in many cultures. Familism is a protective factor and associated with a decrease in feeling withdrawn or depressed.²
Another factor known to instigate depression in these populations is low health literacy. MSAWs are more likely to experience symptoms of depression and sometimes are unsure about the treatments and care available for them.
By acknowledging factors contributing to the mental health of MSAWs, we broaden our understanding of the importance of Community Health Workers (CHWs) in connecting MSAWs to the resources that promote mental health and access to services to support mental health needs. CHWs can establish meaningful connections to MSAWs through outreach efforts that provide valuable insight into the needs and barriers within their communities, work, or home life.
A recent study conducted by National Center for Farmworker Health among MSAWs estimated that 15,725 agricultural workers and their family members who received health care services at Migrant Health Centers in 2019, demonstrated high rates of mental health disorders, which is one of the most reported diagnoses. More than 41,000 (4.6%) individuals were diagnosed with an anxiety disorder, and over 33,000 (3.6%) individuals were diagnosed with a depressive disorder. Substance abuse and alcohol-related abuse were less common, with only 1.2% of the patient population being diagnosed with one of these disorders.³ Barriers to health care for additional underlying factors that contribute to the poor mental health of agricultural workers include economic hardship and poverty, behavioral issues, social problems, and lack of outlets to share challenges and concerns.
Culture influences how mental health and mental health disorders are perceived among many members of the MSAW population. The study Ataques de nervios: Culturally Bound and Distinct from Panic Attacks? notes that, among Latinos, mental health issues are perceived as Mexican folk illnesses. An example of how culture influences mental health perception is susto, a condition that can include several symptoms such as disturbed sleep, depression, gastrointestinal issues, and listlessness that are brought on by a sudden frightful event. Nervios, is a set of symptoms that can include worry, jumpiness, irritability, depression, agitation, and nervousness.4
These beliefs can influence whether MSAWs seek health care, follow medical treatments, and engage in preventive care. Several folk illnesses, such as susto, mal de ojo, and caida de mollera are known cultural beliefs among Latino farmworkers in Florida. Data relating to how much cultural beliefs impact health perception, a group of farmworkers were known to not seek health care after exposure to pesticides because they believed they were suffering from susto. 5
It is important to note, that as CHWs we are not experts in mental health, yet we possess the virtue of knowing our community, including the cultural barriers and how to access resources available. CHWs are an essential link to MSAW access to mental health services because CHWs are from the community they serve and minimize language and cultural barriers that may exist between a community member, the resources available, and their health provider. CHWs assure that underserved populations, like MSAWs, receive the much-needed health services and resources they need to address mental health in a holistic approach.
With the onset of the pandemic and COVID-19 related issues, MSAWs face additional barriers in accessing and obtaining the COVID-19 vaccine.6 Some of those barriers include being misinformed by their community/peers, misconceptions or myths about the vaccine, fear of side effects the vaccine may have, which in turn may contribute to vaccine hesitancy. MSAWs often live paycheck to paycheck and request a day off work to recover from secondary effects of the vaccine, attend a doctor’s visit, get a vaccine, or be tested for COVID-19, which may mean no income for the day. MSAWs and their families face a unique set of challenges related to health, work, and living conditions which can lead to significant health disparities. MSAWs may lack health insurance due to their immigration status or loss of benefits from moving from one state to another for work.7 It is often difficult for MSAWs to maintain treatment regimens, follow up with doctors’ visits, or track medical records due to their frequent migration and work hours. Cultural and language barriers, as well as immigration status, affect the rates at which MSAWs seek medical attention.
Protecting essential workers, such as MSAWs, is important in promoting health equity among this community and aiding against the disruption of the national food system. MSAWs are at a higher risk of contracting COVID-19 due to their congregate housing and crowded working conditions.8 MSAWs are considered essential, frontline workers and have not stopped working during the pandemic, which places them at risk of contracting the virus. Hispanic/Latinos were among the most affected by the pandemic. Hispanic people in the United States have been 2.3 times more likely than non-Hispanic whites to die of COVID-19 due to some of the contributing factors noted above. Hispanic/Latinos have the highest rates of death due to the virus because of underlying, pre-existing health conditions.
Although vaccines are now available, vaccine hesitancy stems from a misunderstanding of vaccination costs, the documents needed to receive the vaccine, vaccine locations, and most recently, fear of vaccine reactions due to the Johnson & Johnson vaccine withdrawal.9 MSAWs depend on their daily income to feed their own families and missing a day or two from work to get vaccine dosages greatly affects their decision to get the COVID-19 vaccine. MSAWs travel often due to their work and may not be in the same city, county, or state for the second dose; as a result, they may opt to forgo the vaccine.
MSAWs can face increased obstacles to getting vaccinated. These include uncertainty around eligibility and cost; fear of side effects; lost income or preferred shifts from missing work; and fear of sharing personal data that could be used for tracking, immigration enforcement, or future immigration decisions. Trusted messengers should be used whenever possible to reassure and educate workers.12
MSAWs live in isolated rural regions, far from testing, vaccination sites, and other resources due to the nature of their work. Having a member of their community, such as a CHW, who speaks their language and can answer any questions they may have can build the confidence of MSAWs with chronic conditions to receive COVID-19 vaccines. CHWs can provide resources and information to MSAWs in their preferred language to help them decide if vaccination is good for them (i.e., assistance with vaccine registration, vaccine locations and hours, health facts, and/or side effects related to their chronic conditions with getting the vaccine).
Salud Para Todos is a CHW-led program aimed at providing services on mental and physical health affecting Latino/Hispanic residents along the U.S.-Mexico border. The Salud Para Todos curriculum includes topics that are not often discussed within the culture but have a serious impact on participants’ overall well-being. The program sessions review the relationship between physical and mental health, stress, everyday issues, and additional mental health challenges related to the management of chronic illnesses. The program is facilitated by a CHW who recruits members of the community to participate in five, two-hour group sessions. Each session covers different topics including Mental Health, Stress, Intimate Partner and Domestic Violence, Substance Abuse, Chronic Disease, and Mental Health.10
CHW Sylvia Rios facilitated the Salud Para Todos sessions for MHP Salud. She shared that each session was an opportunity to empower the community and create awareness for mental health issues through engaging and supportive class discussions. She states that “the goal of the Salud Para Todos program is to provide information, resources, and tools that will help address and decrease health problems. This program helps participants understand and identify symptoms of anxieties, phobias, and disorders to help break down the stigma of mental health.”
Sylvia recalls the empowering remarks that she shared throughout the session: “Always talk to yourself like you would to a loved one. This is related to caring for yourself with the same care you give to others, reminding ourselves that we need self-care. Don’t be embarrassed by your story because it encourages others to speak up. Together, with a reflection of self-care, we can break the silence and bring a voice to mental health, domestic violence, and substance abuse. Each message that carries a powerful story shared by participants; all which were valuable learning opportunities that provided a support system within the sessions”. It is through these experiences that we can see the true impact of programs such as Salud Para Todos.