On the last Sunday morning in August, with the temperature outside headed to 101 degrees, a thick flow of wildfire smoke moves through the quiet streets of Knights Landing, a farming town of 1,117 people northwest of Sacramento. Inside the Family Resource Center, Aury Gutierrez-Zavala leads a group that includes staff who run the center’s weekend medical clinic, residents, and student volunteers in the first meeting of a new local mental health initiative. A flyer posted around town invited people to drop in and talk about health concerns, calling the gathering a charla, Spanish for “chat.” It didn’t mention the words “mental health,” because if it had, there’s a good chance none of the area farmworkers would have shown up.
Gutierrez-Zavala, 47, has long, dark brown hair and the high energy of a woman on an urgent mission: to save lives. She wears a Frida Kahlo T-shirt emblazoned with the words “We can endure much more than we think we can.” A therapist with a master’s in marriage, family, and child counseling, she has worked in community clinics in the area for nearly 20 years and understands the challenges of getting farmworkers to talk about their problems. “If you ask someone, ‘Are you stressed?,’ they’re going to say, ‘No.’ You have to investigate,” she says. “They just think, Well, this is my life. It’s about survival. They already know you can’t complain; you got to do what you need to do. You feel powerless.”
California’s drought is an existential threat to Knights Landing: many of the celebrated rice fields here are fallow this year; the clay soil that makes them suitable for flooding lies cracked and dry. A peculiar quality of wildfire smoke is that you can see the tiny particles of the past as you breathe them—a past when there was more water. Farmworkers come into the Family Resource Center seeking help with diabetes, pregnancies, and sometimes grievous injuries, as well as respiratory complaints, aggravated by the drought’s increased dust and heat. Add to that their poverty wages, substandard housing (often vehicles), food insecurity, vulnerability to discrimination and violence, language barriers, and fear of Immigration and Customs Enforcement, and it can be too much to endure. Minds break.
The National Center for Farmworker Health reports that, for the 915,725 agricultural workers and family members getting care at Migrant Health Centers nationwide in 2019, anxiety and depression were among the most common diagnoses. It’s become a matter of life or death: since the farm crisis of the 1980s, when more than 1,000 farmers took their lives in response to farm losses, the suicide rate for male agricultural workers overall has remained higher than for those in almost any other occupation. And it’s not just in the United States. The rate is startlingly high in France, the U.K., Australia, and Japan; in India, as of 2013, almost 300,000 farmers and farm laborers had killed themselves since the mid-’90s, often by drinking pesticides. In 2018, Congress launched the U.S. Department of Agriculture’s Farm and Ranch Stress Assistance Network (FRSAN), funding suicide prevention and behavioral wellness initiatives nationwide. It took decades to get America’s farmers—usually white—to talk about what was going on in their heads, and now the people in this room are trying to get mostly Latinx farmworkers to do the same.
“You have to be very creative on how to pull certain information because there’s still a lot of stigma and shame around [suicide],” Gutierrez-Zavala says. As a result, we have very little data about farmworkers ending their lives.
“Unfortunately, we don’t have that information for actual agricultural workers. And I would love to have a reason for why that is,” says Gladys Carrillo, director of program services at the Texas-based National Center for Farmworker Health, which has been tracking these issues for 45 years. Carrillo grew up as a farmworker and is now a therapist. She notes that the deep stigma against suicide may actually keep some workers alive, but given their reluctance to open up and trust figures such as doctors or researchers, it’s difficult to know what’s really going on with their emotional states. She adds, “Because this population is really hard to identify and to connect with, it’s even harder to gather real health information.”
“There’s a lot of substance abuse in this community, and there’s a lot of depression,” says Janet Ramos-Ambriz, 21, an undergraduate at UC Davis who has worked at the medical clinic at the Knights Landing center for two years. “There’s also been a couple of suicides around the holidays. I believe it has a lot to do with the stress that this community is suffering from being low-income farmworkers.”
Gutierrez-Zavala says she feels an obligation to help them. Like Carrillo, Ramos-Ambriz, and many of the people in the room with us, she has her own immigration story and her own path to understanding how emotional well-being is connected to health. As the topic of mental health becomes more normalized in American life, with politicians, celebrities, and top sports figures, including Naomi Osaka, Simone Biles, and Michael Phelps, talking openly about their struggles, immigrant farmworkers are still sticking to a survival strategy of saying nothing.
