Healthcare providers that cater services to seasonal and migrant farmworkers in Western North Carolina are increasingly turning their attention to mental healthcare.
Farmworkers who travel seasonally for harvesting and planting often bring with them hardships and emotional stressors -- like trauma and homesickness. But certain barriers make care difficult, like language and a lack of transportation.
It’s 7pm at Vecinos’ in-patient clinic in Cullowhee. A steady flow of patients pass through the waiting room for their appointments. Most of them are here to see a doctor or nurse for medication or minor physical complaints. But a handful are here to see Kenny Hummel Parmenter, one of two bilingual licensed therapists on staff -- and of only three in the eight-county region Vecinos serves.
“I usually have my dog in here, she helps. Her name’s Jazzy and she helps calm people down. I ask clients, and I haven’t had anybody decline that yet,” Hummel-Parmenter said.
In addition to the animal therapy, Hummel-Parmenter does a combination of motivational interviewing and traditional talk therapy. He says trauma is a recurring issue he hears during sessions with his patients.
“That doesn’t necessarily mean that they have PTSD. It just means they're unable to cope with the traumatic experiences that they’ve had in the past, can present as depression, anxiety, suicidality, substance use disorders,” Hummel-Parmenter said. “Those are just mechanisms for dealing with life.”
Often, the trauma stems from a situation back in their home country, like gang violence or growing up in extreme poverty. But he says migrants also face traumatic conditions here in the US, too.
“Some people might not feel safe or adapted to our country and culture,” Hummel-Parmenter said. “We’re in an environment right now that’s not super welcoming for immigrants and foreigners and so you see a lot of anxiety and acculturation difficulties do to that.”
He adds even workers who are here on legal temporary visas express fears about being arrested and deported. And it’s a concern being heard at other clinics that provide care to the seasonal farmworker population.
“If we could just take into consideration those people who are helping to feed us, and helping feed your kids and your grandmother, that would go a long way to help them feel appreciated for the work that they’re slaving away for,” Jackie Antiveros, an outreach coordinator for Blue Ridge Health, a clinic in Hendersonville, said.
Antiverios says negative attitudes toward immigrants are an added source of anxiety, contributing to existing feelings of isolation, homesickness, and work-related stress many farmworkers face. That’s why she says improving the emotional wellbeing among the farmworker population can also come from the wider community -- outside the clinic walls.
“To just see deeper into who they are and get a sense of what it is they’re experiencing, what it is they’re missing and how we can help them feel more at home while they’re here,” Antiveros said.
Which brings up another challenge for providers. By the nature of the job, migrant workers are on the move, as they follow harvesting and planting seasons across the state and the country.
A handful of providers in North Carolina, like Episcopal Farmworker Ministry in Dunn, are starting to incorporate telehealth -- video counseling that can be accessed from remote locations.
Back at Vecinos, in Cullowhee, the provider is helping bridge coverage gaps through the Migrant Clinicians Network. It’s a national organization that helps link up and coordinate care for patients with chronic illnesses. In some instances, patients can get connected to a provider before they arrive at the next job.
“There’s a lot that goes into providing healthcare for any specialized population, but certainly one that’s so marked by recent trauma,” Vecinos executive director Marianne Martinez said. “Barriers to care, like transportation, like language, like costs, like timing -- this is why Vecinos exists.”
Vecinos launched its behavioral health services in January and has so far seen about 30 people. Clinical psychologist and consultant David McCord is helping the Vecinos clinic assess and measure every patient’s mental health that walk through the doors.
“The screening tool that we use, we use every visit. On an individual case, we’ve got many examples where you can see week to week, the impact of what you’re doing, and if you’re not seeing anything, you try something else,” McCord said.
In one particular case, he says, patient, a woman, showed signs of improvement after eight visits. They were able to diagnose her with bipolar disorder, which can be managed with medication and regular therapy.
The clinic screens every medical patient for mental health to determine whether psychotherapy is recommended.
“Given the context and given the history, I think I was expecting more psychological dysfunction in a larger percent of the group that came in,” McCord said. “At least half of the medical patients that come here do not show any elevated indicators of psychological dysfunction.”
McCord takes that to mean that as a patient population, seasonal and migrant farm workers are remarkably resilient.