As if on cue, a woman drops in to the meeting in Knights Landing, peers into the room, and clearly doesn’t feel comfortable joining the group. Gutierrez-Zavala ducks into the hallway to talk to her. She’s looking for help for her son, who has substance-abuse issues. As Gutierrez-Zavala gently probes, it comes out that, between her diabetes and difficulties with her son, the woman is overwhelmed by anxiety. Gutierrez-Zavala helps her see that anxiety could be the real reason she walked into the center and makes arrangements for her to get counseling.
“Teaching about mental health, just that concept, it’s an eye-opening experience for migrant farmworkers,” says Gutierrez-Zavala later.
GOOD FOR THE BODY
Gutierrez-Zavala knows that immigrants are likely to carry trauma. Their story is her story. In 1980, her grandmother fled El Salvador’s brutal civil war, taking six-year-old Gutierrez-Zavala and a cousin on a harrowing journey through Mexico. Chased through fields by helicopters, they were forced to hide during the day in barrels used to store corn, and then, under cover of darkness, smugglers separated them and threw them into the trunks of different cars; she remembers watching lights flash by under the trunk lid as they drove, with no idea where she was going. After arriving in Sacramento, she lived with her mother on and off but also with her grandmother, who was abusive. Gutierrez-Zavala never met her dad. As a preteen, she was plagued by dreams that played like flashbacks of the war: bodies in the streets, bombs going off.
“If I would watch a movie that was about immigration or, like, crossing the border, I would get triggered,” she says. “I didn’t know why I would have anxiety. I didn’t know what mental health was.” Later, she realized this anxiety was shaped by traumatic events in her past. When she was an undergraduate at Cal State Sacramento, she worked in a prenatal clinic and realized many of the immigrant patients also carried trauma that affected their health, and she decided to become a therapist.
After earning her master’s in counseling, Gutierrez-Zavala began leading a behavioral health program at student-run Clínica Tepati in Sacramento in 2016. She refers the few who want mental health help and have insurance to psychological counseling; as for those who have no insurance, she takes them into therapy herself.
Recently, a patient came over from Knights Landing because she couldn’t get her diabetes under control. She was monitoring herself and dosing her insulin correctly, but it wasn’t working. Gutierrez-Zavala started asking questions. The patient was a grandmother who did all the cooking, cleaning, and taking care of four grandkids, and she had a lot of unprocessed trauma from her own immigration journey and family tragedies. She was anxious and depressed.
Gutierrez-Zavala says, “Finally, I told her: ‘You can’t get your diabetes under control because of stress. If your mental health is not right, you can’t get physically healthy, either.’”
The Family Resource Center in Knights Landing was able to refer people to counseling, but it had no in-house psychological services, so, with the help of one of Tepati’s two psychiatrists, Gutierrez-Zavala is now volunteering her services there. The story is the same throughout the state: Dr. Casie Ennis, division manager of clinical services for Tulare County Behavioral Health, at the southern end of the Central Valley, says the lack of behavioral health professionals is chronic, adding, “We have a perfect storm of poverty meets drought and—currently—meets pandemic and so many other things.” Mental health services for California’s farmworkers are as rare as a rainstorm in this prolonged drought.
CLIMATE CHANGE GRIEF
Sitting in that charla, with smoke pouring past the open door, it’s clear we’re not just talking about the mental health of farmworkers. We’re talking about everyone, including you and me. All of us face the impacts of climate change as it warps our world, and often not as slowly as we had hoped. The temperature goes up. The rivers run dry or flood. Smoke drifts through from hundreds or even thousands of miles away. And then there are disasters not explicitly linked to climate, like 22 months (so far) of pandemic. We try to keep our heads together, but these conditions threaten to break us.
Dr. Jesse Bell, a professor of water, climate, and health at the University of Nebraska Medical Center, calls drought a “threat multiplier”: whatever’s going on with agricultural workers, it makes it worse. He coauthored a widely cited 2015 report that reviewed 82 studies linking drought with agricultural mental health issues; in Australia, in particular, drought has been linked to increased suicide rates among male farmers.
“It’s really easy to see when a hurricane makes landfall or when a flooding rain occurs, and you see the devastation,” Bell notes. “Drought is the exact opposite of that. Drought is a slow-moving disaster. Drought can also intensify heat waves, and heat waves likely kill more people in the United States than any other climate- or weather-related event. And then reduction of water quality and quantity, potential link to wildfires. It’s hard for us to see those linkages, let alone the potential linkages that it has to mental health.”
Ten years ago, a climate task force of the American Psychological Association looked at natural disasters exacerbated by climate change, from hurricanes and fires to droughts, and reported a whole raft of behavioral effects, from anxiety to suicide—including the experience of climate grief or even guilt among those who may only hear about disasters in the press. We feel bad because we know climate change is at least partly our own fault.
Australian ecophilosopher Glenn Albrecht coined a word for this feeling of climate grief, calling it “solastalgia,” meaning a pain stemming from loss of place. But many are now saying that it’s no longer adequate to call these emotions grief or homesickness, because what they feel is rage. In a Facebook group on psychology and the environment that I follow, one member wrote, “It’s no longer eco-anxiety, it is pure and simple thanatotal-wrath.” Albrecht himself, who is in the forum, commented, “Terrafurie!”
These feelings of grief or rage can fester, especially given that climate change and drought and storms are just getting worse. But what do you do if your job puts you on the front lines, with your hands in parched soil and smoke in your lungs, and your only coping skill is to remain silent and simply endure?
After the charla, I walk through the smoky streets of Knights Landing with Esmeralda Mandujano, 33, who had attended as part of her new project creating suicide-prevention campaigns in California with a grant through FRSAN, the federal behavioral health program for farmers. She is very frank about what’s at stake, saying, “These are rural people with skills. When it comes to suicide, they have the tools, and if they set out to do it, they are likely to succeed. That makes it all the more necessary to get this info out there and connect them with help right away.”
Mandujano, who has a master’s in public health from nearby UC Davis, works for California AgrAbility, which helps injured agricultural workers return to the fields by pointing them to innovations like lifts to put them back on their tractors. She recalls how she had thought it was so smart that women would rest by sitting in a chair at night while they cooked dinner until she realized that one woman, in particular, had a serious back injury and was cooking while seated because it hurt too much to stand.
“Some of the workers will say, ‘Sometimes when I come home, I’m in so much pain that I just cry, but I cry at night when nobody’s seeing me,’” Mandujano says. “They’re referring to their physical pain, but you also think about how much that is really mental, because of the pressure to continue to work.”
AgrAbility started in the 1990s with a focus on farm safety, but when it asked farm families what they needed, they asked for emotional support programs. One of Mandujano’s colleagues at Colorado AgrAbility, Dr. Bob Fetsch at Colorado State University Extension, conducted studies that found an agricultural worker’s ability to recover from serious injuries often depends on the quality of their behavioral health.
Dr. Michael Rosmann is a psychologist and fourth-generation Iowa farmer who has been working with suicidal farmers since the dawn of the 1980s farm crisis and helped create the field of agricultural behavioral health. Farm people, he notes, are problem solvers. But when the problem is beyond their control, they take it harder than most. Women are often better at finding emotional support, Rosmann says, while men sometimes resort to self-harm. “Men do it four times more often than women,” he adds, “and we know that they take their lives partly because they don’t have adequate skills to manage stress, and they don’t know how to use resources to quell long periods of economic turmoil, like prolonged years of drought or economic doldrums such as we went through for the past seven or so years.”
He’s talking mostly about men who own farms. The challenge for California is to apply the best practices for improving behavioral health not just to them but to the farmworkers, too. They have far less control over their working lives, subject as they are to the whims of their employers, markets, weather, politics, language barriers, immigration policy, visas, and the availability of resources such as the clinical services provided at Knights Landing.
The best way to get farmers some help, Rosmann has found, is to put them in touch with people who know about farming. He understands that, in the same way that immigrants feel better talking to others from their community and in their own language, agricultural workers open up more readily to others in agriculture. That means hotlines manned by knowledgeable staff. Or a group of farmers who get together at a local diner. Another best practice is a referral to free therapy. And training members of the community and families to recognize the signs of trouble. Because Rosmann helped design FRSAN, many of these tactics are now being deployed in the Central Valley.
Mandujano, for instance, lives with her farmworker family within walking distance of the little yellow building in Knights Landing where the meeting took place. Her father worries about his coworkers and counsels her on what kinds of outreach might work. Part of her responsibility is to put together training programs for clinic personnel and others to recognize signs of suicidal thinking or mental distress and then refer the people in need to professionals like Gutierrez-Zavala. Mandujano is cautiously optimistic despite the fact that there simply aren’t enough therapists, or clinic staff, or trainers, or outreach materials, or money. “It does feel like we’re building an airplane as we’re flying it,” she says.
And when agricultural workers don’t come to you, you have to go to them. Gutierrez-Zavala recalls how she realized the severity of farmworkers’ mental health problems at Clínica Tepati five years ago, simply by asking medical patients about other stressors in their lives. She recognized that farmworkers were in crisis up and down the Central Valley; she would have to take her knowledge and experiences farther afield. “At Knights Landing, we’re going to have integrated mental health services. And the integrated part is essential, because that’s what community is about.”•